Investigating the secondary care system burden of CRSwNP in sinus surgery patients with clinically relevant comorbidities using the HES database

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic condition that can adversely affect quality of life for patients. There is no cure for CRSwNP, and patients may require intermittent systemic corticosteroids (SCS) and surgery in addition to intranasal treatment throughout their lifetime. This places a significant burden on the NHS which can be compounded by comorbid conditions such as asthma or NSAID-exacerbated respiratory disease (NERD). Patients with comorbidities are likely to experience higher rates of surgery and more secondary care visits. The aim of this study was to evaluate revision rates and the associated burden for patients with CRSwNP undergoing surgery and compare this to sub-cohorts of patients with comorbidities.

MATERIALS AND METHODS

This study has utilised the Hospital Episodes Statistics (HES) database across a ten-year time period (April 2010 to March 2020) to investigate the NHS resource use attributable to CRSwNP for all patients with the condition who have undergone sinus surgery, and to examine the burden of clinically relevant sub-groups.

RESULTS

Our results showed that 101,054 patients underwent at least one sinus surgery in relation to their nasal polyps, with Kaplan Meier survival analysis estimating that the 10-year probability of revision is between 71-90% for comorbid patients, and 51% for non-comorbid patients. Patients with a relevant comorbid condition in addition to their CRSwNP were up to 4.7 times more likely to undergo at least one revision surgery during the ten-year analytical time window when compared to patients without a comorbidity. Further to this, comorbid patients had a higher tariff associated with their CRSwNP care across the analytical time window and were therefore likely to be more costly to the healthcare system.

CONCLUSIONS

In conclusion, this study demonstrates that there is a high burden attached to CRSwNP-related sinus surgery and that comorbidities are a key driver of NHS resource use.

Treatment outcomes of patients with Atopic Dermatitis (AD) treated with dupilumab through the Early Access to Medicines Scheme (EAMS) in the UK

BACKGROUND

Dupilumab, a monoclonal antibody against interleukin (IL)-4 receptor alpha that inhibits IL-4/IL-13 signalling is indicated in dermatology for the treatment of moderate-to-severe atopic dermatitis (AD) in adult and adolescent patients 12 years and older and severe AD in children 6-11 years, who are candidates for systemic therapy. Dupilumab received Early Access to Medicines Scheme (EAMS) approval for adults in March 2017.

OBJECTIVES

The purpose of this study was to assess the efficacy outcomes of treatment with dupilumab in EAMS.

METHODS

A retrospective analysis of adult patients enrolled in the dupilumab EAMS in the UK. Scores were assessed at baseline and follow up, including the Eczema Area and Severity Index (EASI), Investigator's Global Assessment Score (IGA) and Dermatology Life Quality Index (DLQI).

RESULTS

Data were available for 57 adult patients treated with dupilumab for at least 12 weeks; 73.6% of patients had received prior treatment with 3 or 4 immunosuppressants. Baseline scores for the EASI and DLQI were 27.93 (standard deviation, SD 13.09) and 18.26 (SD 6.18) respectively. AD severity scores showed statistically significant improvement at week 16±4 weeks (p <0.001 for all). The mean change in EASI was 14.13 points with 66.7% and 36.7% achieving a 50% (EASI-50) and 75% (EASI-75) improvement in EASI, respectively at 16^+/- 4 weeks. IGA scores improved by at least two categories for 75% patients. DLQI scores decreased by a mean of 9.0 points, with 80% patients demonstrating a MCID 4-point improvement. For 85% patients, clinicians rated the treatment response as being either 'better' (19%) or 'much better' (65%).

CONCLUSIONS

Dupilumab is associated with a significant and clinically relevant improvements in AD as measured by patient- and physician-reported outcome measures. Importantly, the clinical efficacy, despite the refractory disease of this EAMS cohort, is comparable to that previously reported in clinical trials.

Poly(meta-phenylene oxides) for the design of a tunable, efficient, and reusable catalytic platform

We present poly(meta-phenylene oxides) as versatile and tunable scaffolds for immobilized catalyst design.

Estimating the impact of better management of glycaemic control in adults with Type 1 and Type 2 diabetes on the number of clinical complications and the associated financial benefit

AIM

To estimate potential cost avoidance through modest and achievable improvements in glycaemic control in adults with Type 1 or Type 2 diabetes mellitus in the UK healthcare system.

