Inflammatory Processes In Children Research Articles

Enhanced CD95 and interleukin 18 signalling accompany T cell receptor Vβ21.3+ activation in multi-inflammatory syndrome in children

Multisystem inflammatory syndrome in children is a post-infectious presentation SARS-CoV-2 associated with expansion of the T cell receptor Vβ21.3+ T-cell subgroup. Here we apply muti-single cell omics to compare the inflammatory process in children with acute respiratory COVID-19 and those presenting with non SARS-CoV-2 infections in children. Here we show that in Multi-Inflammatory Syndrome in Children (MIS-C), the natural killer cell and monocyte population demonstrate heightened CD95 (Fas) and Interleuking 18 receptor expression. Additionally, TCR Vβ21.3+ CD4+ T-cells exhibit skewed differentiation towards T helper 1, 17 and regulatory T cells, with increased expression of the co-stimulation receptors ICOS, CD28 and interleukin 18 receptor. We observe no functional evidence for NLRP3 inflammasome pathway overactivation, though MIS-C monocytes show elevated active caspase 8. This, coupled with raised IL18 mRNA expression in CD16- NK cells on single cell RNA sequencing analysis, suggests interleukin 18 and CD95 signalling may trigger activation of TCR Vβ21.3+ T-cells in MIS-C, driven by increased IL-18 production from activated monocytes and CD16- Natural Killer cells.

Inverse association between slow-wave sleep and low-grade inflammation in children and adolescents with major depressive disorder

ObjectiveTo investigate the relationship between both self-reported and objective sleep variables and low-grade inflammation in children and adolescents with major depressive disorder (MDD) of moderate to severe symptom severity. MethodsIn this cross-sectional study, we examined twenty-nine children and adolescents diagnosed with MDD and twenty-nine healthy controls (HC). Following a one-week actigraphy assessment, comprehensive sleep evaluations were conducted, including a one-night sleep EEG measurement and self-reported sleep data. Plasma high-sensitivity C-reactive protein (hsCRP) was employed as a marker to assess low-grade inflammation. ResultsNo significant difference in hsCRP levels was observed between participants with MDD and HC. Furthermore, after adjusting for sleep difficulties, hsCRP exhibited no correlation with the severity of depressive symptoms. In HC, levels of hsCRP were not linked to self-reported and objective sleep variables. In contrast, depressed participants showed a significant correlation between hsCRP levels and increased subjective insomnia severity (Insomnia Severity Index; r = 0.41, p < 0.05), increased time spent in the N2 sleep stage (r = 0.47, p < 0.01), and decreased time spent in slow-wave sleep (r = − 0.61, p < 0.001). Upon additional adjustments for body mass index, tobacco use and depression severity, only the inverse association between hsCRP and time spent in slow-wave sleep retained statistical significance. Moderation analysis indicated that group status (MDD vs. HC) significantly moderates the association between slow-wave sleep and hsCRP. ConclusionOur findings suggest that alterations in the architecture of slow-wave sleep may have a significant influence on modulating low-grade inflammatory processes in children and adolescents with MDD.

The first experience of using magnetic resonance tomography for lung imaging in children with cystic fibrosis: opportunities and prospects

