non-KD Group Research Articles

Harmful metabolic acidosis in children treated by ketogenic diet during prolonged general anesthesia for epilepsy surgery: A single center experience.

Management of ketogenic diet (KD) in case of prolonged anesthesia in children. We conducted a retrospective study in the pediatric neurosurgery department of Rothschild Hospital Foundation in France. All the children who underwent long term anesthesia (>4h) in case of neurosurgery for drug resistant pediatric epilepsy surgery between September 2020 and January 2024 were included, excluding patients with suspected metabolic disorder or without blood sample. Children were analyzed in three subgroups: Children under regular diet before surgery constituted the Non-KD group; strict maintenance of KD with no carbohydrate intake during surgery constituted the KD-S group (stringent); carbohydrate intravenous intake during surgery in a patient treated by KD represented the KD-B group (broken). 22 patients were included, among whom 6 under ketogenic diet (KD). After 4h of anesthesia, children maintained in strict ketogenic diet (KD-S, n=3) exhibited non-lactic metabolic acidosis (pH 7.13 vs 7.34, p=1.38x10-9) associated with an increased anionic gap (17.1mM vs 9.6mM, p=1.58 x10-4). Current recommendations for anesthesia during long term anesthesia (>4h) with strict no-carbohydrate intake during anesthesia in case ok KD may be at risk of life-threatening metabolic acidosis, in a context of absence of protocolized monitoring of variations in hyperketosis throughout a prolonged fast. A KD-management protocol, including routine monitoring of ketosis in addition to usual monitoring (lactacidemia, kaliemia and glycemia), and low carbohydrates intravenous perfusion throughout prolonged general anesthesia, should be implemented throughout prolonged general anesthesia, especially for infants younger than 2 years.

Etiology and prognosis of non-Kawasaki disease induced coronary aneurysms in children: a retrospective case series study

While Kawasaki disease (KD) induced coronary artery aneurysms (KD CAAs) in children are well studied, the features and prognosis of non-KD induced CAAs (non-KD CAAs) in the pediatric population are poorly documented. This case series study is to analyze the etiology and prognosis of non-KD CAAs in children and compare the characteristics of non-KD CAAs and KD CAAs. Non-KD CAA and KD CAA cases at our department from January 2022 to December 2023 were retrospectively collected. Etiologies and prognosis of non-KD CAAs were analyzed. Furthermore, demographic data, biochemical parameters and outcomes between children with Non-KD CAAs and children with KD CAAs were comparatively studied. Fifteen children with non-KD CAAs with a median age of 6 years and 117 children with KD CAAs with a median age of 2.0 years (p = 0.022) were included in this study. The causes of non-KD CAAs include: unknown etiologies (2 cases), coronary artery structural abnormalities (4), Takayasu arteritis (2), virus infection (2), cardiomyopathy (2), aplastic anemia with agranulocytosis (1), ANCA-associated vasculitis (1), and mucopolysaccharidosis (1). In the non-KD CAA group, there were a total of 19 CAAs with 3 being giant, 5 medium, and 11 small; 4 patients had complete CAA regression; an infant with a fistula between the right coronary artery and the coronary sinus complicated with cardiac enlargement died of heart failure. The KD group had significantly higher levels of CRP, white cells counts and ESR with zero mortality. Non-KD CAA cases had a significantly lower regression rate than KD-CAA cases (26.7% vs 66.7%, p = 0.004), and the probability of CAA regression in non-KD patients was 0.341 of that in KD patients (p = 0.006, OR = 0.341, 95% CI: 0.179–0.647).Conclusions: Various etiologies for Non-KD CAAs are identified. Patients with Non-KD CAAs were observed to have lower inflammatory indexes but poorer recovery than patients with KD CAAs. Therapeutic strategies different than those for KD may be needed for non-KD CAAs.What is Known:• Coronary artery aneurysm (CAA) in children is most commonly induced by Kawasaki disease (KD CAA), with a 50 ~ 70% regression rate in 1 to 2 years.• CAA induced by diseases other than KD (non-KD CAA) in children is rare and its prognosis remains largely unknown.What is New:• Most non-KD CAA cases are caused by coronary artery structural malformations.• Non-KD CAA in children has poorer prognosis and lower regression rate compared with KD CAA.• In addition to guideline directed anti-platelet and anti-coagulant therapies, treatments targeting the causal factor are necessary for non-KD CAA.