METHODS

The IMS Core Diabetes Model was used to examine the impact of improved glycaemic control (indicated by reduction in HbA_1c level), in a representative cohort of adults with Type 1 or Type 2 diabetes. The cumulative incidence of microvascular and macrovascular complications was modelled across 5-year periods to a 25-year time horizon. Complication costs were applied to the data to estimate potential accrued cost avoidance.

RESULTS

Significant cost avoidance of ~£340 m is apparent in the first 5 years, increasing to ~£5.5bn after 25 years of sustained improvement in control. The overwhelming majority of cost avoidance arises from reductions in microvascular complications. In people with Type 1 diabetes the greatest cost avoidance comes from a reduction in renal disease (74% of cost avoidance), while in people with Type 2 diabetes it is generated by a reduction in foot ulcers, amputations and neuropathy: 57% cost avoidance). Greater cost reduction is accrued more rapidly in people with higher starting HbA_1c levels.

CONCLUSION

Modest improvements in glycaemic control generate significant reductions in the incidence and, therefore, cost of microvascular complications in people with Type 1 or Type 2 diabetes. This study provides clear support for the premise that prioritized and sustained investment in early and better intervention can provide concrete financial benefits in both the short and longer term.

Mothers and offspring: The rabbit as a model system in the study of mammalian maternal behavior and sibling interactions

This article is part of a Special Issue "Parental Care". Jay Rosenblatt effectively promoted research on rabbit maternal behavior through his interaction with colleagues in Mexico. Here we review the activities of pregnant and lactating rabbits (Oryctolagus cuniculus), their neuro-hormonal regulation, and the synchronization of behavior between mother and kits. Changing concentrations of estradiol, progesterone, and prolactin throughout gestation regulate nest-building (digging, straw-carrying, fur-pulling) and prime the mother's brain to respond to the newborn. Nursing is the only mother-young contact throughout lactation. It happens once/day, inside the nest, with ca. 24h periodicity, and lasts around 3min. Periodicity and duration of nursing depend on a threshold of suckling as procedures reducing the amount of nipple stimulation interfere with the temporal aspects of nursing, though not with the doe's maternal motivation. Synchronization between mother and kits, critical for nursing, relies on: a) the production of pheromonal cues which guide the young to the mother's nipples for suckling; b) an endogenous circadian rhythm of anticipatory activity in the young, present since birth. Milk intake entrains the kits' locomotor behavior, corticosterone secretion, and the activity of several brain structures. Sibling interactions within the huddle, largely determined by body mass at birth, are important for: a) maintaining body temperature; b) ensuring normal neuromotor and social development. Suckling maintains nursing behavior past the period of abundant milk production but abrupt and efficient weaning occurs in concurrently pregnant-lactating does by unknown factors.

CONCLUSION

female rabbits have evolved a reproductive strategy largely dissociating maternal care from maternal presence, whose multifactorial regulation warrants future investigations.

Coupling the magnetic and heat dissipative properties of Fe3O4 particles to enable applications in catalysis, drug delivery, tissue destruction and remote biological interfacing

As interest in nanomaterials continues to grow, and the scope of their applications widens, one subset of materials has set itself apart: magnetic nanoparticles (MNPs).

Synthesis of indoles, benzofurans, and related heterocycles via an acetylene-activated SNAr/intramolecular cyclization cascade sequence in water or DMSO

The synthesis of 2-substituted indoles and benzofurans was achieved by nucleophilic aromatic substitution, followed by subsequent 5-endo-dig cyclization between the nucleophile and an ortho acetylene.

SPAms: A user-friendly software to simulate population genetics data under complex demographic models

Patterns of genetic diversity can be used to reconstruct populations demographic history. Thus, it is crucial to understand the statistical properties of data sets generated under different scenarios. SPAms is a graphical application that allows the simulation of data under a set of demographic models of increasing complexity: (i) population size change (ii) admixture and (iii) population structure (n-island or stepping stone model). SPAms generates data under the infinite site and the stepwise mutation models and computes a set of commonly used statistics. It should thus be a useful tool for both research and teaching purposes.

