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Kawasaki disease (KD), the leading cause of acquired heart disease in children, primarily affects infants and toddlers. Investigations on immune responses during KD are hampered by a limited understanding of normal immune responses in these ages. It's well known that Infants have poorer vaccine responses and difficulty with maintaining prolonged serum immunity, but there are few studies on human infants detailing immune deficiencies. Limited studies propose an inability to maintain life-long bone marrow plasma cells. Plasmablasts are a transitional cell form of B cells that lead to long-term Plasma cells. Plasmablasts levels rise in the peripheral blood after exposure to a foreign antigen. In adult studies, these responses are both temporally and functionally well characterized. To date, there have been few studies on plasmablasts in the predominant age range of KD.Children presenting to an urban pediatric emergency room undergoing laboratory evaluation, who had concern of KD or had fever and symptoms overlapping those of KD, were recruited. Peripheral blood mononuclear cells were isolated and evaluated utilizing flow cytometry with specific B cell markers from 18 KD subjects and 69 febrile controls.Plasmablast numbers and temporal formation are similar between infectious disease controls and KD subjects. In both groups, infants have diminished plasmablast responses compared to older children.In this single-time point survey, infants have a blunted peripheral plasmablast response. Overall, similar plasmablast responses in KD and controls support an infectious disease relationship to KD. Future time-course studies of plasmablasts in infants are warranted as this phenomenon may contribute to observed immune responses in this age group

Psychosocial Characteristics and Gestational Weight Change among Overweight, African American Pregnant Women

Objectives. To describe psychosocial factors identified as contributors of weight gain in the general population and to examine the relationship between these factors and gestational weight gain among low socioeconomic status, African American, overweight pregnant women. Methods. African American women (n=120) with a pregravid body mass index ≥25 kg/m2 completed measures of eating, sleep, and depressed mood between 14 and 24 weeks of gestation. Weight was tracked. Descriptive statistics, correlations, and linear regression modeling were used to characterize the sample and examine predictors of gestational weight gain. Results. Four percent screened positive for night eating syndrome, with 32% consuming at least 25% of their daily caloric intake after dinner (evening hyperphagia). None met criteria for binge eating disorder; 4% reported occasional binge episodes. Cognitive restraint over eating was low. Participants slept 7.1 (SD=1.9) h per night and reported 4.3 (SD=3.6) awakenings per week; 18% reported some level of depressed mood. Night and binge eating were related to each other, sleep quality, and depressed mood. Eating due to cravings was the only psychosocial variable to predict gestational weight gain. Conclusions. Depressed mood, night eating, and nighttime awakenings were common in this cohort, while cognitive restraint over eating was low. Most psychosocial variables were not predictive of excess gestational weight gain

Commentary on Motor proficiency, strength, endurance, and physical activity among middle school children who are healthy, overweight, and obese

Commentary on Motor Proficiency, Strength, Endurance, and Physical Activity Among Middle School Children Who Are Healthy, Overweight, and Obese including How could I apply this information? and What should I be mindful about in applying this information

Outcome of an exercise and educational intervention for children who are overweight

Purpose: The purpose of this study was to investigate the outcome of an education- and exercise-based intervention for children who are overweight. Methods: Forty-one children with a mean age of 10.5 years participated in the study. The eight-week intervention, scheduled twice weekly, included education and exercise components. Outcome measures included body mass index (BMI), waist and hip girth, blood pressure (BP), resting heart rate (RHR), immediate postexercise heart rate (HRfinish), five-minute recovery heart rate (5minHR), and distance walked in six minutes. Using a repeated-measures design, data were collected twice prior to intervention to determine baseline and once upon completion of the intervention. Results: No significant difference existed between pretest I and II measures for each dependent variable, indicating a stable baseline. An intervention effect was established as evidenced by significant improvement in BMI, waist and hip girth, BP, RHR, HRfinish, and 5minHR at posttest. Conclusions: Children who are overweight and participate in an eight week exercise and educational program demonstrate improved morphology and physical conditioning. Copyright © 2005 Lippincott Williams & Wilkins, Inc. and Section on Pediatrics of the American Physical Therapy Association

Observational study of Interleukin-21 (IL-21) does not distinguish Kawasaki disease from other causes of fever in children

Abstract Background Kawasaki disease (KD) is a febrile childhood vasculitis of unknown etiology. The diagnosis is highly concerning as over a quarter of children who fail to receive timely treatment with intravenous immunoglobulin (IVIG) will develop coronary aneurysms. Diagnosis relies on proper symptomatology and is supported by non-specific markers of inflammation. Previous studies have identified elevated plasma levels of interleukin-21 (IL-21) as a sensitive and specific biomarker in KD. The aim of this study is to assess the validity of IL-21 as a diagnostic biomarker for KD in febrile children in North America. Methods Plasma samples were collected from children who presented to an urban Emergency Department in North America. IL-21 levels were measured using commercial ELISA kits in 12 KD versus 60 controls subjects. Results Our study shows that IL-21 levels were non-specifically elevated across all febrile children, irrespective of KD diagnosis. Length of fever prior to sample collection does not correlate with IL-21 levels. Other inflammatory markers and laboratory values were also compared to IL-21 and show no significant correlation. Conclusions Since IL-21 is elevated non-specifically in this cohort, our data supports that IL-21 is not an appropriate biomarker for diagnosis of KD in North American pediatric populations

Plasmablast comparison between different clinical diagnoses.

<p>Plasmablast levels, as a percentage of overall B cell number, were compared between children with KD (star), prolonged fever (closed circle), and all controls (open circles). Mean values are marked by horizontal dash. Data is shown on a logarithmic scale to improve separation of individual points. Five subsets of all controls that qualified as specific diagnoses are shown (Adenovirus, Influenza, Hand-foot-and-mouth (HFM), Skin and Soft tissue infections (SSTI), and Group A streptococcal pharyngitis (GAS)) and also listed in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0193539#pone.0193539.t001" target="_blank">Table 1</a>.</p

Flow cytometry isolation of plasmablasts.

<p>A single example of the flow gating and analysis is shown. After selecting for single cell events, lymphocyte gate was constructed inclusive of blasting cells, which are enriched for plasmablasts. CD14+ and CD3+ cells were excluded. CD19+/CD20low cells that were dual positive for CD27 and CD38 were defined as plasmablasts.</p

Plasmablast level and temporal pattern relative to age of subject.

<p>A) In KD children, Linear regression (small dashed line) shows relationship of older children to higher plasmablast levels. B) Mean values for plasmablast percentage of B cells by day of fever for those 24 months and under (long dashed line) compared to subjects over 24 months of age (solid line).</p