The Significant Impact of High-Fat, Low-Carbohydrate Ketogenic Diet on Serum Lipid Profile and Atherosclerotic Cardiovascular Disease Risk in Overweight and Obese Adults.

Background and objectives Overweight and obesity are becoming more commonplace globally. The ketogenic diet (KD), also known as the high-fat, low-carbohydrate diet, has become increasingly popular in recent years as a means to lose weight quickly. This present study aims to examine the clinical effects of ketogenic diets in individuals who are obese or overweight by evaluating or assessing variations in metabolic parameters associated with lipid control, the risk of atherosclerotic cardiovascular disease, and other kidney risk indicators. Methods and subjects This observational case-control research involved 250 individuals in total and was conducted from May 2023 to January 2024. Of these, 158 were on a ketogenic diet, and 92 adults not following any type of diet were chosen to serve as controls. The biochemistry parameters of the kidney function test and lipid profile were measured for the two comparing groups. Data were analyzed for statistical significance using the Student t-test, Mann-Whitney U test, and one-way analysis of variance (ANOVA), followed by a post hoc test (least significant difference (LSD)). Chi-square tests were employed in the analysis to compare proportions. Results Out of 250 participants, there was a 20-80 age range, with their median age being 40 years old. The two comparing groups' lipid profiles were very different from one another; the cardiovascular risk (triglyceride (TG)/high-density lipoprotein (HDL)), total cholesterol, low-density lipoprotein (LDL), and triglyceride levels were all greater in the KD group when compared to the non-KD group. The mean LDL cholesterol (LDL-C) of the normal-weight participants was 56 mg/dL (p=0.079). Thereafter, it experienced a significant rise to 97.58 mg/dL and 108.2 mg/dL in thoseindividuals who were overweight and obese, respectively (p<0.020). Conclusions As obesity rates in the populace keep rising, dietary fads such as the ketogenic diet are gaining traction. Although they could help with weight loss, this study had a notable observation of severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among the ketogenic diet participants. Additional research is necessary to ascertain if a ketogenic diet can be sustained over the long term and how it affects endpoints that are more clinically significant, such as morbidity and mortality due to obesity.

High-throughput Treg cell receptor sequencing reveals differential immune repertoires in rheumatoid arthritis with kidney deficiency.

Regulatory T (Treg) cells are important immune cells that are regulated by adaptive immunity in the composition of Treg-cell subsets and T-cell receptors (TCRs). Treg cells are related to most autoimmune diseases, such as rheumatoid arthritis (RA). In traditional Chinese medicine (TCM), RA is typically attributed to kidney deficiency (KD) associated with the immunosenescence that causes immune dysfunction and the impaired function of Treg cells. So far, however, no mechanism related to KD and immune repertoires has been identified in RA. Flow cytometry and high-throughput Treg-cell receptor sequencing were used to investigate the amount of different Treg-cell subsets and the diversity of TCRs between RA patients and healthy subjects, as well as between KD RA and non-KD RA patients. RT-qPCR was used to validate the high-throughput sequencing results. The data showed that the amount of naïve Treg cells in KD patients was less than in non-KD RA patients (P = 0.004) with no significant differences observed between other subsets. In the TCR of Treg cells, the length of complementarity determining region 3 (CDR3) was low and clonotypes increased in the KD group compared with the non-KD group. The diversity and abundance of Treg TCRs were low, as determined by the Hill number. In addition, several V(D)J combinations, such as T-cell receptor beta variable 7-2 (TRBV7-2), TRBV11-1, TRBV13, TRBV15, and TRBJ2-3, varied significantly between the two groups, indicating that KD causes Treg dysfunction. RT-qPCR shows that FOXP3 expression in peripheral blood Treg is lower in KD than in non-KD. The results demonstrate the close correlation between KD and immune repertoires in RA and provide a new evaluation method for RA in TCM.

Revisiting Kümmell's disease: MRI findings beyond the intraosseous cavity for improved diagnosis.

