Fibroblast Growth Factor-21 to Adiponectin Ratio: A Potential Biomarker to Monitor Liver Fat in Children With Obesity

Background: There is a pressing need for effective and non-invasive biomarkers to track intrahepatic triglyceride (IHTG) in children at-risk for non-alcoholic fatty liver disease (NAFLD), as standard-of-care reference tools, liver biopsy and magnetic resonance imaging (MRI), are impractical to monitor the course disease. Objective: We aimed to examine the association between serum fibroblast growth factor (FGF)-21 to adiponectin ratio (FAR) and IHTG as assessed by MRI in children with obesity. Methods: Serum FGF21 and adiponectin levels and IHTG were measured at two time points (baseline, 6 months) in obese children enrolled in a clinical weight loss program. The association between percent change in FAR and IHTG at final visit was examined using a multiple linear regression model. Results: At baseline, FAR was higher in the subjects with NAFLD (n = 23, 35.8 ± 41.9 pg/ng) than without NAFLD (n = 35, 19.8 ± 13.7 pg/ng; p = 0.042). Forty-eight subjects completed both visits and were divided into IHTG loss (≥1% reduction than baseline), no change (within ±1% change), and gain (≥1% increase than baseline) groups. At 6 months, the percent change in FAR was different among the three groups (p = 0.005). Multiple linear regression showed a positive relationship between percent change in FAR and the final liver fat percent in sex and pubertal stage-similar subjects with NAFLD at baseline (slope coefficient 6.18, 95% CI 1.90-10.47, P = 0.007), but not in those without NAFLD. Conclusions: Higher value in percent increase in FAR is positively associated with higher level of IHTG percent value at 6 months in children with baseline NAFLD. FAR could be a potential biomarker to monitor the changes in IHTG in children with NAFLD.

Association of Non-High-Density Lipoprotein Cholesterol with Psychosocial Dysfunction in Children and Adolescents with Obesity

BACKGROUND

Children with obesity have worse psychosocial functioning compared to their non-overweight peers. Adult studies suggest that several metabolic factors may participate in the etiology of depression in obesity.

METHODS

We evaluated the association of several metabolic parameters with psychosocial dysfunction in children with obesity, through a retrospective review of electronic medical records in patients ages 6-17. All parents were asked to complete the Pediatric Symptom Checklist (PSC) questionnaire, a validated measurement of psychosocial dysfunction in children.

RESULTS

PSC scores were available in 618 patients. Overall, 11.2% of patients had a PSC score ≥28, suggestive of psychosocial dysfunction. Non-high-density lipoprotein (HDL) cholesterol was associated with a higher PSC score (p = 0.02), after adjusting for age, sex, race, socioeconomic status, and BMI z-score.

CONCLUSIONS

Consistent with adult studies, in children and adolescents with obesity, non-HDL cholesterol may play a role in the etiology of psychosocial dysfunction. Further studies are warranted.

Neonatal thyrotoxicosis and persistent pulmonary hypertension necessitating extracorporeal life support

We report a case of neonatal Graves' disease involving an infant with severe persistent pulmonary hypertension (PPHN) associated with neonatal thyrotoxicosis that necessitated extracorporeal membrane oxygenation. Hyperthyroidism, although uncommon in the newborn period, has been associated with pulmonary hypertension among adults. The exact mechanisms responsible for this effect on pulmonary vascular pressure are not well understood. Recent studies have provided evidence that thyrotoxicosis has direct and indirect effects on pulmonary vascular maturation, metabolism of endogenous pulmonary vasodilators, oxygen economy, vascular smooth muscle reactivity, and surfactant production, all of which may contribute to the pathophysiologic development of PPHN. Therefore, because PPHN is a significant clinical entity among term newborns and the symptoms of hyperthyroidism may be confused initially with those of other underlying disorders associated with PPHN (eg, sepsis), it would be prudent to perform screening for hyperthyroidism among affected newborns.