Lack of alternative coreceptor use by pediatric HIV-1 R5 isolates for infection of primary cord or adult peripheral blood mononuclear cells

HIV-1 infection of neonates results in an extended acute period of virus replication, frequent neurological problems and reduced survival compared to adults. In adults, R5 viruses mainly infect CCR5(+) CD4(+) memory T-cells. In neonates, CCR5(+) memory T-cells form a substantially smaller fraction of total lymphocytes. We therefore tested whether alternative coreceptors confer infection of lymphocytes by pediatric isolates. Pediatric HIV-1 R5 isolates failed to replicate in Delta32/Delta32 CCR5 PBMCs or in cord PBMCs treated with a CCR5 inhibitor. These results do not indicate a role for alternative coreceptors and provide support for CCR5 inhibitors in the therapy of HIV-1(+) neonates.

Extensive coloured identification of dog chromosomes to support karyotype studies: the colour code

The identification of individual dog chromosomes is problematic because the 38 pairs of autosomes are small and acrocentric. Here we describe the design and application of a FISH tool that enables definitive identification of each dog autosome in a normal karyotype, without relying on subjective interpretation of DAPI banding patterns. From a high-resolution physical map of the canine genome, we have chosen a panel of 80 canine chromosome-specific BAC clones. DNA from each clone is labeled with one of five different fluorochrome-conjugated nucleotides. By selecting one to three spatially separated BACs per chromosome, and labelling them with a distinctive combination of colours, each autosome can be identified objectively and orientated accurately, irrespective of the quality of DAPI chromosome banding. This tool, or part of it, can be used for any purpose where accurate identification of canine autosomes in a normal karyotype is essential. In this study, we demonstrate use of the 'colour code' for chromosome identification following CGH analysis of unbalanced genomic aberrations in a canine brain tumour. Our method is an improvement of an earlier procedure, featuring chromosome-specific BACs and sequential FISH hybridisations, as it enables simultaneous identification of all chromosomes in a single hybridisation.

Diurnal pattern of clock gene expression in the hypothalamus of the newborn rabbit

In the European rabbit (Oryctolagus cuniculus) nursing acts as a strong non-photic synchronizer of circadian rhythmicity in the newborn young. Rabbits only nurse for a few minutes once every 24 h and previous studies have shown that the pups, blind at birth, display endogenous circadian rhythms in behavior and physiology entrained by this regular daily event. As a further step toward understanding the neural organization of the rabbit's early circadian system, we investigated the expression of clock genes in the suprachiasmatic nucleus of the hypothalamus (SCN; the principal circadian pacemaker in adult mammals) across the pups' 24-h day. We used 43 pups from seven litters maintained in constant darkness and entrained non-photically by nursing at the same time each day until P7. After nursing on day 7, pups were killed in the dark at 3-h intervals so as to obtain eight groups (n=5-6 pups/group) distributed evenly across the 24 h before the next scheduled nursing. Profiles in the expression of the clock genes Per1, Per2, Cry1 and Bmal1 were determined using in situ hybridization in brain sections through the hypothalamus at the level of the SCN. We report for the first time: 1) that Per1, Per2, Cry1 and Bmal1 are all expressed in the SCN of the newborn rabbit, 2) that the expression of Per1, Per2 and Bmal1 but not Cry1 shows diurnal rhythmicity similar to that in adult mammals, and 3) that the expression of Per1, Per2 and Bmal1 is consistent with the strong entraining effect of nursing found in previous studies. Unexpectedly, and contrasting somewhat to the pattern in the SCN, we also found diurnal rhythmicity in the expression of Cry1 and Bmal1 but not of Per1 in the anterior ventromedial hypothalamic nucleus. Overall, our findings suggest that the SCN is a functional part of the newborn rabbit's circadian system and that it can be entrained by non-photic cues associated with the mother's daily nursing visit.