The diagnostic tool for Kümmell's disease (KD), including the intravertebral vacuum cavity on imaging, is still limited. The purpose of this study was to find other magnetic resonance imaging (MRI) findings that could help the diagnosis of KD. A total of 289 patients (103 males and 186 females with a mean age of 69 ± 15years) with thoracolumbar compression fracture were included. Medical records were reviewed to note symptom duration. MRIs were analyzed for intraosseous cavities (IOC), prevertebral soft-tissue changes (PreSC), posterior wall fracture (PoF), and posterior ligamentous complex tear (PLCT). KD was diagnosed based on surgical findings or clinical report. MRI findings and symptom duration in the presence or absence of KD were compared with chi-squared test, logistic regression, and Student's t-test and area under the curve (AUC) analyses. KDwas diagnosed in 55 cases. IOC was noted in 33 (60%) cases in the KD group and 82 (35%) cases in non-KD group. Definite PreSC was noted in 44 (80%) cases in the KD group and 94 (40%) cases in the non-KD group. PoF was seen in 36 (65%) and 140 (60%) cases, and PLCT was seen in 7 (13%) and 26 (11%) cases in KD and non-KD groups, respectively. The IOC and PreSC MRI findings were significantly correlated with KD(p < 0.001), but not with PoF (p = 0.539) or PLCT (p = 0.814). AUC of combined IOC and PreSC was 0.72, higher than that of IOC alone (0.63) or PreSC alone (0.69) (both p < 0.001). The average duration of symptom was 64days in the KD group and 14days in the non-KD group (p < 0.001). Positive IOC and PreSC findings were associated with longer symptom duration (p < 0.001). Prevertebral soft-tissue changes and intraosseous cavity areassociated with KD. Combinedfindings of prevertebral soft-tissue changes and intraosseous cavity can help the diagnosis of KD.

Diagnostic Value of Immune-Related Genes in Kawasaki Disease.

Kawasaki disease (KD) is a systemic vasculitis that predominantly damages medium- and small-sized vessels, and mainly causes coronary artery lesions (CALs). The diagnostic criterion of KD mainly depends on clinical features, so children could be easily misdiagnosed and could suffer from CALs. Through analysis, a total of 14 immune-related DEGs were obtained, of which IL1B, ADM, PDGFC, and TGFA were identified as diagnostic markers of KD. Compared with the non-KD group, KD patients contained a higher proportion of naive B cells, activated memory CD4 T cells, gamma delta T cells, and neutrophils, while the proportions of memory B cells, CD8 T cells, activated memory CD4 T cells, and activated NK cells were relatively lower. In conclusion, immune-related genes can be used as diagnostic markers of KD, and the difference in immune cells between KD and non-KD might provide new insight into understanding the pathogenesis of KD.

Kawasaki Disease and Vaccination: Prospective Case-Control and Case-Crossover Studies among Infants in Japan.

The causal effects of vaccines on Kawasaki disease (KD) remain elusive. We aimed to examine the association between vaccines administered during infancy and the development of KD in Japan. We conducted a multicenter prospective case-control study using questionnaires and compared the vaccination status of infants (age: 6 weeks to 9 months) who developed KD (KD group; n = 102) and those who did not develop KD (non-KD group; n = 139). Next, we performed a case-crossover study of 98 cases in the KD group and compared the status of vaccinations between the case and control periods. We also compared the incidence of KD in children for each 5-year period before and after the addition of new vaccines (2012–2013) using data from the Nationwide Survey of KD. In the case-control study, the vaccination status of the KD and control groups did not differ to a statistically significant extent. Multivariable analysis of the vaccination status and patient backgrounds showed no significant association between vaccination and KD development. In the case-crossover study, the status of vaccinations during the case and control periods did not differ to a statistically significant extent. In the analysis of data from the Nationwide Survey of KD, the incidence of KD in children of ages subject to frequent vaccination showed no significant increases in the latter five years, 2014–2018. Based on these prospective analyses, we confirmed that vaccination in early infancy did not affect the risk of KD.