Roles of the lactogens and somatogens in perinatal and postnatal metabolism and growth: studies of a novel mouse model combining lactogen resistance and growth hormone deficiency

To delineate the roles of the lactogens and GH in the control of perinatal and postnatal growth, fat deposition, insulin production, and insulin action, we generated a novel mouse model that combines resistance to all lactogenic hormones with a severe deficiency of pituitary GH. The model was created by breeding PRL receptor (PRLR)-deficient (knockout) males with GH-deficient (little) females. In contrast to mice with isolated GH or PRLR deficiencies, double-mutant (lactogen-resistant and GH-deficient) mice on d 7 of life had growth failure and hypoglycemia. These findings suggest that lactogens and GH act in concert to facilitate weight gain and glucose homeostasis during the perinatal period. Plasma insulin and IGF-I and IGF-II concentrations were decreased in both GH-deficient and double-mutant neonates but were normal in PRLR-deficient mice. Body weights of the double mutants were reduced markedly during the first 3-4 months of age, and adults had striking reductions in femur length, plasma IGF-I and IGF binding protein-3 concentrations, and femoral bone mineral density. By age 6-12 months, however, the double-mutant mice developed obesity, hyperleptinemia, fasting hyperglycemia, relative hypoinsulinemia, insulin resistance, and glucose intolerance; males were affected to a greater degree than females. The combination of perinatal growth failure and late-onset obesity and insulin resistance suggests that the lactogen-resistant/GH-deficient mouse may serve as a model for the development of the metabolic syndrome.

184PREGNANCY RATES AFTER ESTRUS SYNCHRONIZATION TREATMENT WITH NEW AND REUSED CIDR-B DEVICES

It is not well known whether used CIDR devices containing progesterone (P4) combined with estradiol benzoate (EB) and prostaglandin F2α (PGF) can provide acceptable estrus synchronization rates (ESR) and pregnancy rates (PR) in ET or AI programs. Three experiments were designed to study the effect of new and used CIDR-B, with different P4, EB and PGF treatments on ESR and PR in a reproductive program in beef cattle in a tropical climate. Experiment 1 was a control to evaluate ESR and PR in lactating recipient females. All cows (n=284) were treated with a new 1.9-g CIDR (CIDR-B, InterAg, New Zealand), combined with 2mg EB and 50mg P4 on Day 0. CIDR devices were removed on Day 8 and all cows received 0.25mg cloprostenol at that time. Estrus was expected to occur 24h later. Seven days after estrus, all cows showing heat were examined by rectal palpation and those with a CL 15mm in diameter or larger were selected to receive a frozen/thawed embryo (1.5M ethylene glycol=EG) by nonsurgical direct transfer (DT). PR were determined by rectal palpation 60d after estrus. Ninety percent of the cows displayed signs of estrus (256/284) and 40% of those that received a frozen embryo were pregnant (96/239). Experiment 2 was designed to evaluate ESR and PR in dry recipient cows treated with a used CIDR-B (first reuse). All cows (n=274) were treated with a reused 1.9-g CIDR combined with 2mg EB and 50mg P4 on Day 0. CIDR devices were removed on Day 8 and all cows received 0.25mg cloprostenol at that time. Estrus was expected to occur 24h later. Seven days after estrus, all cows that showed estrus were rectally evaluated and those with a CL 15mm in diameter or larger received a frozen/thawed embryo (1.5M EG) by DT. A total of 93% of the treated cows showed signs of estrus (254/274) and 51% of those that received an embryo were pregnant (110/217). Experiment 3 was designed to evaluate ESR and PR in virgin heifers, treated with a used CIDR (second reuse). All heifers (n=414) were treated with a reused 1.9-g CIDR combined with 1mg EB on Day 0. CIDR devices were removed on Day 8 and all heifers were expected to show estrus 24h later. Approximately 12h after estrus, all heifers that showed signs of estrus were inseminated, using frozen/thawed semen from a single bull. Of the treated females, 78% showed signs of estrus (323/414) and 69% of the inseminated were pregnant (223/323). These results suggest that in a CIDR that was used in two previous occasions, there is still a remaining amount of P4 that allows estrus synchronization in heifers. Furthermore, the reutilization of CIDR-B devices can contribute to reduce the costs related to ET or AI programs in cattle. However, the diverse existing conditions among the 3 experimental groups in this study make a statistical comparison impossible. Therefore, further studies are needed, under controlled experimental conditions, to confirm the results obtained.

