Normal Adult Values Research Articles

Critical re-evaluation of the identification of iron deficiency states and effective iron repletion strategies in patients with chronic heart failure.

According to current guidelines, iron deficiency is defined by a serum ferritin level <100 ng/ml or a transferrin saturation (TSAT) <20% if the serum ferritin level is 100-299 μg/L. These criteria were developed to encourage the use of intravenous iron as an adjunct to erythropoiesis-stimulating agents in the treatment of renal anaemia. However, in patients with heart failure, these criteria are not supported by any pathophysiological or clinical evidence that they identify an absolute or functional iron deficiency state. A low baseline TSAT-but not serum ferritin level-appears to be a reliable indicator of the effect of intravenous iron to reduce major heart failure events. In randomized controlled trials, intravenous iron decreased the risk of cardiovascular death or total heart failure hospitalization in patients with a TSAT <20% (risk ratio 0.67 [0.49-0.92]) but not in patients with a TSAT ≥20% (risk ratio 0.99 [0.74-1.30]), with the magnitude of the risk reduction being proportional to the severity of hypoferraemia. Patients who were enrolled in clinical trials solely because they had a serum ferritin level <100 μg/L showed no significant benefit on heart failure outcomes, and it is noteworthy that serum ferritin levels of 20-300 μg/L lie entirely within the range of normal values for healthy adults. Current guidelines reflect the eligibility criteria of clinical trials, which inadvertently adopted unvalidated criteria to define iron deficiency. Reliance on these guidelines would lead to the treatment of many patients who are not iron deficient (serum ferritin level <100 μg/L but normal TSAT) and ignores the possibility of iron deficiency in patients with a low TSAT but with serum ferritin level of >300 μg/L. Importantly, analyses of benefit based on trial eligibility-driven guidelines substantially underestimate the magnitude of heart-failure-event risk reduction with intravenous iron in patients who are truly iron deficient. Based on all available data, we recommend a new mechanism-based and trial-tested approach that reflects the totality of evidence more faithfully than the historical process adopted by clinical investigators and by the guidelines. Until additional evidence is forthcoming, an iron deficiency state in patients with heart failure should be defined by a TSAT <20% (as long as the serum ferritin level is <400 μg/L), and furthermore, the use of a serum ferritin level <100 μg/L alone as a diagnostic criterion should be discarded.

Factors Influencing Wound Healing in Diabetic Foot Patients.

Background and objectives: Diabetic foot stands out as one of the most consequential and devastating complications of diabetes. Many factors, including VIPS (Vascular management, Infection management, Pressure relief, and Source of healing), influence the prognosis and treatment of diabetic foot patients. There are many studies on VIPS, but relatively few studies on "sources of healing". Nutrients that affect wound healing are known, but objective data in diabetic foot patients are insufficient. We hypothesized that "sources of healing" would have many effects on wound healing. The purpose of this study is to know the affecting factors related to the source of healing for diabetic foot patients. Materials and Methods: A retrospective review identified 46 consecutive patients who were admitted for diabetic foot management from July 2019 to April 2021 at our department. Several laboratory tests were performed for influencing factor evaluation. We checked serum levels of total protein, albumin, vitamin B, iron, zinc, magnesium, copper, Hb, HbA1c, HDL cholesterol, and LDL cholesterol. These values of diabetic foot patients were compared with normal values. Patients were divided into two groups based on wound healing rate, age, length of hospital stay, and sex, and the test values between the groups were compared. Results: Levels of albumin (37%) and Hb (89%) were low in the diabetic foot patients. As for trace elements, levels of iron (97%) and zinc (95%) were low in the patients, but levels of magnesium and copper were usually normal or high. There were no differences in demographic characteristics based on wound healing rate. However, when compared to normal adult values, diabetic foot patients in our data exhibited significantly lower levels of hemoglobin, total protein, albumin, iron, zinc, copper, and HDL cholesterol. When compared based on age and length of hospital stay, hemoglobin levels were significantly lower in both the older age group and the group with longer hospital stays. Conclusions: Serum levels of albumin, Hb, iron, and zinc were very low in most diabetic foot patients. These low values may have a negative relationship with wound healing. Nutrient replacements are necessary for wound healing in diabetic foot patients.