Cystic fibrosis (CF) is a hereditary disease associated with systemic failure of the exocrine glands. In 95% of the cases, progressive damage to the lung tissue occurs that requires follow-up. The main imaging methods are radiography and computed tomography (CT). Both methods involve ionizing radiation. According to clinical guidelines, a chest X-ray is performed no more than once every 2 years. However, given the high risk of developing inflammatory processes in children with CF, the frequency of radiological examinations may increase significantly. The search for alternative methods without ionizing radiation is in great demand among children with CF. One of these methods is magnetic resonance imaging (MRI).The aim was to explore the capabilities of MRI for imaging lung tissue in children with CF.Methods. The study included 12 patients aged 7 to 18 years with newly diagnosed and previously diagnosed CF. All children underwent CT and MRI of the chest.Results. In all children (100%), chest CT revealed a complex of changes typical of CF: signs of chronic bronchitis, widespread saccular and cylindrical bronchiectasis of various localizations, areas of pulmonary fibrosis, infiltrative changes in the lung tissue. Chest MRI is most effective (100%) in identifying areas of pulmonary fibrosis (thickening of the lung tissue), accumulation of exudate in the lumen of bronchiectasis, and infiltrative changes. In contrast to CT, MRI is less effective in the assessment of bronchitis changes with thickening of the bronchial walls without exudate (83%). A low efficiency of MRI is observed in the visualization of bronchiectasis with a free lumen (without signs of mucostasis).Conclusion. Radiography and computed tomography remain the main methods for lung imaging in children with CF. However, taking into account the absence of ionizing radiation, the development of the method and the emergence of new sequences, chest MRI can be used effectively for follow-up instead of radiography and CT, reducing the radiation dose received.

KARYOLOGICAL CHANGES OF BUCCAL EPITHELIOCYTES IN CHILDREN WITH ACUTE RESPIRATORY PATHOLOGY CAUSED BY SARS-COV-2

Pneumonia is one of the leading causes of death in children under 5 years of age in lowincome countries worldwide. This problem became especially acute with the onset ofthe new coronaviral infection caused by SARS-CoV-2. Community- acquired pneumoniais also one of the most common diseases in children, which requires extensive use ofantibiotics and admission to pediatric clinics. That is why diagnosis of the infectiousinflammatory process activity and prediction of the disease severity is the main factorin optimizing the treatment of children who suffer from infectious respiratory pathology.Objective – to improve the prediction of the severe course of acute respiratory pathologycaused by the SARS-CoV-2 virus by analyzing the results of kariological indicators ofexfoliative cells of the buccal epithelium in children of different ages. Materials and methods. 63 children with acute respiratory pathology caused by theSARS-CoV-2 virus (average age – 10.6±0.5 years) were comprehensively examinedby the method of simple random sampling using the «experiment- control» method.The verification of the etiological factor of inflammation of the respiratory tract wascarried out by the method of polymerase chain reaction with reverse transcriptase(a set of COVID-19 Multiplex RT-PCR in real time from Labsystems Diagnostics Oy) ina nasopharyngeal swab and/or lung expiratory tissue.Fixed smears- imprints of exfoliative cells of the buccal epithelium were stained with azureeosin according to Romanovsky- Giemsa. By light microscopy of cytological samples,changed cells with nuclear abnormalities were evaluated and the number of cells withmicronuclei and karyological indicators of exfoliative cells of the buccal epithelium per100 cells in the preparation were determined.Results.Pathological changes of buccal epithelium exfoliative cells as protrusion, karyopyknosis,karyorrhexis and apoptosis are directly proportional to the disease severity and reflect exclusivelytoxic effects. Identification of the morphological changes expressiveness in the buccal epitheliumcells can be used as a diagnostic factor in prediction of the severe disease, and accordingly,serves as an impetus in optimization of the conducted treatment strategy.Conclusions. A greater number of pathological cells in smears- imprints of the buccalepithelium, and, accordingly, slightly higher cytogenetic indices are determined in patientswith pneumonia and multisystem inflammatory syndrome associated with SARS-CoV-2, whohad a severe and extremely severe course of the disease. Significantly fewer pathologicallychanged cells are found in patients with acute respiratory tract infection of multiplelocalization and bronchitis, who mostly had a medium- severe course of the disease, whichcan be used to predict the severity of the infectious- inflammatory process in children.