Insulin pump therapy in toddlers and preschool children with type 1 diabetes mellitus

OBJECTIVE

To test whether glycemic control in young children could be achieved more effectively and safely by using continuous insulin infusions administered by insulin pumps.

STUDY DESIGN

We analyzed the effects of pump therapy in nine toddlers in whom type 1 diabetes developed between the ages of 10 and 40 months. After a mean of 13.7 months of therapy with multiple daily injections, patients were treated with insulin pumps for periods ranging from 7 to 19 months (mean, 12.7 months).

RESULTS

Before initiation of pump therapy, HbA1c levels averaged 9.5% +/- 0.4%, and patients had a mean of 0.52 episodes per month of severe hypoglycemia (uncontrolled shaking, inconsolable crying, disorientation, or seizures). After initiation of pump therapy, HbA1c levels declined to 7.9% +/- 0.3% (P <.001 vs prepump levels), and the incidence of severe hypoglycemia decreased to 0.09 episodes per month (P <.05). Normal linear growth and weight gain were maintained during pump therapy. There were no changes in the frequency of physician or emergency room visits for acute hyperglycemia or ketoacidosis. However, the frequency of parental contacts with health personnel declined by >80%, reflecting increasing parental confidence and independence in diabetic care. Subjective assessments revealed significant improvements in quality of life and high levels of satisfaction with pump therapy.

CONCLUSIONS

Insulin pump therapy may provide an effective alternative for selected preschool children with type 1 diabetes.

Leptin in the newborn mouse. Plasma concentrations, characterization of the circulating hormone, and tissue source

Previous studies suggested that brown adipose tissue (BAT) provides a source of circulating leptin in the newborn mouse. However, we detected no leptin mRNA in newborn BAT or in newborn liver or stomach. In contrast, leptin expression was detected readily in newborn white adipose tissue (WAT). Fasting plasma leptin concentrations in newborn mice were comparable to those in adult nonpregnant mice. In contrast to adult mice, however, the fasting leptin levels in newborn males were comparable to those in females. While leptin in the late-gestational pregnant mouse circulates as a complex with the leptin-binding protein, leptin in the newborn mouse circulates as the free hormone. Factors regulating the expression of leptin by newborn WAT remain to be elucidated.

Targeted deletion of the PRL receptor: effects on islet development, insulin production, and glucose tolerance

PRL and placental lactogen (PL) stimulate beta-cell proliferation and insulin gene transcription in isolated islets and rat insulinoma cells, but the roles of the lactogenic hormones in islet development and insulin production in vivo remain unclear. To clarify the roles of the lactogens in pancreatic development and function, we measured islet density (number of islets/cm(2)) and mean islet size, beta-cell mass, pancreatic insulin mRNA levels, islet insulin content, and the insulin secretory response to glucose in an experimental model of lactogen resistance: the PRL receptor (PRLR)-deficient mouse. We then measured plasma glucose concentrations after ip injections of glucose or insulin. Compared with wild-type littermates, PRLR-deficient mice had 26-42% reductions (P < 0.01) in islet density and beta-cell mass. The reductions in islet density and beta-cell mass were noted as early as 3 wk of age and persisted through 8 months of age and were observed in both male and female mice. Pancreatic islets of PRLR-deficient mice were smaller than those of wild-type mice at weaning but not in adulthood. Pancreatic insulin mRNA levels were 20-30% lower (P < 0.05) in adult PRLR-deficient mice than in wild-type mice, and the insulin content of isolated islets was reduced by 16-25%. The insulin secretory response to ip glucose was blunted in PRLR-deficient males in vivo (P < 0.05) and in isolated islets of PRLR-deficient females and males in vitro (P < 0.01). Fasting blood glucose concentrations in PRLR-deficient mice were normal, but glucose levels after an ip glucose load were 10-20% higher (P < 0.02) than those in wild-type mice. On the other hand, the glucose response to ip insulin was normal. Our observations establish a physiologic role for lactogens in islet development and function.