Differences in physical symptoms between those with and without kidney disease: a comparative study across disease stages in a UK population

BackgroundThose living with kidney disease (KD) report extensive symptom burden. However, research into how symptoms change across stages is limited. The aims of this study were to 1) describe symptom burden across disease trajectory, and 2) to explore whether symptom burden is unique to KD when compared to a non-KD population.MethodsParticipants aged > 18 years with a known diagnosis of KD (including haemodialysis (HD) and peritoneal dialysis (PD)) and with a kidney transplant) completed the Leicester Kidney Symptom Questionnaire (KSQ). A non-KD group was recruited as a comparative group. Multinominal logistic regression modelling was used to test the difference in likelihood of those with KD reporting each symptom.ResultsIn total, 2279 participants were included in the final analysis (age 56.0 (17.8) years, 48% male). The main findings can be summarised as: 1) the number of symptoms increases as KD severity progresses; 2) those with early stage KD have a comparable number of symptoms to those without KD; 3) apart from those receiving PD, the most frequently reported symptom across every other group, including the non-KD group, was ‘feeling tired’; and 4) being female independently increased the likelihood of reporting more symptoms.ConclusionsOur findings have important implications for patients with KD. We have shown that high symptom burden is prevalent across the spectrum of disease, and present novel data on symptoms experienced in those without KD. Symptoms requiring the most immediate attention given their high prevalence may include pain and fatigue.Trial registrationThe study was registered prospectively as ISRCTN11596292.

Clinical characteristics and long-term prognosis of autoimmune pancreatitis with renal lesions

Autoimmune pancreatitis (AIP) is recognized as the pancreatic manifestation of a systemic IgG4-related disease that can involve various organs, including the kidney. However, renal lesions tend to be overlooked when AIP is diagnosed, and the clinical characteristics and long-term prognosis of AIP with renal lesions are unclear. We retrospectively reviewed 153 patients with AIP diagnosed at our hospital with a median follow-up period of 41 months (interquartile range, 10–86) and classified them into two groups: the KD group (n = 17), with characteristic renal imaging features, and the non-KD group (n = 136). Serum IgG4 levels were significantly higher in the KD group (663 vs. 304.5 mg/dl, P = 0.014). No differences were observed between the two groups in terms of steroid treatment [14/17 (82.4%) vs. 112/136 (82.4%), P = 1] or in the number of patients who exhibited exacerbation of renal function during treatment [1/17 (5.9%) vs. 8/136 (5.9%), P = 1]. However, the cumulative relapse rate was significantly higher in the KD group [61% vs. 21.9% (3 years), P < 0.001]. Patients in the KD group had different clinical features with high relapse rates compared with those in the non-KD group, and thus, it is important to confirm the presence of renal lesions in AIP patients.

Effects of a ketogenic diet on body composition and strength in trained women

BackgroundThe effect of ketogenic diets (KD) on body composition in different populations has been investigated. More recently, some have recommended that athletes adhere to ketogenic diets in order to optimize changes in body composition during training. However, there is less evidence related to trained women. We aimed to evaluate the effect of a KD on body composition and strength in trained women following an eight-week resistance training (RT) program.MethodsTwenty-one strength-trained women (27.6 ± 4.0 years; 162.1 ± 6.6 cm; 62.3 ± 7.8 kg; 23.7 ± 2.9 kg·m− 2) were randomly assigned to either a non-KD group (n = 11, NKD) or a KD group (n = 10, KD). Study outcomes included body composition as measured by dual-energy X-ray absorptiometry (DXA), strength levels measured using one maximum repetition (RM) in back squat and bench press (BP), and countermovement jump (CMJ) measured on a force plate.ResultsA significant reduction in fat mass was observed in KD (− 1.1 ± 1.5 kg; P = 0.042; d = − 0.2) but not in NDK (0.3 ± 0.8 kg; P = 0.225; d = 0.1). No significant changes in fat-free mass were observed in KD (− 0.7 ± 1.7 kg; P = 0.202; d = − 0.1) or NKD (0.7 ± 1.1 kg; P = 0.074; d = 0.2), but absolute changes favored NKD. No significant changes in BP were observed in KD (1.5 ± 4.6 kg; P = 0.329; d = 0.2), although significant changes were noted in the squat and CMJ (5.6 ± 7.6 kg; P = 0.045; d = 0.5 and 1.7 ± 1.9 cm; P = 0.022; d = 0.6, respectively). In contrast, NKD showed significant increases in BP (4.8 ± 1.8; P < 0.01; d = 0.7), squat (15.6 ± 5.4 kg; P = 0.005; d = 1.4) and CMJ (2.2 ± 1.7 cm; P = 0.001; d = 0.5).ConclusionsFindings indicate that a KD may help to decrease fat mass and maintain fat-free mass after eight 8 weeks of RT in trained-women but is suboptimal for increasing fat-free mass.