Factors associated with age-related changes in oral diadochokinesis and masticatory function in healthy old adults

BackgroundThis cross–sectional study aimed to identify factors associated with age-related changes in masticatory performance (MP) and oral diadochokinesis (ODK) and to provide normal values in healthy old adults for the diagnosis of oral frailty.MethodsA total of 385 participants were divided into three age groups (Gr1-3): 20–64 years, 65–74 years, and ≥ 75 years. To investigate tongue-lip motor function, ODK was assessed as the number of repetitions of the monosyllables /pa/ta/ka/. Four questionnaires were used to assess subjective masticatory ability, cognitive ability, and psychological status. MP, bite force, and occlusal area were tested to assess dynamic objective masticatory function, and the number of remaining teeth and functional tooth pairs were determined to assess static objective masticatory function. Handgrip strength (HG), oral dryness, and tongue pressure (TP) were assessed to identify influencing factors. Intergroup differences were evaluated by ANOVA and the Kruskal‒Wallis test, and correlations between ODK and orofacial factors were evaluated.ResultsThis study revealed significant age-related declines in TP, HG, and ODK, especially after 65 years of age. Factors affecting MP were posterior teeth, the Eichner index, bite force, occluding area, the Korean Mini-Mental State Examination (KMMSE) score, and ODK. Each ODK syllable was associated with different factors, but common factors associated with ODK were MP, HG, and PHQ-9 score. For the syllables /pa/ta/, the Eichner Index, TP, and oral dryness were also associated. For the syllable /ka/ in Gr3, MP, TP, HG, oral dryness, and the KMMSE score were associated.ConclusionsThese results could provide practical guidelines for oral rehabilitation in old adults and contribute to improving the understanding of age-related changes in oral function and the multidimensional nature of masticatory dynamics.

Gastric Volume and Antral Area in the Fasting State: A Meta-analysis of Individual Patient Data.

Pulmonary aspiration of gastric content is a serious anesthetic complication. Gastric point-of-care ultrasound can determine the type and volume of gastric content when clinical information is equivocal. However, a cutoff value of either antral cross-sectional area or volume that may be considered as the upper limit of normal in fasting subjects is still controversial. The aim of this study is to characterize the distribution of baseline antral area and volume in fasting adult subjects and to identify an upper limit (95th percentile) of these distributions. The authors conducted a meta-analysis of individual participant data of primary studies from an academic research network of investigators collaborating in gastric ultrasound. Studies between January 2009 and December 2020 were included. Twelve primary studies met inclusion criteria and were included in the analysis with a sample size of 1,203 subjects. The 95th percentile of area values (measured in the right lateral decubitus) was 9.9 cm2 (95% CI, 9.4 to 10.4), and of volume, 2.3 ml/kg (95% CI, 2.3 to 2.4). In addition, an antrum grade 0 or 1 indicates a 98% probability of an antral area below the 95th percentile. An area of 10 cm2 measured in the right lateral decubitus could be a simple, data-driven upper limit of antral area that could serve as a surrogate of upper limit of normal gastric volume values in fasting adults. These results are limited by the highly selected sampling of the studies included.

Impact of sex and age on the lateralisation of the tibial tubercle in normal paediatric and adolescent populations.

