Diagnostic Accuracy of S100B Urinary Testing at Birth in Full-Term Asphyxiated Newborns to Predict Neonatal Death

BACKGROUND: Neonatal death in full-term infants who suffer from perinatal asphyxia (PA) is a major subject of investigation, since few tools exist to predict patients at risk of ominous outcome. We studied the possibility that urine S100B measurement may identify which PA-affected infants are at risk of early postnatal death. METHODOLOGY/PRINCIPAL FINDINGS: In a cross-sectional study between January 1, 2001 and December 1, 2006 we measured S100B protein in urine collected from term infants (n = 132), 60 of whom suffered PA. According to their outcome at 7 days, infants with PA were subsequently classified either as asphyxiated infants complicated by hypoxic ischemic encephalopathy with no ominous outcome (HIE Group; n = 48), or as newborns who died within the first post-natal week (Ominous Outcome Group; n = 12). Routine laboratory variables, cerebral ultrasound, neurological patterns and urine concentrations of S100B protein were determined at first urination and after 24, 48 and 96 hours. The severity of illness in the first 24 hours after birth was measured using the Score for Neonatal Acute Physiology-Perinatal Extension (SNAP-PE). Urine S100B levels were higher from the first urination in the ominous outcome group than in healthy or HIE Groups (p<0.001 for all), and progressively increased. Multiple logistic regression analysis showed a significant correlation between S100B concentrations and the occurrence of neonatal death. At a cut-off >1.0 microg/L S100B had a sensitivity/specificity of 100% for predicting neonatal death. CONCLUSIONS/SIGNIFICANCE: Increased S100B protein urine levels in term newborns suffering PA seem to suggest a higher risk of neonatal death for these infants

Evaluating diagnostic accuracy of anti-tissue Transglutaminase IgA antibodies as first screening for Celiac Disease in very young children

Background: Small bowel biopsy is the gold standard for Celiac Disease (CD) diagnosis, nevertheless serum assays are the first step in ascertaining a diagnosis of CD. New ESPGHAN Criteria 2012 (European Society of Pediatric Gastroenterology Hepatology and Nutrition) suggest using exclusively anti-tissue Transglutaminase IgA antibodies (anti-tTGA) as initial approach to symptomatic subjects. The aim of our study was to evaluate the diagnostic accuracy of anti-tTGA as initial screening assay for CD in a large cohort of pediatric patients. Methods: We selected 730 subjects aged between 6. months and 4. years ("Group A") and 348 subjects younger than 2. years (which are part of the 730 subjects) ("Group B"). We performed anti-Deamidated Gliadin Peptides IgA and IgG antibodies (a-DGP IgA/IgG) and anti-tTGA assays by ELISA test. We evaluated the agreement between anti-tTGA and a-DGP IgA/IgG assays and compared the diagnostic accuracy of a-DGP IgA/IgG with that of anti-tTGA in both groups of patients. Results: There was a substantial agreement between anti-tTGA and a-DGP IgA in "Group A" and an almost perfect agreement in "Group B" the strength of agreement between anti-tTGA and a-DGP IgG was moderate in "Group A" and substantial in "Group B".anti-tTGA were more sensitive and specific than a-DGP IgA/IgG in both groups. Conclusions: anti-tTGA could be used as initial screening assay for CD in all subjects from 6. months of age according to ESPGHAN Criteria 201

Dosaggio del mercurio nel liquido amniotico umano

Obiettivo. L'amalgama d'Ag contiene, tra i suoi componenti, il mercurio che, con i suoi derivati organici, è in grado di passare in organi e fluidi biologici. Un aspetto di questo passaggio, che desta preoccupazione e interesse, è la possibilità che possa, superando la barriera placentare, raggiungere il feto. Scopo del lavoro è la valutazione delle concentrazioni del mercurio totale nel liquido amniotico umano e confrontarle con il numero e l'estensione occlusale delle otturazioni di amalgama d'Ag. Metodi. Sono state selezionate 56 donne gravide destinate all'amniocentesi. Ogni paziente è stata sottoposta a visita odontostomatologica per individuare numero ed estensione delle otturazioni in amalgama. Nel liquido amniotico le concentrazioni di mercurio sono state determinate con lo spettrofotometro ad assorbimento atomico e tecnica FIAS-amalgama. Risultati. Le concentrazioni del mercurio nei campioni esaminati variavano da un minimo di 0,00 ng/ml ad un massimo di 2,55 ng/ml, valore medio di 0,44±0,53 ng/ml. Le correlazioni tra le variabili esaminate sono state valutate calcolando il valore del coefficiente di regressione lineare. Nessuna relazione diretta è stata trovata con la concentrazione del mercurio. I valori ottenuti sono stati inseriti anche per la costruzione di un modello di regressione logistica che ha evidenziato un valore statistico poco significativo (p=0,05) tra il numero delle otturazioni e le quantità di mercurio, mentre l'estensione occlusale dei restauri è risultata essere in rapporto significativo (p ¾0,05) con le concentrazioni del metallo. Conclusioni. Gli Autori consigliano grande cautela nell'uso dell'amalgama d'argento in corso di gravidanza.</br

Point-shear wave elastography predicts liver hypertrophy after portal vein embolization and postoperative liver failure.

To correlate point-shear wave elastography (SWE) with liver hypertrophy after right portal vein embolization (RPVE) and to determine its usefulness in predicting postoperative liver failure in patients undergoing partial liver resection. Point-SWE was performed the day before RPVE in 56 patients (41 men) with a median age of 66 years. The percentage (%) of future remnant liver (FRL) volume increase was defined as: %FRL &lt;sub&gt;post&lt;/sub&gt; -%FRL &lt;sub&gt;pre&lt;/sub&gt; %FRL &lt;sub&gt;pre&lt;/sub&gt; ×100 and assessed on computed tomography performed 4 weeks after RPVE. Median (range) %FRL &lt;sub&gt;pre&lt;/sub&gt; and %FRL &lt;sub&gt;post&lt;/sub&gt; was respectively, 31.5% (12-48%) and 41% (23-61%) (P&lt;0.001), with a median %FRL volume increase of 25.6% (-8; 123%). SWE correlated with %FRL volume increase (P=-0.510; P&lt;0.001). SWV (P=0.003) and %FRL &lt;sub&gt;pre&lt;/sub&gt; (P&lt;0.001) were associated with %FRL volume increase at multivariate regression analysis. Forty-three patients (77%) were operated. Postoperative liver failure occurred in 14 patients (32.5%). Median SWE was different between the group with (1.68m/s) and without liver failure (1.07m/s) (P=0.018). The AUROC of SWE predicting liver failure was 0.724 with a best cut-off of 1.31m/s, corresponding to a sensitivity of 21%, specificity of 96%, positive predictive value 75% and negative predictive value of 72%. SWE was the single independent preoperative variable associated with liver failure. SWE assessed by point-SWE is a simple and useful tool to predict the FRL volume increase and postoperative liver failure in a population of patients with liver tumor