Uric acid,impaired fasting glucose and impaired glucose tolerance in youth with overweight and obesity

Background and aimThe relationships between uric acid (UA) and prediabetes is poorly explored in youth. We investigated the association between UA, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), insulin resistance (IR) and low insulin sensitivity (IS) in youth with overweight/obesity (OW/OB).Methods and resultsA cross-sectional study was performed in 2248 youths with OW/OB (age 5–17 years). The sample was stratified in sex-specific quintiles (Q1 to Q5) of UA and the associations with fasting (FG), 2-h post-load glucose (2H-PG), IR and low IS were investigated. IR and low IS were estimated by assessment model of insulin resistance (HOMA-IR) and whole-body IS index (WBISI), respectively. IFG was defined as FG ≥ 100 < 126 mg/dL, IGT as 2H-PG ≥140 < 200 mg/dL, IR as HOMA-IR ≥75th percentile and low IS as WBISI ≤25th percentile by sex. Age, body mass index z-score, 2H-PG, HOMA-IR and WBISI, increased across sex-quintiles of UA while FG did not. The prevalence of IFG and IR were significantly increased in Q5 vs Q1 (reference quartile, P < 0.025). The prevalence of IGT increased from Q3 to Q5 vs Q1 (P < 0.025–0.0001) and that of low IS from Q2 to Q5 vs Q1 (P < 0.005–0.0001).ConclusionsIn youth with OW/OB, rates of IGT and low IS increased progressively across quintiles of UA. On the contrary, IFG and IR were associated only with the highest quintile of UA. Our data suggest that UA is a biomarker of impaired glucose metabolism prevalently in post–challenge condition rather than in fasting state.     

Screening for hypertension in young people with obesity: Feasibility in the real life

Background and aimScreening for pediatric hypertension (HTN) is based on several measurements of blood pressure (BP) in different visits. We aimed to assess its feasibility in outpatient youths with overweight/obesity (OW/OB) in terms of adherence to two-repeated measurements of BP and to show the features of youths who missed the follow-up and the predictive role of clinical and/or anamnestic features on confirmed HTN.Methods and resultsSix hundred, eighty-eight youths (9–17 years) with OW/OB, consecutively recruited, underwent a first measurement of BP. Those exhibiting BP levels within the hypertensive range were invited to repeat a second measurement within 1–2 weeks. Confirmed HTN was diagnosed when BP in the hypertensive range was confirmed at the second measurement. At entry, 174 youths (25.1%) were classified as hypertensive. At the second visit, 66 youths (37.9%) were lost to follow-up. In the remaining 108 participants, HTN was confirmed in 59, so that the prevalence of confirmed HTN was 9.5% in the overall sample; it was higher in adolescents than children (15.9% vs 6.8%, P = 0.001). HTN at first visit showed the best sensitivity (100%) and a good specificity (91%) for confirmed HTN. The association of HTN at first visit plus familial HTN showed high specificity (98%) and positive predictive value of 70%.ConclusionThe high drop-out rate confirms the real difficulty to obtain a complete diagnostic follow up in the obese population. Information about family history of HTN may assist pediatricians in identifying those children who are at higher risk of confirmed HTN.     

A new formula to improve the screening of impaired glucose tolerance in youths with overweight or obesity

AimTo assess a new formula to improve the screening of isolated impaired glucose tolerance (IGT) in youth with overweight/obesity (OW/OB).Methods and resultsA cross-sectional study was performed in 1189 Caucasian youths with OW/OB aged 5–17 years, in whom impaired fasting glucose and high glycosylated hemoglobin were excluded. The sample was divided into training set (TS) (n = 883) and validation set (VS) (n = 306). Fasting (FG) and post-load plasma glucose, alanine aminotransferase (ALT), lipids and familial history for type 2 diabetes (FD) were available in all individuals. In the TS youths with IGT (n = 58, 7.0%) showed higher prevalence of female sex (FS), FD, and higher levels of FG, post-load glucose, ALT and lower levels of HDL-cholesterol vs individuals without IGT. The linear formula was obtained by logistic regression analysis in the TS: 0.051ALT + 0.071FG + 0.871FD + (0.061HDL1 ? 1) + 11FS. The best cut-off was 5.84. The performance of the formula vs IGT was: sensitivity: 0.74 and specificity: 0.71. Similar results were obtained in the VS.ConclusionsUsing metabolic and anamnestic data we obtained a simple formula with a good performance for screening isolated IGT. This formula may support pediatricians to identify youths with OW/OB in whom the OGTT may be useful for detecting IGT.     

