Klotho and fibroblast growth factors 19 and 21 serum concentrations in children and adolescents with normal body weight and obesity and their associations with metabolic parameters.

BACKGROUND: Fibroblast growth factor 19 (FGF19), fibroblast growth factor 21 (FGF21) and Klotho are regulators of energy homeostasis. However, in the pediatric population, the relationships between obesity, metabolic disorders and the aforementioned factors have not been clearly investigated. We analyzed the role of FGF19, FGF21 and Klotho protein in children with normal body weight as well as in overweight and obese subjects and explored their associations with insulin resistance (IR) and metabolic syndrome (MS) and its components. METHODS: This was a cross-sectional study conducted in a group of hospitalized children and adolescents. Laboratory investigations included serum analysis of FGF19, FGF21, and Klotho with ELISA kits as well as the analysis of the lipid profile and ALT serum concentrations. Moreover, each subject underwent an oral glucose tolerance test (OGTT) with fasting insulinemia measurement to detect glucose tolerance abnormalities and calculate the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index. Furthermore, the clinical analysis included blood pressure measurement, body fat percentage estimation and assessment of the prevalence of MS and its components. RESULTS: The study was conducted with 174 children/adolescents aged 6-17 years with normal body weight (N = 48), obesity (N = 92) and overweight (N = 34). Klotho concentration was significantly higher in the obese children [median 168.6 pg/ml (90.2 to 375.9)]) than in the overweight [131.3 pg/ml (78.0 to 313.0)] and normal-body-weight subjects [116.6 pg/ml (38.5 to 163.9)] (p = 0.0334) and was also significantly higher in insulin-resistant children than in insulin-sensitive children [185.3 pg/ml (102.1 to 398.2) vs 132.6 pg/ml (63.9 to 275.6), p = 0.0283]. FGF21 was elevated in patients with MS compared to the FGF21 levels in other subjects [136.2 pg/ml (86.5 to 239.9) vs 82.6 pg/ml (41.8 to 152.4), p = 0.0286]. The multivariable model showed that FGF19 was an independent predictor of IR after adjusting for pubertal stage and BMI Z-score. CONCLUSIONS: Klotho levels were associated with body weight status in children and adolescents. Moreover, Klotho, FGF19 and FGF21 concentrations correlated with IR status and/or components of MS.

[Thyroid dysfunctions in children with chronic hepatitis C during interferon alpha-2b therapy]. / Zaburzenia czynnosci tarczycy u dzieci z przewleklym zapaleniem watroby typu C leczonych interferonem alfa-2b.

Thyroid dysfunctions are the most frequently described extrahepatic syndromes which complicate HCV infection. Application of interferon in the treatment of chronic hepatitis C increases the frequency their occurrence. The aim of this study was analysis of the frequency of thyroid dysfunctions in children with chronic hepatitis C treated with recombined and pegylated interferon alpha-2b. The study was comprised of 50 children (19 girls, 31 boys) aged from 4 years to 18 years (average 14 years and 6 months) with chronic hepatitis C. Thirty children were treated with recombined interferon alpha-2b and ribavirin, while twenty children received the pegylated interferon alpha-2b and ribavirin. In all children the concentration of thyroid hormones: TSH, fT3 and fT4; as well as the concentration of thyroid antibodies: anty-TG and anty-TPO were examined before beginning of treatment and immediately on its completion. The control group was comprised of 25 children (13 girls, 12 boys) aged from 5 years to 18 years (average 13 years and 6 months) with no observed diseases of liver or thyroid gland. The conducted examinations did not reveal any significant difference in frequency of abnormal concentration occurrence of TSH and fT4 in children with chronic hepatitis C in relation to the control group (respectively: 34% and 20%). However, an abnormal concentration of fT3 was more frequently observed in children infected with HCV, but the average values of this hormone concentration did not significantly differ in both analysed groups of children (respectively: 3.8112 pg/ml and 3.8012 pg/ml). The combined treatment of interferon alpha and ribavirin did not influence more frequent occurrences of abnormal thyroid hormone concentrations, in comparison to their values before treatment. Clinical symptoms of thyroid dysfunction did not accompany the incorrect concentrations of thyroid hormones. Before the treatment, incresed concentration of antithyroid antibodies was observed in a similar percentage of the HCV infected children, as of the healthy children (respectively: 8 and 12%). However, in the group treated with ribavirin and interferon alpha, and especially its pegylated form, the increased concentration of antithyroid antibodies was frequently observed (32% children). The abnormal values of antithyroid antibodies appeared more frequently in girls (10/16). The conducted examinations showed frequent appearance of abnormal values of thyroid hormones and antithyroid antibodies, which indicates the necessity of a systematic control of thyroid gland function in children with chronic hepatitis C treated with interferonem alpha.