Numerous methods have been proposed to characterise tubercle lateralisation. However, their normal values and related changes remain unclear. Accordingly, it was aimed to determine the potential sex and age effects and determined the optimal individualised method of diagnosing lateralisation of the tibial tubercle in patients with recurrent patellar dislocation (RPD). Measurements included the tibial tubercle-trochlear groove (TT-TG) distance, tibial tubercle-posterior cruciate ligament (TT-PCL) distance and tibial tubercle lateralisation (TTL); and the proximal tibial width (PTW), trochlear width (TW) and trochlear dysplasia index (TDI), for adjustment. A two-way analysis of variance was used to determine the effect of age, sex and their interaction within the normal group. When the age effect was statistically significant, a nonlinear regression was created. Areas under the receiver-operating characteristic curve (AUCs) were calculated to assess diagnostic accuracy. A total of 277 normal participants (mean [SD] age, 13.5 [2.6] years; 125 [45.1%] female) and 227 patients with RPD (mean [SD] age, 13.5 [2.6] years; 161 [58.1%] female) were analysed. It was found that in the normal group, in patients aged 7-10, TT-PCL distance (p = 0.006), TTL (p = 0.007) and TT-PCL/PTW (p < 0.001) were significantly larger in females than in males. A significant sex effect was also detected on TT-TG/TW (p = 0.014). TT-TG distance, TT-PCL distance, TTL and TT-PCL/PTW (in male patients) approached an established normal adult value of 12.3 mm, 20.9 mm, 0.64 and 0.28, respectively, with increasing age (p < 0.001). The AUC was greater for TT-TG/TDI and TT-TG/TW (p ≤ 0.01) and TT-TG/TDI outperformed TT-TG/TW in patients aged 15-18 (p = 0.004). Tubercle lateralisation increased with age and was affected by sex, with the exception of TT-TG distance and TT-TG/TDI. TT-TG/TDI is the optimal method of diagnosing a lateralized tibial tubercle in patients with RPD. These findings assist with the evaluation of tubercle lateralisation in that they provide a proper protocol for paediatric and adolescent populations with RPD; and thus, will help determine whether medial tubercle transfer should be included among the tailored surgical procedures considered for the treatment of patients with RPD. Level III.

Standard radiographic values for the acetabulum in Japanese adolescents: a cross-sectional study

BackgroundMost previous reports of normal acetabular radiographic values focused on adults or elderly people. Recent reports have described premature hip osteoarthritis in adolescents not caused by acetabular dysplasia. In addition, there is a certain failure rate of surgical treatment for young patients with borderline acetabular dysplasia. Accurate indices for treatment of adolescent hips are unclear because standard measurement values of the adolescent acetabulum have not been reported.MethodsThis cross-sectional study involved 552 Japanese adolescents aged 12–18 years who had scoliosis or suspected scoliosis and asymptomatic hips. All persons underwent plain standing anteroposterior whole-spine radiography, and measurements were obtained using the pelvic part of the radiograph. We excluded persons who were unable to correctly perform measurements because of conditions such as pelvic rotation or lateral inclination and persons in whom closure of the triradiate cartilage or closure of the secondary ossification centers of the acetabulum had not yet occurred. In 1101 hips, we measured the lateral center–edge angle (LCEA), Tönnis angle, Sharp angle, acetabular head index (AHI), lateral subluxation (LS), vertical subluxation (VS), and peak-to-edge distance (PED). We evaluated the correlation coefficient and coefficient of determination between each parameter and age, height, body weight, and body mass index (BMI) and assessed the intra- and inter-rater reliability of each radiographic parameter.ResultsAmong all hips, the mean of each parameter was as follows: LCEA, 27.9° ± 4.8°; Tönnis angle, 5.0° ± 3.7°; Sharp angle, 44.1° ± 3.1°; AHI, 82.1% ± 5.5%; LS, 5.4 ± 1.4 mm; VS, 0.3 ± 1.2 mm; and PED, 14.0 ± 2.3 mm. The correlation between each parameter and age, height, body weight, and BMI was considerably low. Intra- and inter-rater reliability was moderate or good for almost all parameters.ConclusionsThe values for each radiographic parameter of the acetabulum in this study are considered standard for the adolescent acetabulum without age-related changes. Some parameters differ slightly from the normal values for adults or elderly people in previous reports; thus, we suggest careful evaluation of these parameters for adolescents.