Les protéines purifiées à partir de sardines améliorent les chiffres tensionnels,l’équilibre glycémique,les voies métaboliques anti-athérogènes et la capacité anti-oxydante,chez le rat obèse

Aim of the studyThe effects of sardine by-products (SBy-P) and fillet proteins (SF-P) were compared to casein (Cas) ; these effects were assessed on blood pressure, glycemic control, reverse cholesterol transport, lipid peroxidation and total antioxidant capacity in obese rats.Materials and methodsEighteen male Wistar rats were subjected for three months, to a high-fat diet. The obese rats were divided into three groups and consumed the same high-fat diet for 28 days after addition of either, 20% SBy-P, SF-P or Cas.ResultsThe sardine proteins (SBy-P and SF-P) compared respectively to Cas, reduced diastolic (−14%, −11% P < 0.05) and systolic pressures (−12%, −8% P < 0.05), blood glucose (−24%, −21% P < 0.05), glycated hemoglobin (−28%, −21% P < 0.05), insulinemia (−29%, −18% P < 0.05) and HOMA-IR index (−29%, −18% P < 0.05). They improve the reverse cholesterol transport by increasing the lecithin: cholesterol acyltransferase (LCAT) activity (+43%, +30% P < 0.05) and high-density lipoproteins in cholesterol esters (+108%, +88% P < 0.05), and decreasing the atherogenicity ratios and membrane fluidity (P < 0.05). Furthermore, SBy-P and SF-P induced a reduction of reactive thiobarbituric acid substances concentrations in heart (−45%, −25% P < 0.05), aorta (−62%, −41% P < 0.05), liver (−40%, −21% P < 0.05) and adipose tissue (−50%, −37% P < 0.05) with an improvement in antioxidant capacity.ConclusionSardine proteins, in particular those extracted from by-products, because of their hypotensive, hypoglycemic, anti-atherogenic and antioxidant properties, may have protective effects against the cardiovascular risk associated with obesity.     

The effects of anti-TNF-α treatment with adalimumab on growth in children with Crohn's disease (CD)

IntroductionAdalimumab is used to treat children with Crohn's disease (CD), but the effects of adalimumab on growth in CD have not been studied.AimTo study growth and disease activity over 12 months (6 months prior to (T − 6), baseline (T0) and for 6 months following (T + 6) adalimumab).Subjects and methodsGrowth and treatment details of 36 children (M: 22) who started adalimumab at a median (10th, 90th) age of 14.7 years (11.3, 16.8) were reviewed.ResultsOf 36 cases, 28 (78%) went into remission. Overall 42% of children showed catch up growth, which was more likely in: (i) those who achieved remission (median change in height SDS (ΔHtSDS) increased from −0.2 (−0.9, 1.0) at T0 to 0.2 (−0.6, 1.6) at T + 6, (p = 0.007)), (ii) in those who were on immunosuppression ΔHtSDS increased from −0.2 (−0.9, 1.0) at T0 to 0.1 (−0.8, 1.3) at T + 6, (p = 0.03) and (iii) in those whose indication for using adalimumab therapy was an allergic reaction to infliximab, median ΔHtSDS increased significantly from −0.3 (−0.9, 1.0) at T0 to 0.3 (−0.5, 1.6) at T + 6, (p = 0.02). Median ΔHtSDS also increased from −0.4 (−0.8, 0.7) at T0 to 0.0 (−0.6, 1.6) at T + 6, (p = 0.04) in 15 children who were on prednisolone therapy when starting adalimumab.ConclusionClinical response to adalimumab therapy is associated with an improvement in linear growth in a proportion of children with CD. Improved growth is more likely in patients entering remission and on immunosuppression but is not solely due to a steroid sparing effect.     