Orthostatic and Exercise Effects in Children Years After Kawasaki Disease.

The long-term orthostatic and/or exercise hemodynamic effects in children years after Kawasaki disease (KD) were studied using clinical data from the treadmill exercise test (TMET). Heart rate (HR) and blood pressures (BPs) recorded in TMET were compared between two age, gender, and body scale-matched groups of patients with and without a history of KD. The KD group included 60 patients (9.8 ± 2.7years old) 6.6 ± 2.6years after KD without coronary arterial aneurysm. The non-KD group included 60 children (10.2 ± 2.7years old) with other diagnoses. The exercise tolerance in TMET was not statistically different between the two groups. The KD group had a faster HR on standing than the non-KD group by 8.6% (101.5 ± 12.2 vs. 93.5 ± 15.9bpm, respectively; P < 0.01), suggesting weaker and/or retarded orthostatic vasoconstriction. The pulse pressure was largely augmented above the 4th stage beyond 160mmHg in 10.6 versus 0% (5 vs. 0) of the KD and non-KD groups (P < 0.05), respectively, while HR and BPs were not significantly different through exercise stages between the two groups. The KD group also showed a faster HR recovery five minutes after exercise than the non-KD group, by 5.7% (108.0 ± 11.6 vs. 102.2 ± 14.2bpm, respectively; P < 0.05). Our results might indicate long-term subclinical impacts on the vascular tonus of children years after the disease that have not been recognized in previous studies.

Pilot study of a ketogenic diet in relapsing-remitting MS.

ObjectiveTo assess the safety and tolerability of a modified Atkins diet (KDMAD), a type of ketogenic diet (KD), in subjects with relapsing MS while exploring potential benefits of KDs in MS.MethodsTwenty subjects with relapsing MS enrolled into a 6-month, single-arm, open-label study of the KDMAD. Adherence to KDMAD was objectively monitored by daily urine ketone testing. Fatigue and depression scores and fasting adipokines were obtained at baseline and on diet. Brain MRI was obtained at baseline and 6 months. Intention to treat was used for primary data analysis, and a per-protocol approach was used for secondary analysis.ResultsNo subject experienced worsening disease on diet. Nineteen subjects (95%) adhered to KDMAD for 3 months and 15 (75%) adhered for 6 months. Anthropometric improvements were noted on KDMAD, with reductions in body mass index and total fat mass (p < 0.0001). Fatigue (p = 0.002) and depression scores (p = 0.003) were improved. Serologic leptin was significantly lower at 3 months (p < 0.0001) on diet.ConclusionsKDMAD is safe, feasible to study, and well tolerated in subjects with relapsing MS. KDMAD improves fatigue and depression while also promoting weight loss and reducing serologic proinflammatory adipokines.Classification of evidenceThe study is rated Class IV because of the absence of a non-KD control group.

Efficacy of the ketogenic diet in Chinese children with Dravet syndrome: A focus on neuropsychological development