Normative values for the video Head Impulse Test in children without otoneurologic symptoms and their evolution across childhood by gender

PurposeThe video Head Impulse Test is routinely used to assess semicircular canal function in adults, but to date, pediatric reference values are scarce. This study aimed to explore the vestibulo-ocular reflex (VOR) in healthy children at different development stages and to compare the obtained gain values with reference to those in an adult population.MethodsThis prospective, single-center study recruited 187 children from among patients without otoneurological diseases, healthy relatives of these patients, and staff families from a tertiary hospital. Patients were divided into three groups by age: 3–6 years, 7–10 years, and 11–16 years. The vestibulo-ocular reflex was assessed by video Head Impulse Test, using a device with a high-speed infrared camera and accelerometer (EyeSeeCam®; Interacoustics, Denmark).ResultsWe found a lower vestibulo-ocular reflex gain of both horizontal canals in the 3–6-year-old group when compared with the other age groups. No increasing trend was found in the horizontal canals from age 7–10 years to age 11–16 years, and no differences were found by sex.ConclusionGain values in the horizontal canals increased with age until children reached age 7–10 years and matched the normal values for adults.

Radiometric Parameters of the Forearm in Traumatic Instability of the Distal Radioulnar Joint in Children

Background. At present, the literature describes in sufficient detail the use of various methods of X-ray examination of the bones of the forearm in the diagnosis of distal radioulnar joint instability (DRUJI), but there are no data on radiometric parameters for DRUJI of traumatic origin in children. Quantitative diagnostics becomes mandatory for determining the tactics of treating DRUJI of traumatic origin in children.&#x0D; The purpose of study to analyze the radiometric parameters of the distal forearm in case of DRUJI of traumatic origin in children to plan the method of surgical treatment.&#x0D; Мethods. The paper presents an analysis of the results of X-ray examination of 23 children with instability of the distal radioulnar joint of traumatic origin aged 9 to 17 years (mean age 14.212.5 years) the main group. For comparison, radiographs of the contralateral forearms of the same patients were analyzed the comparison group (23 children), and radiographs of the forearm of 69 pediatric patients without signs of DRUJI (control group). On radiographs in the anteroposterior and lateral projections, the following radiometric parameters were evaluated: radioulnar and volar angles, radioulnar index, radioulnar distance, and the difference between the radioulnar distances of both forearms.&#x0D; Results. In 19 patients of the main group, a positive variant of the radioulnar index with dislocation of the head of the ulna was revealed, while the indicators of the radioulnar and volar angle were characterized by variability in values. The average values of radiometric parameters of DRUJI in children without bone-traumatic changes of the forearm are comparable to normal values in adults.&#x0D; Conclusions. In children with DRUJI of traumatic origin, various changes were revealed radiometric indicators of the distal parts of the bones of the forearm, which depend on the type of forearm fracture. In a particular pediatric patient with DRUJI of traumatic origin, these indicators reflect the biomechanical features of the wrist joint, which must be taken into account when planning surgical intervention and predicting the recovery of the anatomy and function of the forearm.

Effects of geographical factors on reference values of the thyroid stimulating hormone in healthy adults in China and its clinical significance.

The thyroid stimulating hormone (TSH) plays an important regulatory role in maintaining normal function of the thyroid gland. The purpose of this study was to explore the geographical, spatial distribution of TSH normal values in healthy Chinese adults to be used for the formulation of a standard reference. TSH values of 9321 healthy adults from 120 cities in China were collected together with 24 topographic, climatic and soil variables and used for the determination of spatial, significant relationships between TSH and these geographical factors by correlation analysis. Eleven significant factors were extracted and subjected to ridge regression and construction of vector machine models. The predicted values were tested for normality, with the disjunctive Kriging interpolation method used for geographical distribution. The values found showed a spatial pattern of higher values in the North and west but lower in the South and east We concluded that ridge regression models are useful for this kind of investigations and that certain geographical factors determine the level of TSH in healthy adults in a large expanse of land where topography, climate and soil indices vary.