Effects of transjugular intrahepatic portosystemic shunt (TIPS) on blood volume distribution in patients with cirrhosis

BackgroundCirrhosis is accompanied by portal hypertension with splanchnic and systemic arterial vasodilation, and central hypovolaemia.A transjugular intrahepatic portosystemic shunt (TIPS) alleviates portal hypertension, but also causes major haemodynamic changes.AimsTo investigate effects of TIPS on regional blood volume distribution, and systemic haemodynamics.MethodsThirteen cirrhotic patients had their regional blood volume distribution determined with gamma-camera technique before and after TIPS. Additionally, we measured systemic haemodynamics during liver vein and right heart catheterization. Central and arterial blood volume (CBV) and cardiac output (CO) were determined with indicator dilution technique.ResultsAfter TIPS, the thoracic blood volume increased (+10.4% of total blood volume (TBV), p < 0.01), whereas the splanchnic blood volume decreased (−11.9% of TBV, p < 0.001). CO increased (+22%, p < 0.0001), and systemic vascular resistance decreased (−26%, p < 0.001), whereas CBV did not change. Finally, right atrial pressure and mean pulmonary artery pressure increased after TIPS (+50%, p < 0.005; +40%, p < 0.05, respectively).ConclusionsTIPS restores central hypovolaemia by an increase in thoracic blood volume and alleviates splanchnic vascular congestion. In contrast, CBV seems unaltered. The improvement in central hypovolaemia is therefore based on an increase in thoracic blood volume that includes both the central venous and arterial blood volume. This is supported by an increase in preload, combined with a decrease in afterload.     

Corneal thickness in children with growth hormone deficiency: The effect of GH treatment

ObjectiveThe eye represents a target site for GH action, although few data are available in patients with GH deficiency (GHD). Our aim was to evaluate central corneal thickness (CCT) and intraocular pressure (IOP) values in GHD children to assess the role played by GHD or GH treatment on these parameters.DesignIn 74 prepubertal GHD children (51 M, 23 F, aged 10.4 ± 2.4 years) we measured CCT and IOP before and after 12 months of treatment. A baseline evaluation was also made in 50 healthy children matched for age, gender and body mass index. The study outcome considered CCT and IOP during treatment and their correlations with biochemical and auxological data.ResultsNo difference in CCT and IOP between GHD children at baseline and controls was found (all p > 0.005). GHD children after 12 months of therapy showed greater CCT (564.7 ± 13.1 μm) than both baseline values (535.7 ± 17 μm; p < 0.001) and control subjects (536.2 ± 12.5 μm; p < 0.001), with a concomitantly higher corrected mean IOP (15.6 ± 0.7 mm Hg; p < 0.001) than both baseline (12.5 ± 0.8 mm Hg; p < 0.001) and controls (12.3 ± 0.5 mm Hg; p < 0.001), without correlation with auxological and biochemical parameters.Conclusions12 months of GH treatment in children with GHD, regardless of auxological and biochemical data, affect CCT and IOP. Our findings suggest careful ocular evaluation in these patients to prevent undesirable side effects during the follow-up.     

Assessment of antioxidants status and superoxide dismutase activity in HIV-infected children

ObjectiveThis study aims to assess the nutritional status of selenium, copper and zinc; and also the erythrocyte superoxide dismutase activity of HIV-infected children compared to a control group.MethodsA cross-sectional study was carried out with prepubertal HIV-infected children (n = 51) and their healthy siblings (n = 32). All biochemical measurements including plasma selenium, serum copper levels, serum and erythrocyte zinc levels and erythrocyte superoxide dismutase activity were evaluated according to dietary, clinical and biochemical parameters.ResultsCompared to the control group, the HIV-infected children had lower z-score values for height-for-age (p = 0.0006), higher prevalence of stunting (11.8%) (p = 0.047), lower selenium levels (p = 0.0006) and higher copper levels (p = 0.019). No difference was found concerning superoxide dismutase activity (p > 0.05). The HIV-infected group presented a higher proportion (45.1%) of children with zinc intakes below the estimated average requirement (p = 0.014); however, no association with zinc biochemical parameters was found.ConclusionHIV-infected children have an inadequate selenium and copper nutritional status, which could influence the progression to AIDS. An adequate micronutrient status could improve the clinical conditions in these patients and minimize free radical production and cellular oxidative stress.     