[Acute disseminated encephalomyelitis in children as the result of aseptic meningitis - a report of two cases]. / Ostre rozsiane zapalenie mózgu i rdzenia kregowego u dzieci jako nastepstwo jalowego zapalenia opon mózgowo-rdzeniowych - opis dwóch przypadków.

Acute disseminated encephalomyelitis (ADEM) is an inflammation of the spinal cord and brain. Diagnosis of ADEM, due to its rare occurrence and lack of definite laboratory indices, is difficult and is never totally certain. The clinical criterion required for the diagnosis is presence of acute symptoms from the brain and/or spine with fever, occurring after viral or bacterial infection, vaccination or serum administration. Differentiation between ADEM and acute multiple sclerosis in children is difficult, and diagnosis of ADEM may only be confirmed after years of observation, especially as multiple sclerosis is more common than ADEM. The most useful tool in differentiation between the two diseases is MRI. The aim of the study was to present two cases of ADEM with unknown aetiology after aseptic meningitis in children.

[Role of the PD-1/PD-L1 pathway in immunopathology of HBV infection as the chance on the new therapeutic strategy]. / Rola szlaku PD-1/PD-L1 w immunopatogenezie zakazenia HBV jako szansa na nowa strategie terapeutyczna.

Many individuals infected with HBV become chronic carriers and they liver disease may progress to cirrhosis and HCC. The newest data suggests that the interaction between positive and negative costimulatory molecules expressed on T cells are performing the role in the regulation ofT cells immune response. In the last years they were described programmed death-1 (PD-1) [CD279] and programmed death-ligand 1 (PD-L1) [CD274] in immunopathology of HBV infections. In acute exacerbation of hepatitis B, high level of PD-1 expression significantly mediated CD8+T cells apoptosis and protecting before damaging the liver. In the period of recovering, activation of the PD-1/PD-L 1 pathway should dynamically decrease, and if it isn't taking place, increased expression of the PD-1 plays a crucial role in inhibiting the function of virus-specific CD4+ and CD8+ T cells in chronic viral infections. The aim of this article was to explore the potential role of (PD-1/PD-L) pathway in antiviral immunity during HBV infection. Blockade of PD-1/PD-L1 pathway may open a novel therapeutic strategy for restoring the function of the exhausted CD8+ T cells, and enhancing viral control during chronic viral infections.

[Mumps--effect of immunizations on epidemiological situation]. / Swinka--wplyw szczepien na sytuacje epidemiologiczna.

In 2004, 57% of States included mumps vaccine in their routine national immunization programmers. Nevertheless WHO reported then global increase of mumps cases--654 216 in 2004 compared to 334 064 cases in 2003. Cases registered in Europe accounted for 38% of general accidents. In Poland, since 2004 above 90% of population suffered from mumps since 19 years old. After 2006, after introduction second mumps vaccine dose for children at age 10 years in polish routine national immunization program, particularly will be exposure to risk of mumps infection and mumps complications unvaccinated and seronegatived aged in 1985-1995.