Neonatal anthropometrics and correlation to childhood obesity—data from the Danish Children’s Obesity Clinic

Recent evidence has demonstrated the prenatal initiation of childhood obesity as epidemiological studies and animal studies have illustrated the effect of the intrauterine milieu for subsequent development of childhood obesity. This study investigates the relationship between severe childhood obesity and the preceding in utero conditions expressed by birth weight and birth length, birth-weight-for-gestational-age and neonatal ponderal index in a Danish cohort of 1,171 severely obese children (median age 11.48 years, range 3.13 to 17.98 years) with a mean body mass index-standard derivation score (BMI-SDS) of +2.96 (range +1.65 to +9.72) treated in our national referral centre. In a linear general regression model adjusted for socioeconomic status and breastfeeding duration, a significant linear correlation between BMI-SDS at time of enrolment and both birth weight (p, 3.8?×?10^?6) and birth length (p, 6.1?×?10^?4), birth-weight-for-gestational-age (p, 4.3?×?10^?7) and the neonatal ponderal index (p, 0.02) was demonstrated. Duration of breastfeeding, however, was not found to be significant for either the BMI-SDS/BW or the BMI-SDS/BL correlation. Conclusion: These results indicate that the prenatal period can be considered as a potential window of opportunity for prevention of childhood overweight and obesity and anthropological measurements may in theory be used to help identify neonates at high risk for developing childhood obesity.     

Transport with ongoing cardiopulmonary resuscitation - when does is it make sense?

The currently valid guidelines for resuscitation of the European Resuscitation Council (ERC) do not give any unambiguous recommendations for "transport with ongoing cardiopulmonary resuscitation". Furthermore, up to now there are no generally accepted criteria for terminating cardiopulmonary resuscitation, apart from certain signs of death. In spite of the generally poor outcome of patients being transported with ongoing cardiopulmonary resuscitation, there are a number of positive case reports and undisputable indications (e.g., in cases with a potentially reversible cause of cardiac arrest). The increase observed over the past few years in the number of patients being transported under cardiopulmonary resuscitation has as yet not been reflected in an improved prognosis for these patients. The use of mechanical chest compression devices with a better quality of chest compression, also under transport conditions, may have an influence on the number transports but this has not yet been evaluated sufficiently with regard to patient outcome. However, the decision to transport a patient resides with the responsible emergency physician who has to evaluate the prognosis for the patient on an individual basis.     

An adult-based insulin resistance genetic risk score associates with insulin resistance,metabolic traits and altered fat distribution in Danish children and adolescents who are overweight or obese

Aims/hypothesis

A genetic risk score (GRS) consisting of 53 insulin resistance variants (GRS₅₃) was recently demonstrated to associate with insulin resistance in adults. We speculated that the GRS₅₃ might already associate with insulin resistance during childhood, and we therefore aimed to investigate this in populations of Danish children and adolescents. Furthermore, we aimed to address whether the GRS associates with components of the metabolic syndrome and altered body composition in children and adolescents.

Methods

We examined a total of 689 children and adolescents who were overweight or obese and 675 children and adolescents from a population-based study. Anthropometric data, dual-energy x-ray absorptiometry scans, BP, fasting plasma glucose, fasting serum insulin and fasting plasma lipid measurements were obtained, and HOMA-IR was calculated. The GRS₅₃ was examined for association with metabolic traits in children by linear regressions using an additive genetic model.

Results

In overweight/obese children and adolescents, the GRS₅₃ associated with higher HOMA-IR (β?=?0.109?±?0.050 (SE); p?=?2.73?×?10^?2), fasting plasma glucose (β?=?0.010?±?0.005 mmol/l; p?=?2.51?×?10^?2) and systolic BP SD score (β?=?0.026?±?0.012; p?=?3.32?×?10^?2) as well as lower HDL-cholesterol (β?=??0.008?±?0.003 mmol/l; p?=?1.23?×?10^?3), total fat-mass percentage (β?=??0.143?±?0.054%; p?=?9.15?×?10^?3) and fat-mass percentage in the legs (β?=??0.197?±?0.055%; p?=?4.09?×?10^?4). In the population-based sample of children, the GRS₅₃ only associated with lower HDL-cholesterol concentrations (β?=??0.007?±?0.003 mmol/l; p?=?1.79?×?10^?2).

Conclusions/interpretation

An adult-based GRS comprising 53 insulin resistance susceptibility SNPs associates with insulin resistance, markers of the metabolic syndrome and altered fat distribution in a sample of Danish children and adolescents who were overweight or obese.

     

Upper thermal limits of Drosophila are linked to species distributions and strongly constrained phylogenetically

Upper thermal limits vary less than lower limits among related species of terrestrial ectotherms. This pattern may reflect weak or uniform selection on upper limits, or alternatively tight evolutionary constraints. We investigated this issue in 94 Drosophila species from diverse climates and reared in a common environment to control for plastic effects that may confound species comparisons. We found substantial variation in upper thermal limits among species, negatively correlated with annual precipitation at the central point of their distribution and also with the interaction between precipitation and maximum temperature, showing that heat resistance is an important determinant of Drosophila species distributions. Species from hot and relatively dry regions had higher resistance, whereas resistance was uncorrelated with temperature in wetter regions. Using a suite of analyses we showed that phylogenetic signal in heat resistance reflects phylogenetic inertia rather than common selection pressures. Current species distributions are therefore more likely to reflect environmental sorting of lineages rather than local adaptation. Similar to previous studies, thermal safety margins were small at low latitudes, with safety margins smallest for species occupying both humid and dry tropical environments. Thus, species from a range of environments are likely to be at risk owing to climate change. Together these findings suggest that this group of insects is unlikely to buffer global change effects through marked evolutionary changes, highlighting the importance of facilitating range shifts for maintaining biodiversity.     