Clinical and immunological efficacy of immunotherapeutic program after surgical treatment of children with various forms of acute peritonitis

Acute peritonitis (AP) is among the most frequent and severe conditions in pediatric abdominal surgery. Due to development of antibiotic resistance and increasing number of atypical infectious and inflammatory diseases (IIDs), a lot of specialists suggest combined treatments for these patients which should include not only surgical and etiotropic approaches, as well as therapy aimed at correction of functional defects of immunity. Neutrophilic granulocytes (NGs) reepresent a unique population of cells of primary anti-infectious immune response. Functional NG defects in pediatric AP play a leading role in development, prevalence, severity of peritoneal inflammation, and response to the therapy. Special role is given to functionally significant NG subsets responsible for triggering and implementation of phagocytosis and microbicidal properties of NG in purulent lesions and inflammatory process in children. There is an urgent need for development of new approaches to targeted immunomodulatory therapy in order to correct the NG dysfunction. The aim of the present study was to arrange the programs of immunomodulatory therapy after surgical treatment of immunocompromised children with various forms of acute peritonitis followed by subsequent evaluation of its clinical and immunological efficacy. The study included 12 immunocompromised children aged 5-12 years with different clinical course of acute peritonitis. The study group 1 included patients with local nonrestricted AP; study group 2 involved children with diffuse AP. The comparison groups consisted of 6 children who received standard therapy, i.e., clinical comparison groups 1 and 2, matched for sex, age and diagnosis. A control group consisted of 18 conditionally healthy children at similar age. Clinical examination included collection of the patient’s history, complaints, objective examination and clinical course assessment of the underlying disease. Immunological study included determination of receptor, phagocytic and microbicidal activity of NCs; assessment of NC subpopulations by their numbers and phenotype using flow cytometry, i.e., the cells co-expressing CD64, CD16, CD32, CD11b, with testing density of these membrane receptors by the MFI approach. Targeted immunomodulatory therapy programs were applied for treatment of children with unrestricted local and diffuse AP, taking into account clinical features of AP, as well as changes in number and phenotype of NC subpopulations, and impairment of their effector function. The standards of postsurgical treatment in the children with various forms of AP included different courses of treatment with Imunofan (Hexapeptide – arginyl-alpha-aspartyl-lysyl-valyl-tyrosyl-arginine; HP) using different schedules and duration. We have shown high clinical and immunological efficiency of these therapeutic programs. Thus, reversal of adequate NG functioning was observed, including positive rearrangements of negatively transformed functional NG subpopulations. In this respect, a positive clinical effect was noted in children with atypical AP with various clinical courses, i.e., absence of postsurgical complications, rapid regression of intoxication signs, normalization of body temperature, reduced volume of antibiotic therapy and shorter hospitalization terms.

Modern trends in complex treatment of children with dacryocystitis

Aim. To assess the effectiveness of modern methods of therapy for children with complicated dacryocystitis.Materials and methods. We have studied the results of clinical observations of 75 children in the Pediatric ophthalmological department of the SI “NMC Shifobakhsh” of the MoHSP of RT. The age of children ranged from 7 days to 3 years. 60 children had chronic and 15 phlegmonous dacryocystitis. Immediately after the patients were admitted to the department, clinical and laboratory studies were carried out before the start of antibiotic therapy, inoculum (the contents of the lacrimal sac) was examined to determine the nature of the microflora.Results and discussions. It was found that one of the main causative agents of a purulent inflammatory process in children with dacryocystitis is Staphylococcus epidermidis (n = 34; 45.3%) and Staphylococcus aureus (n = 11; 15%). Also, 6 (8.7%) children were diagnosed with mixed infection - association of Staphylococcus epidermidis and Pneumococcus pneumoniae. In 5 (7.3%) cases, the culture was sterile.Conclusion. Thus, the current strategic direction in the antibacterial treatment of these diseases is the use of the latest generation of antibiotics, to which there are few resistant strains. Such medicines include fluoroquinolones - levofloxacin and ofloxacin.

Assessment of mediator regulation of inflammatory processes in children with congenital malformations of maxillo-facial area

In the article results of mediator regulation of inflammatory processes in patients after one-sided (15 children) and reconstructive (15 children) rinocheiloplasty are presented. It is determined that in patients after reconstructive rinocheiloplasty at 57th day post operation antioxidant capacity of blood plasma is below normal values, that points on lack of compensatory increasing of anti-radical ferments. Specified deficit is necessary to be considered in conservative treatment by applying antioxidants.