Radiographic measurement of the posterior tibial slope in normal Chinese adults: a retrospective cohort study

BackgroundMeasurement of the posterior tibial slope (PTS) angle has important applications in total knee replacement surgery, high tibial osteotomy, and anterior cruciate ligament reconstruction. This study aimed to determine the mean PTS of knee joints in healthy Chinese adults, and provide data to guide knee surgery in China.MethodsA retrospective analysis of 1257 (n = 1233, 50.4% male) plain X-ray films of participants aged 25–59 years was performed. The picture archiving and communication system was used for PTS measurement. The PTS was defined as the angle between the vertical line of the tangent of the anterior tibial cortex of the proximal tibia, and the tangent line of the tibial cortex. Two imaging physicians conducted the PTS measurements independently, and both the inter- and intraclass correlation coefficients (ICCs) were calculated.ResultsThe mean PTS value was 7.68 ± 3.84° (range: 0–21°). The left PTS was significantly smaller in males than in females (7.22 ± 3.89 vs 8.05 ± 3.60; P = 0.005). Additionally, the PTS in participants aged 25–29 years was significantly larger than that in the other age groups (Left side: 8.64 ± 3.73 vs 6.92 ± 3.42, 7.42 ± 3.75, 7.53 ± 3.98; P < 0.001 and Right side: 8.68 ± 3.84 vs 7.48 ± 4.21, 7.13 ± 3.64, 7.66 ± 3.80; P = 0.004). There were no significant differences in PTS between the left and right sides. Two-way analysis of variance suggested that the differences in PTS between age groups were not affected by sex. The interobserver ICC was 0.91 (95% confidence interval [CI]: 0.85–0.94), and the intraobserver ICC was 0.90 (95% CI: 0.82–0.94).ConclusionsThis study demonstrated that there were significant differences in PTS based on sex and age, highlighting the need to provide individualized treatment for knee surgery. It provided valuable information regarding the normal PTS values in Chinese adults and presented regionalised data to guide knee surgery.

Optimization of the Transwell® assay for the analysis of neutrophil chemotaxis using flow cytometry to refine the clinical investigation of immunodeficient patients

Chemotaxis is the directed movement of neutrophils towards an infected site. This physiological process can be reproduced using a modified Boyden chamber, such as the Transwell® support. Different techniques can be used to count neutrophils after migration to the lower chamber of the holder. The present study supports the use of an optimized Transwell® assay coupled with a flow cytometry-based method (Sysmex XN-9000) to detect chemotaxis abnormalities. A reference interval of neutrophil's chemotaxis was determined as part of this work.A first step involves the extraction of neutrophils from whole blood. The migration of neutrophils from the upper to the lower support chamber is subsequently directed by a chemoattractant gradient using N-formyl-l-Methionyl-l-Leucyl-l-Phenylalanine (fMLP). Neutrophils collected in the lower chamber are finally counted by flow cytometry.The original protocol was optimized through the comparison of different parameters. The use of Polymorphprep®, in the extraction of neutrophils, showed an improvement of the neutrophils yield of 1.65 times (57.5% of recovery) compared to the extraction using the Ficoll-Hypaque® gradient.A solution containing 5% of Bovin Serum Albumin (BSA) was used to suspend the extracted neutrophils, stabilize their viability and preserve their integrity. The mechanical agitation of the Transwell® permeable supports during migration did not show an increase in neutrophil yield. A migration time of 1 h 30 was identified as the best time for collecting the largest number of neutrophils after migration. Finally, we demonstrated that scraping the bottom of the well after migration improved neutrophil collection from the lower chamber by 1.9-fold compared to a non-scraping method.In conclusion, our results support the use of Polymorphprep® and a 5% BSA solution in the suspension, without agitation of the medium. An incubation time of 1 h 30 was identified as optimal for neutrophil migration through the chamber. Scraping the bottom after neutrophil migration improved neutrophil collection yield. Normal adult values were obtained with directed migration equal to 32.4% ±13.41% on 15 men and 18 women.

Contact Heat Evoked Potentials in China: Normal Values and Reproducibility.