High-intensity interval exercise lowers postprandial glucose concentrations more in obese adults than lean adults

AimsTo compare postprandial glucose responses to high-intensity interval exercise (HIE) between obese and lean individuals.MethodsThirty healthy young adult males (15 obese, 15 lean) ate a standardised meal, then performed HIE (4 × 30-s Wingate cycling/4-min rest) or a no-exercise control trial (CON). Blood glucose was measured preprandially and up to 150 min postprandially.ResultsCompared to CON, HIE reduced postprandial glucose concentrations at 120–150 min in obese (p < 0.001) and lean men (p < 0.05), with greater reductions in obese than lean subjects at 120 (−27.0% vs. −8.3%), 135 (−31.9% vs. −15.7%), and 150 min (−21.8% vs. −10.6%). The total glucose area under the curve (AUC) for the testing period was lower with HIE than CON among obese men (p < 0.05), but not lean men (p > 0.05). We found moderate correlations between body mass and postprandial glucose changes (r = 0.39–0.44, p < 0.05), and between glucose AUC and body mass and fat free mass (r = 0.39–0.48, p < 0.05).ConclusionsOur findings suggest that HIE may act as a time-efficient lifestyle intervention strategy for improving obesity-related diabetes risk factors, and might play a role in primary diabetes prevention for the healthy but sedentary population.     

Effects of levothyroxine on growth hormone (gh) sensitivity in children with idiopathic short stature

BackgroundThe possible relationship between the circulating concentrations of T4 and GH sensitivity has not been elucidated.ObjectiveThe aim of this study is to evaluate the effect of levothyroxine supplementation on GH sensitivity in prepubertal boys with idiopathic short stature (ISS).MethodsWe selected 28 prepubertal boys with ISS (mean age 8.2 ± 0.5 years) and free T4 (Ft4) concentrations between the 3rd and the 25th percentiles (Ft4: 0.8–1.5 ng/dl). They were randomly divided into two groups: Group A received thyroid supplementation (1–3 μg/kg/day) for 120 days, and Group B received placebo for the same period. To evaluate GH sensitivity, an IGF-I generation test (GH: 33 μg/kg/day sc for 3 days) was performed in both groups: under basal conditions, and after 120 days of levothyroxine supplementation (or placebo).ResultsAfter thyroid supplementation, Group A had higher Ft4 concentrations compared with Group B (2.14 ± 0.06 vs 1.48 ± 0.06 ng/dl, p = 0.01), their growth velocity was significantly higher (2.3 ± 0.1 vs 1.5 ± 0.2 cm/4 months), and they exhibited a greater increase in IGF-I after GH administration (Group A: 32.5 ± 3.8% vs Group B 17.3 ± 2.6%).ConclusionSupplementation with levothyroxine for 120 days promotes an increase in growth velocity, and a greater IGF-I response to short-term GH administration in prepubertal boys with ISS and low-normal thyroid hormone concentrations.     

Comparison between weight-based and IGF-I-based growth hormone (GH) dosing in the treatment of children with GH deficiency and influence of exon 3 deleted GH receptor variant