1H MRS assessment of hepatic steatosis in overweight children and adolescents: comparison between 3T and open 1T MR-systems

Purpose

In recent years, proton magnetic resonance spectroscopy (MRS) has emerged as a non-invasive technique for measurement of fat content in the liver. The technique is often applied for overweight and obese patients. However, excessively obese patients cannot be examined in most conventional magnetic resonance systems due to limited space. The purpose of this study was to examine the ability of open 1T system to monitor liver fat with proton MRS and to compare hepatic fat fractions (HFFs) obtained using an open 1T system with assessment with 3T proton MRS.

Methods

The study included 23 children and adolescents up to 20 years of age with a body mass index above the 97th percentile according to age and gender. Proton MRS for each patient was performed in both 1T and 3T using point resolved spectroscopy sequence in a single volume positioned in the right liver lobe.

Results

Average T2 relaxation times obtained for an open 1T system (55 ± 7 ms for water and 85 ± 11 ms for fat) were higher than average T2 relaxation times obtained for a 3T system (31 ± 4 ms for water and 66 ± 10 ms for fat). HFFs measured using an open 1T system showed strong correlation with HFFs measured using a 3T system (r = 0.99, P < 0.0001).

Conclusions

Proton MRS measurements of HFF with an open 1T system are feasible. Open 1T system may reliably replace 3T magnetic resonance system for the assessment of liver fat.     

A MIF haplotype is associated with the outcome of patients with severe sepsis: a case control study

Background  

Macrophage migration inhibitory factor (MIF) plays an important regulatory role in sepsis. In the promoter region a C/G single nucleotide polymorphism (SNP) at position -173 (rs755622) and a CATT_5-8 microsatellite at position -794 are related to modified promoter activity. The purpose of the study was to analyze their association with the incidence and outcome of severe sepsis.     

Lymphocyte distribution in the tonsils prior to and after influenza vaccination

The tonsils, consisting of the adenoid, tubal, palatine and pharyngeal tonsils, form a ring like structure in humans called Waldeyer's ring. The ring of tonsils is rich in lymphocytes and may play an important role as a reservoir of memory and immune competent cells serving the respiratory tract. The tonsils may also function as an activating and effector site for immune responses against respiratory pathogens. In this study, we have examined histological tissue sections from palatine tonsils for influenza specific antibody secreting cells (ASC) and several cell surface markers, from non-vaccinated and influenza vaccinated subjects. We found an increase in the number of influenza specific ASC in the tonsils of the influenza vaccinated subjects. These ASC was found scattered inside and surrounding the germinal centres, indicating that they may have homed to the tonsils. In addition, we observed a significant decrease in CD4 positive cells in tonsils of vaccinated subjects. Similar trends were also detected for CD45RA and CD45RO positive cells, which were significantly reduced in the vaccinated tonsils. The number of macrophages bearing the CD68 surface marker increased in numbers in vaccinated subjects. This shows that dynamic changes takes place in the tonsils after parenteral influenza vaccination, which may point to an important role of the tonsils in combating respiratory pathogens.     

Time course and determinants of leptin decline during weight loss in obese boys and girls.

OBJECTIVE: To investigate whether changes in leptin concentrations during weight loss can be explained by gender, puberty, baseline adiposity and changes in adiposity, body composition, rate of weight loss, physical activity and insulin concentrations. DESIGN: A longitudinal study with 9 repeated measures during a 12-week weight loss programme. SUBJECTS: Fifty-three boys and 62 girls (7.9-15.2 years) with body mass index (BMI) standard deviation scores (SDS) of median 2.78 and 2.70, respectively. MEASUREMENTS: Height, weight, fat mass percentage assessed by bioimpedance, Tanner stages, testicular size, physical activity scores, blood leptin (ng/ml) and insulin concentrations (pmol/l) were measured at baseline, and except for Tanner stage and testicular size, repeated regularly during the programme. RESULTS: The weight loss was accompanied by a steep decline in leptin concentrations during the first 10-11 days, followed by a less steep decline until day 82. Leptin declined to 39% in boys and 51% in girls of the level that was expected given the relationship at baseline between leptin and BMI SDS, and the BMI SDS changes during weight loss. The biphasic leptin decline was independent of gender, puberty, baseline adiposity or concomitant changes in BMI SDS, fat mass percentage, rate of weight loss, physical activity scores or insulin concentrations. CONCLUSION: The biphasic leptin decline, which exceeded the level expected, was independent of puberty, baseline adiposity and changes in adiposity, body composition, rate of weight loss, physical activity scores and insulin concentrations. The dissociation of the leptin-weight relationship during weight loss may contribute to the general leptin variability in obese subjects.     

Deep brain stimulation electrode anchoring using BioGlue((R)), a protective electrode covering, and a titanium microplate

The authors present an easily applicable deep brain stimulation (DBS) electrode anchoring technique for use in human and experimental animals. The anchoring technique combines the use of fibrin glue, a two-component surgical adhesive (BioGlue), a protective electrode covering, and a titanium microplate. The BioGlue (CryoLife International, Inc., Kennesaw, GA, USA) hinders unwanted electrode movement during the electrode fixation step and seals the burr hole, while the protective electrode covering protects the electrode under the titanium microplate which keeps the electrode in a permanent position. The described technique further has the advantage of being cosmetically acceptable to the human patient, and furthermore it perfectly adapts to the smaller and irregular-shaped skull in experimental animals. The described technique has clinically been used to implant DBS-electrodes in the subthalamic nucleus for Parkinson disease and is the preferred DBS-electrode anchoring technique for our experimental DBS-studies in the G?ttingen minipig.