МЕТОД ПРОГНОЗИРОВАНИЯ РАЗВИТИЯ ВЫСОКОЙ СТЕПЕНИ ВЫРАЖЕННОСТИ ВОСПАЛИТЕЛЬНОГО ПРОЦЕССА У ДЕТЕЙ С ОСТРЫМИ ВНЕГОСПИТАЛЬНЫМИ ПНЕВМОНИЯМИ

Aim of study. To identify a set of independent factors and develop a method for predicting the high degree of severity of the inflammatory process in children with acute community-acquired pneumonia. Material and methods. A cohort of 100 patients was examined, including children with acute pneumonia with (n=70) and without (n=30) endothelial dysfunction. All children underwent a comprehensive study, which included a clinical examination, laboratory studies according to generally accepted methods. The study of the function of external respiration was carried out using the spirograph “Spiro-spectrum”. Determination of the content of nitric oxide in blood serum was performed by spectrophotometric method using cadmium and Griss reagent, circulating endothelial cells by microscopy. Results. A regression model was created that enables to predict the probability of a high degree of inflammatory process in children with segmental and lobar pneumonia (sensitivity 96.4%, specificity 93.3%). Conclusions. The use of the regression equation enabled to develop a method for predicting the probability of a high degree of inflammatory process in children with segmental and lobar pneumonia that have signs of endothelial dysfunction, and as a result – to choose the optimal management strategy for such patients.

The Influence of Diffuse Nontoxic Goiter on the State of Protective Mechanisms of the Oral Cavity in Children.

Immunopathogenesis of inflammatory and dystrophic diseases of the tissues of the oral cavity is characterized by cellular and humoral factors of specific and nonspecific resistance, the functioning of which is determined by the overall somatic state.This study aimed to study the features of protective mechanisms of the oral cavity due to orthodontic pathology, pathology of periodontal tissues, and odontogenic inflammatory process in children with diffuse nontoxic goiter.Eighty children with diffuse nontoxic goiter aged 12-15 years with different dental status were examined. Evaluation of local immunity of the oral cavity was carried out by determining the content of sIgA, IgA, IgG, lysozyme activity, and levels of IL-1β, IL-4 by enzyme immunoassay.Immunological studies have shown that in children with diffuse nontoxic goiter, the activity of lysozyme in the oral fluid is decreased. The level of sIgА is also reduced by about 20%. Besides, there is an increase in the content of IgG and a growing trend in the level of IgА. The content of IL-1β and IL-4 in such children fluctuates more compared to somatically healthy children.In conclusion, a violation of the local protective mechanisms of the oral cavity is observed in children with diffuse nontoxic goiter. Also, the increase in the severity of dental pathology leads to increased tension of local protective and compensatory reactions.

