Background and aims The PI3K pathway is frequently activated during tumourigenesis through deletion of the tumour suppressor PTEN. In contrast, increased PTEN expression in adipose tissue results in an increase in UCP1 expression and provides metabolic protection from tumourigenesis. This intrinsic protection normally arises from interscapular brown adipose tissue (iBAT) but may also arise from 'beiging' of inguinal white adipose tissue (iWAT). The aim of this study was to see if an association existed between UCP1 expression in adipose tissue and paediatric brain tumour growth through elevated PTEN levels. Methods Two types of medulloblastoma (WNT and group 4) and ependymoma tumour cells were orthotopically xenografted into mice. iBAT and iWAT samples were extracted from tumour and non-tumour bearing mice to examine UCP1 and PTEN expression through QRT-PCR and Western blotting. Haematoxylin and eosin staining and UCP1 antibody immunohistochemistry (IHC) was also used to determine BAT activity in adipose tissue. Thermogenic activity of the adipose tissue was indirectly measured by thermal imaging of mice. Results iWAT from ependymoma tumour-bearing mice had evidence of beiging and increased UCP1 expression through histology and IHC, while UCP1 expression in iBAT remained high in all mice. An increase in UCP1 gene expression and thermogenesis was observed with spinal metastasis. PTEN expression did not relate to UCP1 expression. Conclusion Our data indicated mice implanted with aggressive tumours had increased UCP1 expression in iWAT. In conclusion, this pilot study suggests rapidly growing and metastatic brain tumours stimulate metabolic protection via an increase UCP1 expression in iWAT. Background and aims To evaluate the diagnostic usefulness of biomarkers in the management of children with fever at risk of serious bacterial infections (SBI) at the emergency department (ED). Paediatric Emergency Medicine IIMethods In this prospective observational study previously healthy children with fever, aged 1 month to 16 years, attending the EDs of a university hospital and a teaching hospital (Rotterdam, the Netherlands) between 2009 and 2012 were included. Standardised information on clinical signs and symptoms, Creactive protein (CRP), procalcitonin (PCT), neutrophil CD64 expression and urinalysis were collected prospectively. Logistic multivariable regression analysis was used to assess diagnostic performance.Results 1,084 children were included, median age was 1.6 years (interquartile range: 0.8-3.5), 170 children (16%) had SBI. CRP (receiver operating characteristic curve (ROC-area) 0.77 (95% confidence interval (CI) 0.69-0.85)) and PCT (ROC-area 0.75 (95% CI 0.67-0.83)) were both strong predictors of SBI. CD64 lacked diagnostic strength (ROC-area 0.62 (95% CI 0.54-0.70)). A score containing PCT and CRP together with urinalysis, the Lab-score, performed well (ROC-area 0.79 (95% CI 0.72-0.87)), but thresholds performed similar to often used cut-offs of single biomarkers. Combined with clinical signs and symptoms b...
Background Otitis media (OM) is a common problem for primary care, pediatricians and otorhinolaryngologists. The Aim of our work is to analyze the evolution of OM in children of the first 7 years of life after respiratory tract (RT) pathology. Subjects Children from 1 to 7 years of life (2785) without evident OM after standard treatment of RT pathology -bronchitis, pneumonia; RT infection-prone children; chronic nasal breathing difficulties. Healthy children of the same age were included in the control group. Outcome measures Screening tympanometry, otoscopy; audiology assessment and otomicroscopy for children who failed the screening tests, paranasal sinuses evaluation, otological follow up for children with middle ear pathology during 2 years. Results We diagnosed OM in 68% of cases from RT pathology group and in 6% of cases from control group (p less than 0.001). Acute middle ear effusion was presented in 53%, chronic OM with effusion in 38%, recurrent OM in 9%. Chronic and recurrent OM was related with RT infection-prone children (p less than 0.01), age younger than 5 years of life (p less than 0.01) and sinusitis (p less than 0.01). Adhesive and chronic OM was recorded during otomicroscopy and surgery in 12% of cases. Conclusions Screening for OM is important for children with recurrent and chronic RT pathology. These groups of patients need comprehensive diagnostic management and intensive treatment, including surgical one. In healthy children OM is a relative rare and temporary condition.
Objective To determine the agreement between peripheral and central capillary refill time (pCRT/cCRT) and their diagnostic value for the detection of serious bacterial infection (SBI) in febrile children presenting to the paediatric emergency department (ED). Methodology A prospective observational study at the Paediatric ED, Erasmus MC-Sophia Children’s hospital, the Netherlands. We included 1193 previously healthy febrile children (1 month-15 years) with data on both pCRT- and cCRT-measurements available, as recorded in categories (normal <2 s., prolonged 2–4 s. and severely prolonged >4 s.) by triage nursing staff. Main outcome measures were agreement between pCRT and cCRT (determined by weighted kappa), diagnostic odds ratio (DOR) and area under the receiver-operating characteristic curve (AUC) for the detection of SBI. Results Abnormal pCRT was observed in 153 (12,8%) and abnormal cCRT in 55 (4,6%) children. Overall agreement was 0,343 (considered as ‘fair’). Agreement stratified for age was lower (0,143) in the group of 1–5 years of age. Stratified for body-temperature, agreement showed a declining trend ranging from 0,509 (temperature <37,5°C) to 0,201 (temperature >39,5°C). The DOR of abnormal pCRT (>2 s.) for SBI was 1.10 (95% CI:0,65–1,84), with an AUC of 0,505 (95% CI:0,454–0,557). For abnormal cCRT (>2 s), the DOR was 0,43 (95% CI:0,13–1,39) with an AUC of 0,514 (95% CI:0,464–0,564). Presence of both abnormal pCRT and cCRT did not improve diagnostic performance. Conclusions pCRT and cCRT showed fair agreement in febrile children at the ED which was reduced particularly in children with high temperature and age 1–5 years. Both abnormal pCRT and cCRT showed low diagnostic value for the detection of SBI.
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