Background: Contact heat evoked potentials (CHEPs) is used to diagnose small fiber neuropathy (SFN). We established the normal values of CHEPs parameters in Chinese adults, optimized the test technique, and determined its reproducibility.Methods: We recruited 151 healthy adults (80 men; mean age, 37 ± 14 years). CHEPs was performed on the right forearm to determine the optimal number of stimuli, and then conducted at different sites to establish normal values, determine the effects of demographic characteristics and baseline temperature, and assess the short- (30 min) and long-term (1 year) reproducibility. N2 latency/height varied with age and sex, while P2 latency/height and N2–P2 amplitude varied with age. The optimal number of stimuli was three.Results: N2 latency/height (t = 5.45, P < 0.001) and P2 latency/height (χ2 = −4.06, P < 0.001) decreased and N2–P2 amplitude (t = −5.01, P < 0.001) and visual analog scale score (χ2 = −5.84, P < 0.001) increased with increased baseline temperature (35 vs. 32°C). CHEPs parameters did not differ with time (baseline vs. 30 min vs. 1 year).Conclusion: We established normal CHEPs values in Chinese adults. We found that CHEPs parameters changed with baseline temperature and that the short- and long-term test reproducibility were satisfactory.

Thyroid Disorders.

Thyroid Disorders.

Can the Enhanced Liver Fibrosis Score Be Used to Diagnose Children With Liver Fibrosis?

The noninvasive Enhanced Liver Fibrosis (ELF) score is used in adults with liver fibrosis as a diagnostic aid. The ELF score combines 3 serum markers of extracellular matrix remodeling and fibrogenesis: hyaluronic acid (HA), the N-terminal pro-peptide of collagen type III (PIIINP), and tissue inhibitor of metalloproteinase-1 (TIMP-1). We aimed to evaluate the clinical use of the ELF score in children. A reference interval for the ELF score was established using 343 liver-healthy children ages 6 to 17 years. The median ELF score of 8.9 in healthy children was significantly increased compared with healthy adults. ELF scores increased significantly in both female and male healthy controls with peak levels at puberty, driven by elevated levels of HA and PIIINP likely explained by increased growth. If adult normal values were applied to the group of liver-healthy children, only 6.4% were in the normal range. Prospectively, we analysed ELF scores in patients with possible or confirmed liver fibrosis because of autosomal recessive polycystic kidney disease (ARPKD). All ELF scores in children with ARPKD were within the reference intervals generated from the group of healthy children. The usual diagnostic cut-off ranges for the ELF score in adults are not applicable; instead age and gender-appropriate cut-off values should be used in children. The clinical value of ELF scores in children is questionable as children during pubertal growth showed elevated ELF scores and patients with ARPKD and liver fibrosis showed normal levels.

Normal Values and Associated Factors in High-resolution Anorectal Manometry in Healthy Vietnamese Adults

Abstract Introduction The present study aims to identify normal high-resolution anorectal manometry (HRAM) values and related factors in healthy Vietnamese adults. Methods The present cross-sectional study was conducted at the Viet Duc hospital, Hanoi, Vietnam, during April and May 2019. Healthy volunteers were recruited to participate in the study. Anorectal measurement values from the digestive tract, including pressure, were recorded. Results A total of 76 healthy volunteers were recruited. The mean functional anal canal length was 4.2 ± 0.5 cm, while the mean anal high-pressure zone length was 3.4 ± 0.5 cm. The mean defecation index was 1.4 ± 0.8, with values ranging from 0.3 to 5.0. The mean threshold volume to elicit the rectoanal inhibitory reflex (RAIR) was 18.1 mL. The mean rectal sensation values were 32.4 mL, 81.6 mL, and 159 mL for first sensation, desire to defecate, and urge to defecate, respectively. Dyssynergic patterns occurred in ∼ 50% of the study participants and included mainly types I (27.6%) and III (14.6%). There were significant differences between male and female patients in terms of maximum anal squeeze pressure, maximum anal cough pressure, maximum anal strain pressure, maximum rectal cough pressure, and maximum rectal strain pressure (all p &lt; 0.01). Conclusions The present study establishes normal HRAM values in healthy Vietnamese adults, particularly regarding normal values of anorectal pressure and rectal sensation. Further studies that include larger sample sizes should be conducted to further confirm the constants and their relationships.

