Objectives: To define clinically relevant reference ("normal") values for cerebrospinal fluid (CSF) protein concentrations in pediatric patients who were evaluated for meningitis by traditional criteria and by enteroviruspolymerase chain reaction (EV-PCR). Design and Patients:A cohort of 906 consecutive pediatric patients to receive CSF analysis at St Louis Children's Hospital, St Louis, Mo, from June 1, 1998, to December 31,1998, was studied for clinical and laboratory data. Age-dependent CSF protein concentrations were then derived from a reference group of 225 patients in whom meningitis and other neurologic diseases were excluded by traditional clinical or laboratory criteria (excluding EV-PCR). Available CSF samples from 132 patients of the reference group were subsequently tested for EV-PCR.Results: In the reference group, the CSF protein concentration was highest and most variable in neonates, with a maximum of approximately 1.0 g/L. Cerebrospinal fluid protein concentration decreased rapidly to a nadir by 6 months and remained low throughout childhood, rarely exceeding 0.3 g/L and, finally, increasing in adolescence toward adult values. Enteroviruspolymerase chain reaction was positive in CSF of 11% of the reference group, with EV-PCR-positive patients having significantly higher CSF protein concentrations than EV-PCR-negative patients aged between 4 months and 14 years. Conclusions:Reference values for CSF protein exhibit a characteristic age dependence in pediatric patients. Continued standard use of adult reference values in the pediatric population is inappropriate. The unexpected finding of a positive EV-PCR in patients not diagnosed with meningitis by traditional criteria further emphasizes the importance of selecting the most clinically relevant reference group for age and other variables when defining normal laboratory values.

Context: Of the 3 branched-chain amino acids (BCAA), leucine has arguably received the most attribution for the role of BCAA supplementation in alleviating symptoms of exercise-induced muscle damage and facilitation of acute performance recovery. Purpose: To examine whether enrichment of a standard BCAA supplement with additional leucine or a standalone leucine (LEU) supplement differentially affects exercise-induced muscle damage and performance recovery compared with a standard BCAA supplement. Methods: A total of 22 recreationally active male and female subjects were recruited and assigned to consume a BCAA, leucine-enriched BCAA (LBCAA), or LEU supplement for 11 d. On the eighth day, subjects performed eccentric-based resistance exercise (ECRE). Lower-body mean average and peak power, plasma creatine kinase, soreness, and pain threshold were measured before and 24, 48, and 72 h after ECRE. Results: LEU showed decreased mean average power (P = .02) and mean peak power (P = .01) from baseline to 48 h post-ECRE, whereas LBCAA and BCAA only trended toward a reduction at 24 hours post-ECRE. At 48 h post-ECRE, BCAA showed greater recovery of mean peak power than LEU (P = .04). At 24 h post-ECRE, LEU demonstrated a greater increase in plasma creatine kinase from baseline than BCAA (P = .04). Area under the curve for creatine kinase was greater in LEU than BCAA (P = .02), whereas BCAA and LBCAA did not differ. Only LEU demonstrated increased soreness during rest and under muscular tension at 24 and 48 h post-ECRE (P < .05). Conclusions: LBCAA failed to afford any advantages over a standard BCAA supplement for postexercise muscle recovery, whereas a LEU supplement was comparatively ineffective.

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The effects of a multi-ingredient performance supplement (MIPS) incorporating a mixture of branched chain amino acids, beta-alanine, glutamine, creatine, and piperine on resistance training (RT)-induced adaptations remains unclear. Therefore, the purpose of this study was to investigate the effects of this investigational MIPS during six weeks of RT on performance and body composition. Thirty recreationally trained males and females were recruited for this pair-matched, double-blind, placebo-controlled investigation. Subjects were assigned to consume either an experimental MIPS (MIPS) (n = 15) or a placebo (PLA) (n = 15) concurrently with a six-week periodized RT program. Body composition, one-repetition maximum (1RM), and muscular power were assessed at pre- and post-training. Weekly relative volume load was compared between groups. The MIPS and PLA groups demonstrated a significant increase in total body mass (MIPS = +2.9 ± 1.3%; PLA = +2.5 ± 1.7%) and lean mass (MIPS = +5.0 ± 2.1%; PLA = +3.1 ± 1.9%) (p < 0.001) with no changes in fat mass. There were no group × time interactions for any of the body composition measures. Both groups demonstrated similar improvements in maximum strength for the back squat, bench press, and deadlift as well as lower body power from pre- to post-training (p < 0.001). Within the limitations of the current investigation, results failed to demonstrate the benefits of the experimental MIPS for muscular strength and body composition across six weeks of RT compared to PLA.

Background: The purpose of this study was to investigate the effects of 30-day consumption of trans-resveratrol and polyphenol-enriched extracts on indices of exercise-induced muscle damage (EIMD) and performance following eccentric-loaded resistance exercise (ECRE). Methods: Following 30 days of resveratrol-polyphenol (RES) (n = 10) or placebo control (CTL) (n = 12) supplementation, subjects performed a bout of ECRE to induce EIMD. EIMD biomarkers, perceived soreness, pain threshold and tolerance, range of motion, and performance were measured before and 24 and 48 h after ECRE. Results: CTL subjects demonstrated increased soreness at 24 (p = 0.02) and 48 h (p = 0.03) post-ECRE, while RES subjects reported increased soreness at 24 h post-ECRE (p = 0.0003). CTL subjects exhibited decreased pain threshold in the vastus lateralis at 24 h post-ECRE (p = 0.03). CTL subjects also displayed decreased pain tolerance in the vastus intermedius at 24 h post-ECRE (p = 0.03) and the vastus lateralis at 24 (p = 0.003) and 48 h (p = 0.003). RES participants showed no change in pain threshold or tolerance from baseline. CTL subjects showed a decrease in mean (p = 0.04) and peak power (p = 0.04) at 24 h post-ECRE, while RES participants demonstrated no changes from baseline. No between-group differences were observed for the changes in serum creatine kinase. Serum C-reactive protein increased similarly in both groups at 24 h post-ECRE (p < 0.002), remaining elevated in CTL subjects while RES participants demonstrated a decline from 24 to 48 h (p = 0.04). Serum interleukin 6 increased at 24 h post-ECRE in both groups (p < 0.003) followed by a decrease from 24 to 48 h, returning to baseline levels only for RES subjects. Conclusion: Trans-resveratrol and polyphenol-enriched extract supplementation may support the attenuation of soreness and inflammation and improve performance recovery following ECRE without modulation of indirect biomarkers of EIMD.