Trefoil factor 2 expression and its significance as a predictor of severity of sepsis in children

Intestinal injury significantly contributes to critical illness, sepsis and multiorgan failure. TFF2 (Trefoil Factor 2) is expressed and secreted preferentially by gastric mucous neck cells. TFF2 gene expression is promptly increased after gut injury, and its expression profile broadens to include the regenerative epithelia of virtually the entire gastrointestinal tract. The first objective of our study was an analysis of TFF2 levels dynamics in patients with Systemic Inflammatory Response Syndrome (SIRS) or septic condition during a 5-day period after admission. The second objective was to determine optimal cut-off value and quantify diagnostic characteristics of TFF2 between controls and patients with various septic states. The study included 57 children aged 0-19 years, with expected or proven SIRS and septic condition. The degree of severity was evaluated according to PELOD Score (Pediatric Logistic Organ Dysfunction). Blood samples to determine levels of TFF2 factor were taken during the time patient met the criteria of SIRS or sepsis. Control group samples to determine the serum levels of TFF2 were taken from patients undergoing elective surgery. Analysis of TFF2 levels dynamics revealed that TFF2 levels kept steady state during the 5-day period. Significantly higher levels of TFF2 were in patients with Multiple Organ Dysfunction Syndrome (MODS). The difference was noticed also in ROC analysis.

Hyperphosphorylated neurofilament NF-H as a predictor of mortality after brain injury in children

OBJECTIVE

The aim of the study was to determine whether serum levels of hyperphosphorylated neurofilament NF-H correlate with severity of brain injury in children.

METHODS

Forty-nine patients with traumatic brain injury (TBI) were enrolled into the prospective study. Venous blood samples were taken after admission and every 24 h for a maximum of 6 consecutive days. Serum NF-H concentrations were quantified by enzyme-linked immunosorbent assay. The outcome was evaluated 6 months after TBI using Glasgow Outcome Scale (GOS) in all patients.

RESULTS

The quantitative level of pNF-H remained significantly higher in patients with poor outcome (GOS = 1) in comparison with the other patients for the 2nd-4th day (p = 0.027; p = 0.019; p = 0.01). Levels of pNF-H were significantly higher in patients with diffuse axonal injury on initial CT scan (p = 0.004). Normal levels pNF-H in the paediatric population are unknown. Objective ROC analysis was identification of optimal cut-offs of proteins for prediction of GOS = 1.

CONCLUSIONS

Although further, prospective study is warranted, these findings suggest that levels of hyperphosphorylated neurofilament NF-H correlate with mortality and may be useful as predictors of outcome in children with TBI.

Quantitative ultrasound and densitometric measurements and laboratory variables in patients on long-term acenocoumarol therapy

The aim of the study was to establish whether chronic use of acenocomarol affects bone metabolism. Eighty-two males [41 treated with acenocumarol (mean therapy duration of 6.0+/-6.4 years) and 41 age-matched controls] were studied. Skeletal assessment included densitometric measurements at ultradistal forearm and calcaneus and ultrasound examination of hand phalanges and laboratory measurements included serum total calcium, phosphates, bone alkaline phosphatase (bAlp) and C-terminal telo peptide of type I collagen (ICTP). Densitometric and ultrasound variables did not differ significantly between patients and controls. Mean dose and duration of acenocumarol treatment did not affect skeletal and laboratory variables. Bone turnover was depressed, and bAlp and telopeptide were significantly lower in patients than in controls (10.0+/-7 vs. 23.0+/14 U/l, p<0.05, and 1.6+/-1.3 vs. 3.1+/-1.3 microg/l, respectively). In conclusion, despite of the lack of changes in skeletal status, male subjects on long-term acenocumarol therapy may be at high risk for fracture due to disturbances in bone turnover.