ObjectivesIn this retrospective study, we evaluated the efficacy of the ketogenic diet (KD) treatment in Chinese children with Dravet syndrome (DS) as well as its effect on neuropsychological development. MethodsTwenty-six children (14 male) living with DS and being treated with KD at our department between July 2014 and December 2017 were enrolled in the study. The efficacy of KD was measured by seizure frequency before and after the diet. Additionally, children's neuropsychological development, as evaluated by the Gesell developmental schedule, was compared between the KD and a non-KD group. ResultsAfter 3, 6, 12, 18, 24, and 30 months, 92.3%, 84.6%, 46.2%, 30.8%, 19.2%, and 19.2% remained on the KD, while 38.4%, 34.6%, 38.4%, 23.0%, 15.4%, and 15.4% showed >50% reduction in seizure. The development age (DA) subscores of 12 children, as measured by the Gesell developmental schedule, increased after commencement of KD. However, children's development quotient (DQ) subscores (age-adjusted) decreased after KD. In the non-KD group (40 participants), an increase of DA subscores and decrease of DQ subscores were also observed. Results found no difference in changes of DQ subscores over time between the two groups. The DQ subscores after the diet in the KD group (20 participants) did not differ significantly when compared to the DQ subscores at same age in the non-KD group (20 patients) (t-test). ConclusionsThe DA subscores of 12 children in KD group increased after KD; when compared with that of the non-KD group, no significant difference was observed in respect to the changes of DQ subscore over time. Effects on cognitive and other neuropsychological development outcomes of KD for children living with DS require further study.

Efficacy of ketogenic diet on body composition during resistance training in trained men: a randomized controlled trial

BackgroundKetogenic diets (KD) have become a popular method of promoting weight loss. More recently, some have recommended that athletes adhere to ketogenic diets in order to optimize changes in body composition during training. This study evaluated the efficacy of an 8-week ketogenic diet (KD) during energy surplus and resistance training (RT) protocol on body composition in trained men.MethodsTwenty-four healthy men (age 30 ± 4.7 years; weight 76.7 ± 8.2 kg; height 174.3 ± 19.7 cm) performed an 8-week RT program. Participants were randomly assigned to a KD group (n = 9), non-KD group (n = 10, NKD), and control group (n = 5, CG) in hyperenergetic condition. Body composition changes were measured by dual energy X-ray absorptiometry (DXA). Compliance with the ketosis state was monitored by measuring urinary ketones weekly. Data were analyzed using a univariate, multivariate and repeated measures general linear model (GLM) statistics.ResultsThere was a significant reduction in fat mass (mean change, 95% CI; p-value; Cohen’s d effect size [ES]; − 0.8 [− 1.6, − 0.1] kg; p < 0.05; ES = − 0.46) and visceral adipose tissue (− 96.5 [− 159.0, − 34.0] g; p < 0.05; ES = − 0.84), while no significant changes were observed in the NKD and CG in fat mass (− 0,5 [− 1.2, 0.3] kg; p > 0.05; ES = − 0.17 and − 0,5 [− 2.4, 1.3] kg; p > 0.05; ES = − 0.12, respectively) or visceral adipose tissue (− 33.8 [− 90.4, 22.8]; p > 0.5; ES = − 0.17 and 1.7 [− 133.3, 136.7]; p > 0.05; ES = 0.01, respectively). No significant increases were observed in total body weight (− 0.9 [− 2.3, 0.6]; p > 0.05; ES = [− 0.18]) and muscle mass (− 0.1 [− 1.1,1.0]; p > 0,05; ES = − 0.04) in the KD group, but the NKD group showed increases in these parameters (0.9 [0.3, 1.5] kg; p < 0.05; ES = 0.18 and (1.3[0.5, 2.2] kg; p < 0,05; ES = 0.31, respectively). There were no changes neither in total body weight nor lean body mass (0.3 [− 1.2, 1.9]; p > 0.05; ES = 0.05 and 0.8 [− 0.4, 2.1]; p > 0.05; ES = 0.26, respectively) in the CG.ConclusionOur results suggest that a KD might be an alternative dietary approach to decrease fat mass and visceral adipose tissue without decreasing lean body mass; however, it might not be useful to increase muscle mass during positive energy balance in men undergoing RT for 8 weeks.