DYSFUNCTIONS OF NEUTROPHILIC GRANULOCYTES IN CHILDREN WITH CONGENITAL CLEFT LIP AND PALATE

The problem of rehabilitation of children with congenital cleft lip and palate (CCLP) is a difficult task and doesn’t lose its relevance. Children with CCLP often suffer from repeated acute viral and bacterial infections of the respiratory tract and upper respiratory tract, which leads to a forced delay in surgical, orthodontic treatment, adequate speech therapy and complications after staged surgical operations. The development of inflammatory processes in children with CCLP is associated with anatomical and topographic features that facilitate the penetration of pathogenic microflora in oral and nose mucosa and, consequently, negative changes in the immune system (IS). The key cells of IS in maintaining homeostasis and ensuring oral health are neutrophil granulocytes (NG). NG dysfunctions in CCLP interfere with the elimination of pathogens and support their persistence. This can occur against the background of previously existing defects in the functioning of the NG system and is aggravated by the significant pathogenicity and massiveness of the impact of various infectious agents. Full diagnostics of NG dysfunctions is necessary for the further implementation of their timely immune correction and prevention of the development of pathological chronic inflammation in response to the pathogenic microflora long-term on the mucous membrane of the mouth and nose. For this purpose study was conducted of the functional activity and phenotypic characteristics of NG in children with CCLP at different stages of complex rehabilitation. Blood samples of 56 children with CCLP 1-3 years (n = 20, group 1), 4-6 years (n = 20, group 2), and 7-12 years (n = 20, group 3) at different stages of complex rehabilitation and 30 conditionally healthy children (control groups) of the corresponding age was studied. A violation of the microbiocenosis of the mucous membranes of the oral and nasal cavities was revealed, which may be a cause or a consequence of a decrease in antibacterial immunity, first of all NG dysfunctions. Common for all age groups children with CCLP NG dysfunction was found: the appearance of NG expressing CD14 receptors that are absent in children of all three control groups, which indicates the presence of viral and bacterial load; defects of phagocytosis associated with a decrease in the number of actively phagocytic NG, impaired NG capture functions; impaired NADPH oxidase release with partial or complete blockade of the response to additional antigenic load, even in the absence of acute clinical manifestations. Comparative analysis of the studied indicators of the expression level of the receptors CD64, CD16, CD32, CD14 NG in children with CCLP demonstrates different equipment, which determines the inconsistency of the phagocytic and microbicidal function of NG in different age periods. Thus, an increase in the expression of these membrane markers, especially CD64 and CD14, in older age groups is accompanied by more significant defects in phagocytic and killing functions of NG, which is associated not only with recurrent viral respiratory infections, but also with a high frequency of associated bacterial infections of the respiratory system and ENT – organs. Revealed NG dysfunctions in children with CCLP of various age groups indicate their inability to implement adequate anti-infective protection, which can lead to atypically occurring viral – bacterial infections and the occurrence of various, including purulent complications in the postoperative period, which requires the development of targeted immunotherapy, included in the program of comprehensive rehabilitation in children with CCLP and aimed at restoring impaired NG functions.

Features of innate immunity in children with moderate course of acute urticaria

Background. The prevalence of acute urticaria in children remains high. Urticaria is polietiologic disease, maintaining the homeostasis of the body is carried out by close cooperation of various parts of the immune system. The aim of this investigation was to study the features of innate immunity in children with moderate acute urticaria. Methods. To achieve this goal 71 children with moderate acute urticaria were examined. The control group included 30 healthy children of both sexes of the same age. Clinical methods of the study included disease history analysis, phisical examination of the child with determination of the degree of urticaria severity (calculation of the urticaria activity index within 7 days). Immunological methods included NK-lymphocytes, CD14+CD282+, CD14+CD284+, CD14+CD289+, serum IgE level, lactoferrin, IFN-y, IL-4, IL-6, test with NBT rate. Statistical calculations were performed in R Foundation for Statistical Computing. Results. Urticaria with undetermined causal factor happend more often, urticaria with allergic or pseudo-allergic genesis, as well as parasitic infections were established only in 17% of patients, family allergic history was found in a third of patients, in 41% of children acute urticaria proceeded with angioedema, in 9,3% of children urticaria acquired chronic course. Statistically significant increase of CD14+CD284+, decrease of CD14+CD289+, high concentrations of lactoferrin, decrease of natural killers, increase total serum IgE level in the half of the patients, low microbicidal activity with a decrease in adaptation reserves and reduced levels of IL-4, increased the content of IFN-y were found. Conclusion. The revealed changes indicate an imbalance in innate immunity, the launch of the cytokine cascade of inflammation, which is accompanied by further activation of the regulatory components of the inflammatory process in children suffering from acute urticaria.

