Bicycle spiroergometry: comparison of standardized examination protocols for adolescents: is it necessary to define own standard values for each protocol?

PURPOSE: To compare performance data of adolescents collected with five different bicycle spiroergometry protocols and to assess the necessity for establishing standard values for each protocol. METHODS: One-hundred-twenty adolescents completed two bicycle spiroergometries within 14 days. One of the two tests was performed based on our institutional weight-adapted protocol (P0). The other test was performed based on one out of four exercise protocols widely used for children and adolescents (P1, 2, 3 or 4) with 30 persons each. The two tests were performed in a random order. Routine parameters of cardiopulmonary exercise tests (CPET) such as VO2peak, maximum power, O2 pulse, OUES, VE/VCO2 slope as well as ventilatory and lactate thresholds were investigated. Agreement between protocols was evaluated by Bland-Altman analysis, coefficients of variation (CV) and intra-class correlation coefficients (ICC). RESULTS: None of the CPET parameters were significantly different between P0 and P1, 2, 3 or 4. For most of the parameters, low biases between P0 and P1-P4 were found and 95% confidence intervalls were narrow. CV and ICC values largely corresponded to well-defined analytical goals (CV < 10% and ICC > 0.9). Only maximal power (Pmax) showed differences in size and drift of the bias depending on the length of the step duration of the protocols. CONCLUSION: Comparability between examination protocols has been shown for CPET parameters independent on step duration. Protocol-dependent standard values do not appear to be necessary. Only Pmax is dependent on the step duration, but in most cases, this has no significant influence on the fitness assessment.

C-reactive protein (CRP) as tumor marker in pediatric and adolescent patients with Hodgkin disease.

BACKGROUND: C-reactive protein (CRP) is an acute phase protein produced in the liver. An elevated CRP is a nonspecific marker of inflammation. Additionally, it also appears to be a prognostic marker in several malignancies. Elevated CRP levels in adult patients with Hodgkin disease (HD) were reported previously. However, levels of CRP have not been evaluated in pediatric and adolescent HD patients. PROCEDURE: We analyzed CRP serum levels in 95 consecutive pediatric and adolescent patients with Hodgkin disease. CRP levels were correlated with stage, absence or presence of B symptoms, and prognosis. RESULTS: At the time of diagnosis increased serum CRP levels were found in 64 % (61/95) of the patients with a median of 21 mg/L (range: <5-211). Serum C-reactive protein levels correlated with stage and were higher in patients with B symptoms. Higher CRP levels were associated with an increased risk of relapse. CONCLUSION: In addition to soluble interleukin 2 receptor (sIL-2R) levels, CRP holds promise as a diagnostic and prognostic index and follow-up monitor in pediatric and adolescent patients with Hodgkin disease, and merits further investigation.