Obesity: new insight into the anthropometric classification of fat distribution shown by computed tomography

Twenty eight women presenting for routine computed tomography had their waist, hip, and thigh circumferences measured. The ratio of the area of intra-abdominal fat to the area of subcutaneous fat shown in the computed tomogram taken at the umbilical level was calculated and found to correlate highly significantly with the ratio of waist to hip circumference. The correlation between these two ratios remained significant after allowing for the degree of obesity (weight (kg)/height (m)2) and age. In contrast, there was no significant correlation between the ratio of intra-abdominal to subcutaneous fat and degree of obesity. A high ratio of waist to hip circumference has been shown to be associated with a high proportion of intra-abdominal fat. Thus women with a centralised distribution of fat (high waist to hip ratio: "apples") tend to have a greater proportion of their fat in the intra-abdominal depot than do women with a peripheral fat distribution (low waist to hip ratio: "pears"). The metabolic complications of obesity, which are associated with a high ratio of waist to hip circumference, may therefore relate specifically to the amount of intra-abdominal fat.     

Insulin glargine: the first clinically useful extended-action insulin analogue

Insulin glargine is a new extended-action insulin analogue, created by recombinant DNA modification of human insulin. Extension of the C-terminal of the B-chain with two arginine residues and the substitution of glycine for asparagine at position A-21 increases the isoelectric point, resulting in precipitation of the insulin at the injection site and a protracted absorption. Pharmacodynamic studies have demonstrated a prolonged metabolic profile without a pronounced peak and with a duration of action of 20 - 30 h. In clinical studies in people with Type 1 and Type 2 diabetes, insulin glargine has demonstrated improved pre-breakfast blood glucose control and a reduction in the frequency of hypoglycaemia, especially nocturnal hypoglycaemia, in comparison with neutral protamine hagedorn (NPH) insulin. In addition, 24h glycaemic control in Type 2 diabetes and treatment satisfaction may also be improved. However, whilst appearing achievable, insulin glargine has not yet demonstrated the ability to improve HbA(1c), though this may relate to inexperience in the use of the new compound. In order to fully exploit its metabolic advantages, it appears vital that the dose of insulin glargine should be titrated to achieve aggressive pre-breakfast blood glucose targets beyond those achievable with NPH in the absence of nocturnal hypoglycaemia. Insulin glargine appears to be a promising new addition to the insulin family and with increased experience in its use, especially in combination with rapid-acting insulin analogues, its full benefits may be realised. The use of insulin glargine with a rapid-acting insulin analogue brings us the closest we have ever been to providing the physiological insulin replacement that has long been awaited.     

Development of microglia in the albino rabbit retina

In this study the development of ameboid microglia and resting microglia in the retina of the albino rabbit has been examined by means of a lectin derived from Griffonia simplicifolia. Ameboid microglia are present in the retina as early as E12, when the optic fissure is in the process of closure, and appear to be concentrated initially at the vitreal surface. At E14 many ameboid microglia can be seen to extend processes to the ventricular surface of the cytoblast layer, but in subsequent ages these cells are rare and ameboid microglia are largely confined to the ganglion cell layer, inner plexiform layer, and occasionally the developing inner nuclear layer. By adult life, mature (or resting) microglia are confined to the inner plexiform and ganglion cell layers. Numbers of microglia increase steadily throughout fetal life from a mean of 400 at E14, the earliest age quantified, to a peak of 28,600 at E30. There is a small postnatal drop in numbers to 17,150 at P9. Microglia could only be labelled faintly in animals older than P11, but analysis of two adult (P130) retinas with adequate labelling suggested that numbers rise to a value of about 23,800 at this age. Ameboid microglia thus appear in the retina 11 days prior to the onset of axon loss in the optic nerve (about E23) and 14 days prior to the beginning of the period of reduction of retinal ganglion cell numbers (about E26). The present findings indicate that while some microglial precursors may enter the retina in response to debris generated during the natural retinal ganglion cell death period, most enter the retina well before this period. Also, microglia present a uniform density distribution with apparently regular spacing as early as E16, so the uniform regular distribution cannot simply be the consequence of regularly distributed pyknotic figures as previously suggested.     

