Energy balance and type 2 diabetes: a report from the Shanghai Women's Health Study

BACKGROUND AND AIMS: The combined effect of the components of energy balance (energy intake and physical activity) and the development of type 2 diabetes (T2D) has not been adequately investigated. The aim of this study was to examine the components of energy balance and the incidence of T2D in a cohort of middle-aged women. METHODS AND RESULTS: A population-based prospective study of 64,227 middle-aged Chinese women who had no prior history of diabetes or chronic disease at study recruitment. Participants completed in-person interviews at baseline and follow-up surveys that collected information on diabetes risk factors including dietary and physical activity habits and disease occurrence. Anthropometric measurements were taken by trained interviewers at recruitment. Average follow-up time was 4.6 years. During 297,755 person-years of follow-up, 1608 new cases of T2D were documented. Body mass index (BMI) and weight gain (since age 20) were strongly associated with T2D incidence. Energy intake (EI) was associated with modestly increased risk, while physical activity (PA) was associated with decreased risk of T2D. Less active women with higher EI had higher risk of T2D (RR=1.96; 95% CI: 1.44, 2.67) than active women with lower EI (P(interaction)=0.02). The EI to PA (EI:PA) ratio was positively associated with T2D risk; the association was more evident among overweight and obese women (BMI > or = 23 kg/m(2)). CONCLUSION: These data suggest that energy balance plays an important role in the development of T2D, and this effect may be modified by BMI.     

Intravascular tumors: transvenous biopsy

A technique is described for transfemoral biopsy of intravenous tumors. Positive results were obtained at biopsy in three patients who had an intraluminal mass in the inferior vena cava and in one patient with a mass in the iliac vein. Transvenous biopsy is helpful in obtaining a histologic diagnosis and provides an alternative method to surgery or percutaneous transabdominal needle biopsy.     

Abdominal aortic thrombosis in association with an attempted Heimlich maneuver

We report herein a case of an incorrectly applied Heimlich maneuver--to the best of our knowledge, the first reported fatal complication associated with a Heimlich maneuver, acute thrombosis of an abdominal aortic aneurysm, and the distal aorta. While the Heimlich maneuver is effective for the relief of foreign body-induced upper airway obstruction, increased efforts should be directed toward instructing the public in correctly recognizing and optimally treating airway obstruction.     

Medullary carcinoma of thyroid gland in a girl aged 10 years

A healthy girl of 10 years presented with lumps on her tongue, shown on biopsy to be neuromas. She had had operations to her feet for pes cavus and was relatively long-limbed but had no other 'Marfanoid' features. She had a high plasma calcitonin level. At operation a normal sized thyroid gland was totally removed. It contained two discrete masses of malignant C-cells and diffuse foci elsewhere. The plasma calcitonin fell slowly to normal on follow-up but was noted to be rising 2 1/2 years later. We stress the importance of making this diagnosis as early as possible and mention briefly another child aged 15 months, similarly diagnosed and operated upon.