Neonatal endocrinology

Neonatal endocrinology is a diverse topic. Several chapters could be devoted to the endocrinology of fetal transition alone. The next several pages contain a brief overview of some pertinent illnesses. It is intended not to give an absolute map in the care of these patients but to help guide the physician in tailoring an approach for each patient based on current theories and practice parameters. It could also aid in improving the physician's understanding of screening laboratories used to identify those infants at risk of preventable, treatable and potentially disastrous diseases (i.e. congenial hypothyroidism). These metabolic screens are discussed due to their efficacy in the United States. In our experience, depending on the prevalence of a specific disease a few simple procedures allow for an efficient and economic way to reach ill children in a timely fashion. Other topics included in this article were reported based on their common occurrence, the lethality of illnesses if undiagnosed or their unique treatment. In the neonate hypoglycemia, either iatrogenic or secondary to sepsis, a congenital disorder of neisidioblastosis can have severe implications on the development of the CNS if not promptly treated and prevented. Some of these disorders require an experienced endocrinologist or neonatologist to treat and supervise conscientiously (i.e. CAH). However, as most of us know, it is sometimes hard to find such an individual in a community based practice. Therefore, it becomes of paramount value that each of us pays attention to the treatment of these illnesses for the sake of the children we care for.

[Malignant non-Hodgkin's lymphoma of the joint. Report of two cases, review of the literature and problems of classification]

This paper gives a survey of malignant Non-Hodgkin lymphomas (NHL) of joints. Primary and secondary malignant lymphomas of joints are rare. Our analysis of 6 years', new entries in the lymph node register in Kiel, covering 37.367 cases of malignant lymphomas, revealed only 20 cases (0.05%) with infiltration of joints. Slightly more men than women (1.18:1) are actually affected by articular lymphomas. In addition to 34 articular lymphomas of joints described in the literature between 1974 and 1992, we analyse 2 cases seen in our own institute and the 20 cases taken from the Kiel lymph node register. The peak incidence is between 40 and 60 years of age. One of our own cases, a woman of 92, is the oldest person ever affected. The most frequent localizations of NHLs are the knee, hip, and shoulder joints, with low-grade lymphomas predominating. Osteolytic lesions on radiographs are of decisive clinical and diagnostic significance for malignant articular lymphomas with affected bones. Lymphomas of joints are treated almost exclusively by radiation and chemotherapy, and sometimes a combination of both. Decisive prognostic significance attaches to the grade of malignancy and the fact of primary or secondary infiltration of the synovium and of the bone. The average survival time for patients with low-grade NHLs is 19 months with infiltration of the synovium and 27 months with infiltration of joint forming bones only, whereas the average survival time for patients high-grade lymphomas is 8 months with infiltration of the synovium and 11 months with infiltration only of joint-forming bones.(ABSTRACT TRUNCATED AT 250 WORDS)

Refractoriness of both uterus and mammary gland of the cow to prostaglandin F2 alpha administration:P clinical application

Uterine and mammary pressure changes were simultaneously measured in lactating nonpregnant cows injected (IV) with different doses (0.1 to 32.0 mg) of prostaglandin F2 alpha (PGF2 alpha). The total work of the uterus increased up to 250% of base-line value as the dose of PGF2 alpha was increased. But, a dose-response relationship was not seen in the uterus. Partial refractoriness was developed in the uterus, and total refractoriness was developed in the mammary gland. Further challenge with oxytocin (30 U) elicited significant responses in both the uterus and the mammary gland. Because of the development of refractoriness and side effects, PGF2 alpha is not recommended as a drug to be used when mechanical evacuation (free of endocrine effect) of the uterus or mammary gland (or both) is indicated.