Diffusion Tensor Imaging of the Median Nerve: A Systematic Review and Meta-Analysis of Normal Values in Asymptomatic Adults and How They Change in Carpal Tunnel Syndrome

Diffusion Tensor Imaging of the Median Nerve: A Systematic Review and Meta-Analysis of Normal Values in Asymptomatic Adults and How They Change in Carpal Tunnel Syndrome

Normative values of cardiac chamber dimensions and global longitudinal strain in Indians: the Indian Normative Data of Echocardiography Analyzed (INDEA) study.

Ethnic-specific normal reference ranges for various echocardiographic measurements are essential for accurate diagnostic interpretation and clinical decision-making. Unfortunately, such normative data for Indians is lacking. A total of 880 healthy volunteers (mean age 39.7 ± 12.3 years, 63.8% men) from six centers across different regions of India were enrolled in this study. Comprehensive transthoracic echocardiographic study was performed in all subjects, in accordance with the existing guideline recommendations. Cardiac chamber dimensions [Left ventricular (LV) end-diastolic diameter and volume; right ventricular (RV) basal diameter, left atrial volume] were obtained and indexed to body surface area. LV ejection fraction, LV global longitudinal strain (LVGLS) and measures of RV systolic function were also obtained. The subjects were divided into 3 age groups (35years or less, 36-55years and 56years or above) for analysis. Age- and gender-specific reference values for various clinically relevant echocardiographic parameters were derived. Compared with women, men had larger cardiac chamber dimensions and volumes, but not when indexed. In contrast, the women had higher LV systolic function, but right ventricular systolic function was not different. The indexed LV volumes in our study were much smaller than those recommended in the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) 2015 chamber quantification guidelines but were similar to those reported in the Indian patients included in the recent World Alliance Societies of Echocardiography (WASE) Normal Values Study. LVGLS was also comparable with the WASE data. INDEA study is the first, multi-centric study to provide normal echocardiographic references values for Indian adults. Our findings underscore the need to follow India-specific reference values, instead of those recommended by the ASE/EACVI, which are largely applicable to the western populations.

Effect of Bifidobacterium crudilactis and 3′-sialyllactose on the toddler microbiota using the SHIME® model

The important changes in diet during the first years of life strongly modulate the intestinal microbiota of young children. Among in vitro digestive models, the simulator of human intestinal microbial ecosystem (SHIME®) model, seems particularly adapted to study the effects of prebiotics and/or probiotics on the dynamic microbiota of toddlers.The main purpose of this study was to investigate different formulations with prebiotic (3′-sialyllactose: 3′SL) and probiotic (Bifidobacterium crudilactis FR/62/b/3) effects on young child microbiota using the SHIME® model. The ascending (AC), transverse (TC) and descending (DC) colons of the SHIME® model were inoculated with feces from 3 donors aged between 1 and 2 years, in three separate vessels. After two weeks of microbiota stabilization, four treatments of one week (prebiotic, probiotic, synbiotic and cell-free spent media from the synbiotic) were administered.In all the colon vessels, the short chain fatty acid analyses, determined using high-performance liquid chromatography highlighted a ratio acetate/propionate/butyrate proportion of 5:19:6, situated between infant and adult normal values. As already observed in other validated studies focusing on the SHIME® model, the 16S rDNA sequencing highlighted a low richness and diversity in the AC, while the microbial communities in the TC and the DC remained similar to each other. Although some bacteria involved in biofilm development have been identified (Stenotrophomonas, Megasphera and Enterobacter), specific bacterial populations, proper to each colon were developed. Some bacteria associated to the upper intestinal tract, such as Lactobacillus and Veillonella genera, seemed to grow easily in the AC. The quantitative polymerase chain reaction (qPCR) targeting the hsp60 gene confirmed the ability of bifidobacteria to survive in this toddler model. In addition, the synbiotic treatment tended to a bifidogenic effect (P < 0.1). On the other hand, the feces of the donors and the content of the three colon vessels were filtered and placed in contact with Escherichia coli O157:H7 ATCC 43890 to evaluate the modulation of virulence gene expression using reverse transcription PCR. Finally, filtered supernatants from donor feces significantly up-regulated the expression of the luxS gene of E. coli O157:H7 (P = 0.013).In conclusion, despite the presence of biofilms, the toddler SHIME® model used in his study shared characteristics found both in adults and infants. Although additional investigations should be performed, combining 3′SL and B. crudilactis FR/62/b/3 could lead to a beneficial effect on infant microbiota by favoring bifidobacterial presence. Finally, the filtrated supernatant from young child feces could be able to modulate the quorum sensing mechanism for E. coli O157:H7.