Mean platelet volume as a marker of Kawasaki disease in children

Background: Kawasaki disease (KD) is a clinical diagnosis, with common confusion among other causes of febrile illnesses. There are no confirmatory laboratory parameters for diagnosing KD. Objective: To investigate whether low mean platelet volume (MPV) is associated more with fever due to KD than due to the other common causes. Methods: This retrospective case-control study was done on febrile children between 6 months and 6 years of age admitted from January 2015 to January 2017. The MPV values of 28 KD and 50 non-KD febrile children admitted to our hospital were obtained from the hospital records. The diagnosis of KD was accepted only when (1) two pediatricians had agreed upon the diagnosis independently based on the American Heart Association guidelines 2004, (2) no other cause of fever coexisted with KD in a particular patient, and (3) prompt clinical response within 48 h of administration of intravenous immunoglobulin. Using suitable statistical software, the range of MPV in KD fever and non-KD fevers was compared. Results: MPV was lower in the KD group (9.75±0.98 femtoliter) than in the non-KD fever group (11.14±1.53 femtoliter). From the receiver operating characteristic curve, it was found that at MPV ?10.0 fl, KD can be diagnosed with 75% sensitivity and 80% specificity. This means that lower the value of MPV, lower is the probability that a non-KD patientwill be wrongly diagnosed as KD. Conclusion: Our study shows that low MPV is associated with KD. Hence, a low MPV can raise the index of suspicion for KD in febrile children, especially in cases of incomplete KD. Further, prospective studies involving larger sample size are needed to ascertain its diagnostic utility.

Kawasaki disease associated with Mycoplasma pneumoniae.

BackgroundKawasaki disease (KD) is an illness of unknown etiology that mostly occurs in children under 5 years of age and is the leading cause of acquired heart disease all over the world. Mycoplasma pneumoniae (MP) was one of the likely causative agents of KD. However, the etiologic effect of MP in KD has not been fully recognized.MethodsWe prospectively analyzed the clinical records of 450 patients with KD hospitalized in Children’s Hospital of Soochow University from 2012 to 2014. Using medical records, we retrospectively identified patients with low respiratory tract infection (non-KD group).ResultsOf the 450 KD patients, MP was positive in 62 (13.8 %). The median age of the MP + KD+ group was significantly older than the MP-KD+ group (25 vs 14.5 months, P < 0.01). MP + KD+ group had higher levels of ESR, N% and CRP than the MP-KD+ group. MP + KD+ group were more frequent in respiratory disorders than MP-KD+ group with a P < 0.05. No statistical difference of non-responders or coronary artery lesion was found between the groups.ConclusionsMP infections are found in an important proportion of the KD patients (13.8 % in our series). MP infection tended to occur in older populations and with a higher rate of respiratory tract involvement in patients with KD. No statistical difference of non-responders or coronary artery lesion was found between the MP+ and MP- KD patients.

Long-term Cardiovascular Outcomes in Survivors of Kawasaki Disease

Kawasaki disease (KD) may result in coronary aneurysm formation, but there is incomplete knowledge regarding its long-term effects. Our objective was to quantify the longer-term rates of adverse cardiac events in a modern North American KD cohort. Using the Kaiser Permanente Northern California population, we performed a retrospective cohort study in patients with a history of KD versus matched patients without KD. Chart review was used to confirm the diagnosis of KD and all outcomes of interest, including acute coronary syndrome, coronary revascularization, heart failure, ventricular arrhythmia, valve disease, aortic aneurysm, and all-cause mortality. All outcomes occurring at age ≥15 years were included in the primary analysis. Outcome rates were compared between the 2 groups by using Cox proportional hazards analysis. The study included 546 KD patients and 2218 matched patients without KD. Seventy-nine percent of the KD patients received intravenous immunoglobulin and 5% had persistent coronary aneurysm. The average follow-up time was 14.9 years. Only 2 KD patients experienced outcomes after age 15 (0.246 events per 1000 person-years) compared with 7 events in the non-KD group (0.217 events per 1000 person-years), a nonsignificant difference (hazard ratio: 0.81; 95% confidence interval: 0.16-4.0). Within the KD subgroup, persistent coronary aneurysm predicted the occurrence of adverse events (P = .007). This is the largest US study of longer-term cardiac outcomes after KD and reveals a low rate of adverse cardiovascular events through age 21. Additional validation studies, including studies with longer-term follow-up, should be performed.