CHARACTERISTICS OF LOCAL PROTECTIVE MECHANISMS OF THE ORAL LIQUID OF CHILDREN WITH DIFFUSIVE NON-TOXIC DAMAGE

Introduction. Immunopathogenesis of inflammatory and dystrophic diseases of oral tissue sisrealized through cellular and humoral factors of specific and nonspecific resistance, the functioning of which is determined by the over all somatic state of the child's body.Aim of study. Study the features of local defense mechanisms of the oral cavity in the pathology of periodontal tissues and the odontogenic inflammatory processin children with diffuse non-toxic goiter.Materials and methods. 65 children with a diffuse non toxic goiter aged 12-15 years with different dental status were examined: healthy; patients with chronic catarrhal gingivitis; patients with odontogen icinflammatory processes. Control group sconsisted of somatically healthy children with similar dental diseases of the same age. Local oral immunity was evaluated by determining the content of sIgA, IgA, IgG by simple radial diffusion in agar according to G. Manchini (1963) using monospecific standard antisera against the immunoglobulin classes studied, lysozymeactivityby G. Gorin (1971) in modification A. P. Levitskyand A.A. Zhiginoi (1974) and levels of IL-1β, IL-4 bythe method of enzyme immunoassay.Results. Immunological studies have shown that in children with diffuse nontoxic goiter, a decrease in lysozyme activity in the oral fluid is observed both in the studied dental pathology and in healthy oral tissues. The level of sIgA also decreases by about 20%. There is an increase in the IgG content and a tendency toward an increase in the IgA level, which indicates an increase in the local immunity of the oral cavity in children with diffuse non-toxic goiter. The content of IL-1β and IL-4 in these children varies more than in somatically healthy children.Conclusion. 1. In children with diffuse non toxic goiter, there is a violation of local oral defense mechanisms, which are characterized by a decrease in sIgA, an increase in IgA and IgG, a decrease in lysozyme activity and an imbalance in pro- and anti-inflammatory cytokines. 2. An increase in the severity of dental pathology leads to an increase in the tension of local defense-compensatory reactions.

Secure Base Representations in Children With Asthma: Links With Symptoms, Family Asthma Management, and Cytokine Regulation.

Children's perceptions of caregivers as a secure base have been linked with socioemotional outcomes, but little is known about connections to physical health. We examined whether secure base representations are associated with children's symptoms, family management strategies, and inflammatory processes in children with asthma. Participants included 308 children (ages 8-17) and one parent. Children completed a blood draw to measure asthma-related immune functions and reported on perceptions of their mothers as a secure base and their asthma symptoms. Dyads completed interviews about asthma management. Analyses revealed that children's secure base perceptions were associated with better family asthma management and lower Type 2 T-helper cell cytokine production. These findings suggest that secure base representations may be protective for children with asthma.

Akt-dependent enhanced migratory capacity of Th17 cells from children with lupus nephritis.

Th17 cells infiltrate the kidneys of patients with lupus nephritis (LN) and are critical for the pathogenesis of this disease. In this study, we show that enhanced activity of Stat3 in CD4(+)CD45RA(-)Foxp3(-) and Foxp3(low) effector T cells from children with LN correlates with increased frequencies of IL-17-producing cells within these T cell populations. The levels of retinoic acid-related orphan receptor c and IL-17 mRNA are significantly higher in PBMCs from children with LN than in those from controls. Mammalian target of rapamycin inhibition by rapamycin reduces both Stat3 activation in effector T cells and the frequency of IL-17-producing T cells in lupus patients. Complement factor C5a slightly increases the expression of IL-17 and induces activation of Akt in anti-CD3-activated lupus effector T cells. Th17 cells from children with LN exhibit high Akt activity and enhanced migratory capacity. Inhibition of the Akt signaling pathway significantly decreases Th17 cell migration. These findings indicate that the Akt signaling pathway plays a significant role in the migratory activity of Th17 cells from children with LN and suggest that therapeutic modulation of the Akt activity may inhibit Th17 cell trafficking to sites of inflammation and thus suppress chronic inflammatory processes in children with LN.