ObjectiveCompare the most frequently used weight-based GH dosing with an IGF-I level-based strategy in the treatment of children with severe GH deficiency. Additionally, analyse the influence of the GH receptor exon 3 polymorphism on IGF-I levels during GH therapy.DesignThirty children with GH deficiency on treatment with GH for 4.3 ± 3.2 yr in a single University Hospital were divided in group W (weight-based GH dosing) and group I (IGF-I-based dosing). In group I, GH doses were changed by 8.3 μg/kg d to maintain IGF-I levels between 0 and +2 SDS, whereas in group W the dose was fixed at 30 μg/kg d in prepubertal and 50 μg/kg d in pubertal patients. Growth velocity was measured after 1 yr, IGF-I and IGFBP3 levels quarterly. GH receptor exon 3 was genotyped by PCR.ResultsMost patients in Group I reached target IGF-I levels after 6 months with a GH dose ranging between 25 and 66 μg/kg d (mean ± SD, 38 ± 8). Each change of 8.3 μg/kg d of GH dose, resulted in change of 1.17 ± 0.6 SDS of IGF-I levels. Mean IGF-I levels were higher in Group I 0.8 ± 0.5 SDS than in Group W ?0.3 ± 1.9 SDS (p < 0.05), but growth velocities were similar, 6.8 ± 2.6 cm/yr and 6.9 ± 2.6 cm/yr (p = NS), respectively. Serum IGFBP3 levels were similar in both groups and were less useful to individualize GH therapy. Even treated with a similar mean GH dose, patients carrying at least one GH receptor d3-allele reached higher IGF-I levels (0.7 ± 1.2 SDS) than those homozygous for the full-length allele (?0.3 ± 1.2 SDS; p < 0.05), however, growth velocities were not different.ConclusionsBy adjusting the GH dose, it was feasible to maintain IGF-I in the desired range (0–+2 SDS). Patients carrying at least one GH receptor d3-allele reached higher circulating IGF-I levels than those homozygous for the full-length allele. A multiple regression analysis failed to demonstrate an independent influence of IGF-I levels on GV during the 12 months of observation.     

Preclinical signs of liver and cardiac damage in youth with metabolically healthy obese phenotype

Background and aims

We aimed to evaluate whether the metabolically healthy obese (MHO) phenotype was associated with hepatic steatosis (HS) or left ventricular hypertrophy (LVH) in young people with overweight (OW), obesity (OB) and morbid obesity (MOB) and whether the prevalence of these comorbidities was affected by OB severity.

Active surveillance of carbapenem-resistant Gram-negative healthcare-associated infections in a low-middle-income country city

BackgroundCarbapenem-resistance in healthcare-associated infections (HCAIs) is of great concern, and it is urgent to improve surveillance. We aimed to describe and analyze HCAIs trends on Gram-negative antimicrobial susceptibility in a city from a developing country, following the implementation of an active surveillance program.MethodsThis is an aggregated study describing data from 24 hospitals with intensive care units, including a trend analysis by Joinpoint regression between January 2012 and December 2017.ResultsThere were 23,578 pathogens in 39,832 HCAIs, from which 16,225 were Gram-negatives (68.8%). Carbapenem susceptibility was lowest in A. baumannii (15.4–25.9%), K. pneumoniae (51.0–55.9%), and P. aeruginosa (64.9–84.1%) and highest in E. coli (96.5–99.2%). Only K. pneumoniae showed a significant Joinpoint at 95% confidence interval: −10.71% (−18.02; −2.75) from 2012 to 2014, p = 0.02, and 6.54% (−2.00; 15.83) from 2015 to 2017, p = 0.12, which was most influenced by urinary tract infections: −9.98% (−16.02; −3.48) from 2012 to 2014, p = 0.01, and 9.66% (−1.75; 22.39) from 2015 to 2017, p = 0.09.ConclusionAlthough we found a significant change toward an improvement in carbapenem susceptibility in K. pneumoniae, resistance is high for most pathogens. These data should encourage health institutions to improve their prevention and control strategies.     

Static cutoffs or tables for the diagnosis of hypertension? Effect on identification of organ damage in youths with obesity