Changes of myeloid related protein-8/myeloid related protein-14 expressions in children with Kawasaki disease

Objective To investigate the expression changes of myeloid-related protein-8(MRP-8) and myeloid-related protein-14(MRP-14) in children with Kawasaki disease(KD) and to obtain laboratory diagnostic serum markers and new targets for its drug therapy. Methods A total of 46 patients with KD(KD group) were enrolled from Jul.2009 to Dec.2010 and divided into the coronary artery dilatation(CAD) group(n=15) and the normal coronary artery group(n=31); Meanwhile, 25 febrile patients with acute respiratory tract infection but without disease in the circulatory, blood, immune systems formed the non-KD febrile group.Twenty healthy children from the out-patient department formed the healthy control group.Peripheral venous blood was collected in the acute and subacute stage of KD.Levels of MRP-8/MRP-14 were detected with enzyme-linked immunosorbnent assay(ELISA). Gene expressions of MRP-8, MRP-14 in leukocytes were analyzed by semi-quantitative reverse transcription-polymerase chain reaction(RT-PCR). Results The serum levels of MRP-8/MRP-14 along with mRNA expressions of MRP-8 and MRP-14 in the leukocytes in the out-patient acute and subacute stage of KD were significantly higher than those in the non-KD febrile group and the healthy control group(all P 0.05). The serum levels of MRP-8/MRP-14 along with mRNA expressions of MRP-8 and MRP-14 in leukocyte in actue stage of KD were significantly higher than those in subacute stage(all P<0.001). The serum levels of MRP-8/MRP-14 as well as mRNA expressions of MRP-8 and MRP-14 in the acute and the subacute stage of CAD group were significantly higher than those in the normal coronary artery group(P<0.05). Conclusions MRP-8/MRP-14 may probably play a role in the pathogenesis of KD and can be used as a diagnostic indicator for KD; MRP-8/MRP-14 may be involved in the formation of coronary artery lesion and can be used as an effective predictor for the coronary artery lesion. Key words: Kawasaki disease; Myeloid related protein-8; Myeloid related protein-14; Coronary arterial lesion

Absence of Linkage Between the Interleukin-6 Promoter Gene (-174 G/C) Polymorphism and Kawasaki Disease

Objectives. Kawasaki disease (KD), an acute vasculitis with unknown etiology, involves a complex interaction of immunoinflammatory processes, cytokine activation, and genetic factors. Gene polymorphisms of proinflammatory cytokines, such as interleukin-6 (IL-6), are associationed with cardiovascular disease. We aimed to investigate whether the IL-6 -174 promoter gene polymorphism is as a marker of susceptibility to KD. Methods. Individuals were divided into two groups: 1) KD (n=120); 2) non-KD groups (n=102). Genomic DNA was obtained from peripheral leukocytes. The IL-6 promoter gene (-174 G/C) polymorphism was amplified by polymerase chain reaction and detected after NlaIII restriction enzyme digestion. Genotypes and allelic frequencies were compared between both groups. Results. The genotype distributions and allele frequencies of the IL-6 promoter polymorphism did not differ significantly between the KD and non-KD groups. The proportions of C homozygote/heterozygote/G homozygote for IL-6 promoter in the KD group were 99.2/0.8/0%, and those in the non-KD group were 99.01/0.99/0%. The proportion of allele C/G in the KD group was 99.6/0.4%, and that in the non-KD was 99.5/0.5%. Conclusions. There is no association between KD and the IL-6 -174 G/C gene polymorphism. Differences in IL-6 genotypes and alleles are not associated with KD development. Therefore, the IL-6 -174 G/C gene polymorphism is not a genetic marker of susceptibility to KD.

Increased plasma endothelin levels in Kawasaki disease: a possible marker for Kawasaki disease.

Plasma immunoreactive endothelin (iET) levels were investigated in patients with Kawasaki disease (KD). The iET level was 2.49 +/- 0.13 pg/mL in KD patients and 1.32 +/- 0.06 in age-matched control subjects, showing a significant increase with KD. The iET level was not increased in patients with febrile inflammatory diseases of bacterial origin without KD (non-KD group). Parameters indicating an inflammatory reaction, such as C-reactive protein, platelet count, white blood cell count, and interleukin-6 level, were increased in the KD patients. However, they were similarly increased in the patients with febrile diseases of bacterial origin and showed no significant differences between the two groups. This study is the first to report that plasma iET levels are elevated in a disease mainly involving vasculitis. These results suggest that blood iET levels are increased in KD patients as a result of the associated vascular endothelial damage and that iET can be a useful marker for the diagnosis of KD.