PO-1003 Characteristics Of The Immune Response To Influenza Vaccine In Children With Allergic Diseases

<h3>Background</h3> Patients with chronic diseases, including atopic bronchial asthma (BA), should be vaccinated annually against influenza. Purpose. To determine the impact of vaccination against influenza in the state of immune response in children with atopic BA. <h3>Object</h3> Studied immune status of 39 children with moderate persistent BA in children from 7 to 14 years, which annually for three years were vaccinated influenza subunit vaccine. <h3>Methods</h3> Compared the levels of serum markers of activation of apoptosis and immune cells before and one month after vaccination. Results. After the vaccination was determined by the tendency to increase of level of IFNγ and IL12 in the serum. Also demonstrated increased in 1.3 times sCD25 (p &lt; 0.05), in 1.6 times IL8 (p &lt; 0.001), reduction in 1.5 times IL4 (p &lt; 0.001), in 1,3 times TNFα (p &lt; 0.05). In vaccinated children was revealed a tendency to increase sCD25 and the reduction of sCD30, sCD95 (p &lt; 0.05), with the all of the listed indicators were significantly rejected from the reference levels. Reliable dynamics of the content of eotaxin, soluble ligands markers of apoptosis sFASL, TRAIL (Apo-2L), the enzyme Caspase-1/ICE and protein Annexin V have been identified. <h3>Conclusions</h3> The data show a pronounced inflammatory process in children with atopic bronchial asthma. At the same time, the observed dynamics of the studied indicators can be interpreted as evidence of an absence of negative impact of vaccination on the various links of the immune response in children with atopic bronchial asthma, including on the processes of activation and apoptosis.

PO-1024 The Importance Of Proinflamatory Cytokine’s In Immune Response In Mycoplasma Pneumoniae Infection In Children With Bronhopulmonary Affection

<h3>Aims</h3> Our study was to evaluate proinflammatory cytokine’s (IL-2) interaction with humoral immunity in children with <i>Mycoplasma pneumoniae </i>lower respiratory tract infection. <h3>Methods</h3> The study group included 20 children, aged 5 months – 7 years, with pneumonia and wheezing induced by <i>Mycoplasma pneumoniae </i>infection. The diagnosis of <i>M.pneumoniae</i> was based on clinical, radiological and on the immunological determinations of specific antibodies in diagnosis titers. Levels of IgA, IgM, IgG, IL-2 were determined in serum samples obtained from all children and were tested by <i>ELISA</i>. <h3>Results</h3> IL-2 levels in children with <i>Mycoplasma</i>-positive bronchopulmonary disease was 36,51 ± 2,26 pg/ml (variation 20,0–100,85 pg/ml) and it is higher, than in healthy children (variation 2,44–7,2 pg/ml) pg/ml. In study group average level of IgA was 0,96 ± 0,13 g/l did not differ from levels of IgA in healthy children (IgA 0,9 ± 0,04 g/l). But level of serum IgM was higher (p &lt; 0,05) in <i>Mp</i>-positive group (1,8 ± 0,16 g/l) in comparison with levels of IgM in healthy children (1,2 ± 0,1 g/l). In study group level of IgG was higher (9,47 ± 0,67 g/l; p &lt; 0,05) in comparison with age norms (7,5 ± 0,1 g/l). <h3>Conclusion</h3> Inflammatory processes in children with <i>Mycoplasma pneumoniae</i> infection are characterised by hyper production of IL-2, and they are associated with high serum levels of IgM, IgG.

Arsenic and fluoride co-exposure affects the expression of apoptotic and inflammatory genes and proteins in mononuclear cells from children