Left Ventricular Diastolic Function in Healthy Adult Individuals: Results of the World Alliance Societies of Echocardiography Normal Values Study

The World Alliance Societies of Echocardiography (WASE) study was conducted to describe echocardiographic normal values in adults and to compare races and nationalities using a uniform acquisition and measurement protocol. This report focuses on left ventricular (LV) diastolic function. WASE is an international, cross-sectional study. Participants were enrolled with equal distribution according to age and gender. Echocardiograms were analyzed in a core laboratory based on the latest American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Left ventricular diastolic function was assessed by E, E/A, e' velocities, E/e', left atrial volume index (LAVI), and tricuspid regurgitation velocity. Determination of LV diastolic function was made using the algorithm proposed by the guidelines. A total of 2,008 subjects from 15 countries were enrolled. The majority were of white or Asian race (42.8%, 41.8%, respectively). E and E/e' were higher in female patients, while LAVI was similar in both genders. Consistent increase in E/e' and decrease in E/A, E, and e' were found as age increased. The upper limit of normal for LAVI was higher in WASE compared with the guidelines. The lower limits of normal for e' were smaller in elder groups than those in the guidelines, while the upper limits of normal for E/e' were below the guideline values. These findings suggest that the cutoff value for LAVI should be shifted upward and age-specific cutoff values for e' should be considered. In WASE, <93.6% of patients were classified as normal LV diastolic function using the guidelines' algorithm, and the proportion increased to 97.4% when applying the revised cutoff values for LAVI obtained in our study. Guideline-recommended normal values for e' velocities and LAVI should be reconsidered. The algorithm for the determination of LV diastolic function proposed by the guidelines is useful, but adjustments to LAVI could further improve it.

Vitamin K Is Necessary for Newborns.

1. Alyssa Stachowiak, MD, IBCLC, FAAP* 2. Lydia Furman, MD, FAAP* 1. *University Hospitals Rainbow Babies and Children’s Hospital and Case Western Reserve University School of Medicine, Cleveland, OH Fat-soluble vitamin K is a critical part of the activation of coagulation factors II (prothrombin), VII, IX, and X. Compared with adults and older children, newborns have much lower levels of vitamin K: approximately 40% to 60% of normal adult values, which are not typically reached until approximately 6 months of age. This phenomenon is multifactorial, driven in part by low transplacental transfer of vitamin K, low levels of vitamin K excreted in human milk, and a physiologic delay in the acquisition of gut microflora that synthesize vitamin K, which is actually active in several forms. Vitamin K1, or phylloquinone, is present in green leafy vegetables and is the most common source of vitamin K for humans. Vitamin K2, or menaquinone, is synthesized by bacteria and is found in some animal and fermented products. Vitamin K was first discovered in 1929 by Henrik Dam, who observed hemorrhages in chicks fed fat-free diets. Edward Doisy identified the structure and forms of vitamin K in the 1940s, and both men received the Nobel Prize for their collective work on vitamin K in 1943. Because of its critical role in hemostasis, vitamin K deficiency can cause bleeding in the infant. Vitamin K deficiency bleeding (VKDB) was first described in the 1930s shortly after …