Computed tomography for cervical spine trauma. The impact of MDCT on fracture detection and dose deposition

A multidetector computed tomography (MDCT) was installed in our department. Referral rates, examination protocols and detection rates of abnormal findings in CT examinations for cervical spine trauma 6 months before and 6 months after MDCT installation were compared to look for changes in practice. Retrospective analysis of all CT cervical spine examinations in patients with multiple trauma over two contiguous 6-month periods: from July 2003 to December 2003 (helical CT) and from January 2004 to June 2004 (MDCT). Variables recorded were number of CT examinations performed, scan plane coverage and traumatic abnormalities detected. Phantom dosimetry measurements for cervical spine examination in both helical CT and MDCT were compared. One hundred and fifty four patients underwent cervical spine CT during these periods. Helical CT period: of 91 patients undergoing CT cervical spine examination for trauma, 65 (71%) were complete cervical examinations and 26 (29%) were level-specific examinations. Eight patients (9%) had cervical spine fracture, six of which were apparent on radiographs. Dose estimations for thyroid, lens and breast were 24.76, 1.86 and 0.21 mGy, respectively, for complete cervical spine examinations. MDCT period: of 63 patients who underwent CT cervical spine examination for trauma, 61 (97%) were complete examinations and 2 (3%) were level-specific examinations. Six patients (11%) had cervical spine fracture, three of which were apparent on radiographs. Dose estimations for thyroid, lens and breast were 75.8, 9.7 and 0.7 mGy, respectively, for complete cervical spine examinations, which were notably higher than those for helical CT. After installation of MDCT, clinical requests for complete examination of the cervical spine following trauma increased. This changing trend resulted in a significantly higher radiation dose to thyroid, lens and breast.     

Developmental expression of the CD15-epitope in the brainstem and spinal cord of the mouse

 The expression of the 3-fucosyl-N-acetyl-lactosamine (FAL, CD15, Le^x) epitope has been examined immunohistochemically in paraffin sections of the brainstem of the mouse. The initial appearance of labelling was at embryonic day (E)11, when immunoreactivity of radial glial fibres was noted in the medulla, pons and dorsal isthmus, while the spinal cord was immunoreactive from E12. Labelling remained faint until E14, when a distinctive radial pattern appeared in the medulla, pons and spinal cord. Immunoreactivity at E14 in both the spinal cord and medulla was strongest in a band in line with the sulcus limitans, passing ventrolaterally through the nucleus of the solitary tract in the case of the medulla. In both the spinal cord and the medulla, CD15 immunoreactivity divided the brainstem into radially arranged compartments, with an immunonegative paramedian region, strongly labelled ventrolateral segments, and moderately labelled lateral regions. Labelling of midline radial fibres was also apparent in the ventral mesencephalon at E14. After E18, labelling appeared in the paramedian region of the medulla, in particular around the inferior olivary nucleus, and gradually adopted a tufted appearance throughout the brainstem. Several regions of the developing brainstem showed specific labelling during fetal life. Distinct labelling of the developing red nucleus was visible from E15 to the time of birth, while some longitudinal bands of labelling were noted in the deeper layers of the superior colliculus from E17 until postnatal day (P)2. The adult pattern of immunolabelling was achieved by the end of the second postnatal week. The striking concentration of CD15 along the sulcus limitans of both the spinal cord and brainstem may serve to demarcate and separate dorsal (sensory) and ventral (motor) columns in a similar fashion to Pax gene expression. The precise timing of transient CD15 expression in the developing inferior olive and red nucleus is suggestive of a role for this epitope in developmental events of those structures. Accepted: 24 March 1997     