Humans may be exposed to arsenic (As) and fluoride (F) through water consumption. However, the interaction between these two elements and gene expression in apoptosis or inflammatory processes in children has not been thoroughly investigated. Herein, the expression of cIAP-1, XIAP, TNF-α, ENA-78, survivin, CD25, and CD40 was evaluated by RT-PCR. Additionally, the surface expression of CD25, CD40, and CD40L on peripheral blood mononuclear cells was analyzed by flow cytometry, and TNF-α was measured by Western blotting. This study examined 72 children aged 6–12 years who were chronically exposed to As (154.2μg/L) and F (5.3mg/L) in drinking water and in food cooked with the same water. The urine concentrations of As (6.9–122.4μg/L) were positively correlated with the urine concentrations of F (1.0–8.8mg/L) (r2=0.413, p<0.0001). The CD25 gene expression levels and urine concentrations of As and F were negatively correlated, though the CD40 expression levels were negatively correlated only with the As concentration. Age and height influenced the expression of cIAP-1, whereas XIAP expression was correlated only with age. Additionally, there was a lower percentage of CD25- and CD40-positive cells in the group of 6- to 8-year-old children exposed to the highest concentrations of both As and F when compared to the 9- to 12-year-old group (CD25: 0.7±0.8 vs. 1.1±0.9, p<0.0014; CD40: 16.0±7.0 vs. 21.8±5.8, p<0.0003). PHA-stimulated lymphocytes did not show any changes in the induction of CD25, CD69, or CD95. In summary, high concentrations of As and F alter the expression patterns of CD25 and CD40 at both the genetic and protein levels. These changes could decrease immune responses in children exposed to As and F.

Clinical Outcomes of Pediatric Patients With Acute Abdominal Pain and Incidental Findings of Free Intraperitoneal Fluid on Diagnostic Imaging

The presence of free intraperitoneal fluid on diagnostic imaging (sonography or computed tomography [CT]) may indicate an acute inflammatory process in children with abdominal pain in a nontraumatic setting. Although clinical outcomes of pediatric trauma patients with free fluid on diagnostic examinations without evidence of solid-organ injury have been studied, similar studies in the absence of trauma are rare. Our objective was to study clinical outcomes of children with acute abdominal pain of nontraumatic etiology and free intraperitoneal fluid on diagnostic imaging (abdominal/pelvic sonography, CT, or both). We conducted a retrospective review of medical records of children aged 0 to 18 years presenting to a pediatric emergency department with acute abdominal pain (nontraumatic) between April 2008 and March 2009. Patients with intraperitoneal free fluid on imaging were divided into 2 groups: group I, imaging suggestive of an intra-abdominal surgical condition such as appendicitis; and group II, no evidence of an acute surgical condition on imaging, including patients with equivocal studies. Computed tomograms and sonograms were reviewed by a board-certified radiologist, and the free fluid volume was quantitated. Of 1613 patients who underwent diagnostic imaging, 407 were eligible for the study; 134 (33%) had free fluid detected on diagnostic imaging. In patients with both sonography and CT, there was a significant correlation in the free fluid volume (r = 0.79; P < .0005). A significantly greater number of male patients with free fluid had a surgical condition identified on imaging (57.4% versus 25%; P < .001). Children with free fluid and an associated condition on imaging were more likely to have surgery (94.4% versus 6.3%; P < .001). We found clinical outcomes (surgical versus nonsurgical) to be most correlated with a surgical diagnosis on diagnostic imaging and not with the amount of fluid present.

The Role of Ultrasound in Intestinal Inflammatory Processes in Children and Adolescents

Purpose: To disseminate the current knowledge about the intestinal inflammatory processes in children and its approach by ultrasound (US) and provide necessary information to pediatricians for early diagnosis through this complementary method. Source of Data: The sources of data were selected by Medline, the international manuscripts, international medical journals more relevant in the last 20 years about Gray Scale and Color Doppler Ultrasound in the evaluation of inflammatory bowel disease in children and adolescents. Conclusions: Several authors have suggested that the ultrasound should be the first study in the diagnostic investigation process in suspected inflammatory bowel disease to determine the most affected region and monitor the therapy response. While colonoscopy still remains as the reference diagnostic method, the literature suggests that US can be an extremely useful tool in the context of the suspected diagnosis of a wide variety of intestinal inflammatory processes in children.

Exhaled nitric oxide as a measure of pulmonary involvement in the inflammatory process in children with Crohn's disease

Exhaled nitric oxide as a measure of pulmonary involvement in the inflammatory process in children with Crohn's disease