Background and aimRecently, the European Society of Cardiology task force released a Consensus document (ESC-CD) on pediatric hypertension (HTN) supporting the use of normative tables (age range 6–16 years) for the diagnosis of HTN, while the Hypertension Canada Guidelines (HTN-CGs) proposed static cutoffs. We aimed to assess the prevalence of HTN by ESC-CD or HTN-CGs and their association with glomerular function and left ventricular (LV) geometry in youths with overweight/obesity (OW/OB).Methods and resultsData of 3446 youths were analyzed. HTN by was defined using normative tables (ESC-CD) or static cutoffs of BP ≥ 120/80 in children (age <12 years) and ≥130/85 mmHg in adolescents (age ≥12 years) (HTN-CGs). Mildly reduced glomerular filtration rate was defined by GFR <90 ≥ 60 mL/min/1.73 m². Concentric LV hypertrophy (cLVH) was assessed in 500 youths and defined by LVH and high relative wall thickness as proposed by ESC-CD. Prevalence of HTN was 27.9% by ESC-CD and 22.7% by HTN-CGs. The association with mildly reduced glomerular filtration rate was significant only in hypertensive adolescents classified by HTN-CGs [Odds Ratio (OR), 95%Cl] 2.16 (1.44–3.24), whereas the association with cLVH was significant using both criteria: children OR 2.18 (1.29–3.67) by ESC-CD and 2.27 (1.32–3.89) by HTN-CGs; adolescents OR 2.62 (1.17–5.84) by ESC-CD and 2.83 (1.14–7.02) by HTN-CGs.ConclusionAlthough static cutoffs may represent a simplification for HTN identification, tables by ESC-CD detect a higher number of hypertensive youths before a clear appearance of glomerular impairment, which offers advantages in terms of primary cardiovascular prevention.     

Intestinal permeability is increased in children with non-alcoholic fatty liver disease,and correlates with liver disease severity

BackgroundIncreased intestinal permeability seems to play a major role in non-alcoholic liver disease development and progression.AimTo investigate the prevalence of altered intestinal permeability in children with non-alcoholic fatty liver disease, and to study its potential association with the stage of liver disease.MethodsWe performed a case–control study examining intestinal permeability in children using the lactulose–mannitol bowel permeability test.ResultsOverall, 39 consecutive patients (30 males, median age 12 years) and 21 controls (14 males, median age 11.8 years) were included. The lactulose/mannitol ratio resulted impaired in 12/39 patients (31%) and none of the controls. Intestinal permeability was higher in children with non-alcoholic fatty liver disease (lactulose/mannitol ratios: 0.038 ± 0.037 vs. 0.008 ± 0.007, p < 0.05). Within the non-alcoholic fatty liver disease group, intestinal permeability was increased in children with steatohepatitis compared to those with steatosis only (0.05 ± 0.04 vs. 0.03 vs. 0.03, p < 0.05). Pathological lactulose/mannitol ratio correlated with portal inflammation (p = 0.02), fibrosis (p = 0.0002), and ballooning of hepatocytes (p = 0.003). Blood lipopolysaccharides levels were higher in children with steatohepatitis (2.27 ± 0.68 vs. 2.80 ± 0.35, p < 0.05).ConclusionsIntestinal permeability is increased in children with non-alcoholic fatty liver disease, and correlates with the severity of the disease.     

Effets d’un régime obésogène enrichi en coproduits de sardine sur les facteurs de risque pro-athérogènes,chez le rat Wistar

Aim of the studyThe effects of an obesogenic diet enriched in sardine by-products (Sardina pilchardus) on blood pressure, glycemic control and some cardiovascular risk factors, in particular pro-atherogenic were studied on an experimental model.Materials and methodsMale rats (n = 12) weighing 200 ± 10 g were subjected to an adjustment phase of 10 days in an obesogenic diet containing 30% sheep fat. After this period, the rats were divided into two homogeneous groups. The first group (HF-SBp) consumes the obesogenic diet supplemented with 30% of by-products flour (F-SBp), and the second (HF) continuous to consume the obesogenic diet and serve as control.ResultsAt day 30, in HF-SBp versus HF group: a reduction was noted in diastolic (−11%) and systolic (−10%) pressure, glycemia (−19%), glycated hemoglobin percent (−43%), serum total lipids concentration (−22%), triacylglycerols (−37%), total cholesterol (−29%) and unesterified cholesterol (−30%), cholesteryl esters (−30%), cholesterol of very low density lipoprotein (−37%) and low density (−37%) was noted. Inversely, high-density lipoprotein cholesterol and LCAT activity were enhanced by 19% and 77%, respectively. However, the atherogenicity index and membrane fluidity were reduced (P < 0.05).ConclusionSardine by-products probably by their bioactive compounds properties seem to have antihypertensive, antidiabetic, hypolipidemic and antiatherogenic properties that could prevent and/or attenuate some metabolic disorders associated with obesity.     