The world trade center clean up and recovery worker cohort study: respiratory health amongst cleanup workers approximately 20 months after initial exposure at the disaster site

OBJECTIVE: Respiratory health among cleanup workers at the World Trade Center (WTC) disaster site was evaluated approximately 20 months after the initial exposure to assess the risk of lower respiratory symptoms. METHODS: In 2003 a self-administered questionnaire requesting information about site experience, current respiratory and historical health, and smoking was sent to 4,546 workers employed at the site (response 25%), and 2103 workers who were never at the WTC (response 12%). RESULTS: As compared with those never at the site, WTC workers were more than three times as likely to report any lower respiratory symptoms (rate ratio = 3.40, 95% confidence interval: 2.33-4.94). CONCLUSIONS: These results suggest an impact on respiratory health related to work experience at the WTC and indicate further monitoring to address potential long-term effects.     

Interleukin 2 upregulates expression of its receptor on a T cell clone

Stimulation of a class II-restricted, antigen-specific T cell clone with interleukin 2 (IL-2) resulted in substantial increases in both cell surface IL-2 receptor (IL-2-R) and cytoplasmic IL-2-R messenger RNA (mRNA), whereas no increase was observed for cell-surface expression of Thy-1 and L3T4 antigens, and only a modest increase in Thy-1 mRNA was observed. These experiments demonstrate that, after initial acquisition of the IL-2-R, IL-2 as well as antigen is able to directly upregulate both the level of IL-2-R mRNA and cell surface IL-2-R molecules.     

LOGISTICS OF PERFORMING AN OPHTHALMIC ASSESSMENT IN ELDERLY INPATIENTS

SUMMARY To assess the feasibility of performing an ophthalmic assessment on elderly inpatients, we examined 48 patients over 75 years of age who were consecutively admitted to an acute elderly-care ward. Difficulties were encountered in 35 patients (73%). By employing simple methods to overcome these problems, useful information was obtained in all cases and the time taken to complete the examination ranged from six to 20 minutes (mean 7.5 minutes). Doctors looking after elderly patients should be encouraged to assess visual function and must not be deterred by anticipated logistical difficulties.     

Detection of residual lymphoma cells by polymerase chain reaction in peripheral blood is significantly less predictive for relapse than detection in bone marrow

Polymerase chain reaction (PCR) amplification of the t(14;18) has been shown to be a highly sensitive method to detect minimal residual disease in patients with non-Hodgkin's lymphoma (NHL) whose tumors bear this translocation. The ideal tissue source to detect residual lymphoma would be from a previously involved lymph node. However, lymphoid tissue is rarely available once patients achieve complete remission. Although PCR amplification has been used to detect residual lymphoma cells in both bone marrow (BM) and peripheral blood (PB) of patients in complete remission, it is presently unknown whether BM and PB are equivalent tissue sources to detect residual disease. In the present study, we compared the clinical utility of the detection of residual lymphoma in both the BM and the PB of patients with advanced-stage non- Hodgkin's lymphoma before, at the time of, and after high-dose therapy and autologous BM transplantation (ABMT). The detection of residual lymphoma in either the BM or PB was associated with decreased disease- free survival. However, in the present study, 44% of patients who relapsed had no evidence of circulating lymphoma cells in their PB. At the time of BM harvest, PCR-detectable residual lymphoma cells were detected in 211 of 212 patients; although, in a subset of these patients analyzed, lymphoma cells were detected in the peripheral blood of only 49% of patients. When residual lymphoma cells within the autologous BM are infused into the patient these cells are rapidly detectable circulating in the PB in the patient. These cells continue to circulate during the immediate posttransplant period and be detectable in the PB in the majority of patients who are infused with marrow containing residual lymphoma. We conclude that BM is a more informative tissue source than PB in detecting minimal residual disease at the time of and after ABMT, and that contamination of PB early after ABMT appears to be the consequence of reinfusion of lymphoma cells within autologous marrow.