Self-directed physical activity interventions for motor symptoms and quality of life in early and mid-stage Parkinson's disease: A systematic review and meta-analysis

BackgroundSelf-directed physical activity (SDPA) has been found in previous research to alleviate some of the symptoms of early and mid-stage Parkinson's disease (PD) patients. So, this study aimed to determine the impact of SDPA on these patients in the areas of motor symptoms, and quality of life (QoL).MethodPubMed, Embase, the Cochrane Library, the Web of Science, Scopus, and ProQuest were all searched. The risk-of-bias tool of Cochrane for randomized trials, Version 2 (RoB 2), was also used to assess the credibility of studies in terms of their procedures.Results15 eligible studies were analyzed. SDPA improved motor function and mobility, including timed up and go (TUG) test [standardized mean difference (SMD), −0.55 (95% CI, −0.91 – −0.18), p = 0.003], 6-minute walking (6MW) test [1.11 (0.75 − 1.47), p < 0.00001], stride length [0.45 (0.18 – 0.72), p = 0.001], gait velocity [0.42 (0.04 – 0.81 p = 0.03], Unified Parkinson's Disease Rating Scale Part-III (UPDRS-III) [−0.76 (−1.18 – −0.33), p = 0.0005] and enhanced Berg Balance Scale (BBS) [0.88 (0.50 – 1.27), p < 0.00001]). Despite engaging in SDPA, there was no significant improvement observed in freezing of gait (FOG) [0.23 (−0.11 – 0.56), p = 0.18] as well as the Parkinson's Disease Questionnaire-39 (PDQ-39) [0.04 (−0.55 – 0.62), p = 0.90]).ConclusionThe motor symptoms of those with early to mid-stage PD improved with SDPA, however the research found no enhancement in FOG or QoL.     

The GHRH + arginine stimulated pituitary GH secretion in children and adults with Prader–Willi syndrome shows age- and BMI-dependent and genotype-related differences

ObjectiveThe quantitative and qualitative aspects of the pituitary response in children and adults with Prader–Willi syndrome (PWS) are compared in order to verify the possible age-dependent and genotype-related differences in terms of GH secretion.Design29 young subjects (21 males and 8 females) and 65 adults (24 males and 41 females) with PWS were studied. All subjects underwent a standard GH Releasing Hormone (GHRH 1-29, 1 μg/kg as i.v. bolus at 0 minutes) + arginine (0.5 g/kg) test. Peak GH values, standard GH area under the curve (AUC), AUC of the instantaneous secretion rate (ISR), and secretion response analysis (i.e. half-secretion time) were evaluated. A regression analysis was performed to investigate which are the patient characteristics that affect the amplitude and shape of the GH secretion response.ResultsPeak GH values and AUC_GH were significantly higher in PWS children than in PWS adults, these differences being also significant both in PWS DEL15 (only peak GH value) and PWS UPD15. Moreover, PWS children showed significantly lower half secretion time than PWS adults, this delayed response being present both in PWS DEL15 and PWS UPD15.Significant negative correlations between AUC_GH and BMISDS were observed in the two groups (adults and children), as well as in adults and children DEL15, but not in adults and children PWS UPD15. A regression analysis performed on the whole dataset showed that for PWS DEL15 the statistically significant variable explaining GH responsiveness was BMISDS (p < 0.0001), while for UPD15 no statistically significant covariate was found. Conversely, when the delay of the secretion response was considered, the regression model yielding the best performances was the one with only age as a regressor (p < 0.001).ConclusionsThe quantitative and qualitative analyses of GH responsiveness to GHRH + arginine highlight relevant differences between PWS children and PWS adults and genotype-related traits.The negative influence of BMISDS on GH secretion reinforces the need for an early start of life-long weight management in PWS subjects.