Participation of estradiol and progesterone in the retrograde labeling of pubococcygeus motoneurons of the female rat

Retrograde labeling with horseradish peroxidase conjugated to wheat germ agglutinin showed that the pubococcygeus muscles of the female rat are innervated by a population of motoneurons located in a column approximately 2 mm in length in the central region of lamina IX of the sixth lumbar-first sacral spinal cord segments. These neurons have a dendritic distribution that projects to the lateral, medial and ventral regions of the gray matter. Values for soma size, primary dendrite length and arborization area obtained from intact animals that were in diestrous-2, were significantly reduced following ovariectomy. After hormone priming of the ovariectomized animals with estradiol benzoate and progesterone, an additional injection of estradiol benzoate alone or followed by progesterone increased the labeled length of the primary dendrites distributed to the lateral, but not to the medial or ventral regions of the gray matter in the spinal cord. However, dendritic labeling was not significantly increased when only progesterone was additionally injected. It therefore seems that pubococcygeus muscle motoneurons of the female rat are sensitive to the effects of gonadal hormones.

The development and characterisation of porphyrin isothiocyanate-monoclonal antibody conjugates for photoimmunotherapy

A promising approach to increase the specificity of photosensitisers used in photodynamic therapy has been through conjugation to monoclonal antibodies (MAb) directed against tumour-associated antigens. Many of the conjugations performed to date have relied on the activated ester method, which can lead to impure conjugate preparations and antibody crosslinking. Here, we report the development of photosensitiser–MAb conjugates utilising two porphyrin isothiocyanates. The presence of a single reactive isothiocyanate allowed facile conjugation to MAb FSP 77 and 17.1A directed against internalising antigens, and MAb 35A7 that binds to a non-internalising antigen. The photosensitiser–MAb conjugates substituted with 1–3 mol of photosensitiser were characterised in vitro. No appreciable loss of immunoreactivity was observed and binding specificity was comparable to that of the unconjugated MAb. Substitution with photosensitiser had a minimal effect on antibody biodistribution in vivo for the majority of the conjugates, although a decreased serum half-life was observed using a cationic photosensitiser at the higher loading ratios. Tumour-to-normal tissue ratios as high as 33.5 were observed using MAb 35A7 conjugates. The internalising conjugate showed a higher level of phototoxicity as compared with the non-internalising reagent, using a cell line engineered to express both target antigens. These data demonstrate the applicability of the isothiocyanate group for the development of high-quality conjugates, and the use of internalising MAb to significantly increase the photodynamic efficiency of conjugates during photoimmunotherapy.

Effect of photoperiod on the mechanical response of the pregnant rabbit uterus to oxytocin

We present findings suggesting that photoperiod is important in determining the sensitivity of the late-pregnant rabbit uterus to oxytocin (OT). Longitudinal myometrial strips were taken from term-pregnant and estrous rabbits and mounted in an organ bath for isometric myographic recording at different times during a 16:8-h light-dark cycle (lights on 0600–2200; n = 5/group), and the strength of contractions was registered in response to the application of OT or KCl. Strength of contractions was dose dependent and was up to 200 times greater at doses three to four orders of magnitude lower in tissue taken from pregnant animals during the light phase (0700 and 1300) than during the dark phase (2400 and 0400). Strips from nonpregnant estrous females also showed greater sensitivity and contractile force when taken in the light (0700) than in the dark (0400), although the differences were not significant. Consistent with the influence of photoperiod on uterine sensitivity to OT, strips taken from two groups of pregnant females ( n = 5/group) maintained on a light-dark cycle advanced 12 h showed significantly greater sensitivity and force in response to OT during the new subjective light than during the new subjective dark phase. The photoperiod-dependent contractile response to OT was specific and not simply the result of a change in general mechanical properties of the muscle, because administration of KCl resulted in dose-dependent contractions of similar magnitude in both the light and dark phase. These results are consistent with the fact that rabbits, like other nocturnal mammals, typically give birth during the day.

Thermal benefit of sibling presence in the newborn rabbit

Newborn rabbits compete vigorously for the mother's milk, and survivors benefit from littermate deaths. Here we report that rabbit pups also may benefit from littermate presence in terms of increased thermal efficiency. Pups nursed normally once a day by their mother but otherwise raised alone had a lower probability of survival, lower body temperature, and lower efficiency of converting milk into body mass than their siblings raised with littermates. The contribution of a more favorable thermal environment to the better growth and survival of group-raised pups was supported by the finding that single pups raised at higher ambient temperatures grew more rapidly than single pups raised at lower temperatures. These effects were most clearly seen across Days 2 to 5, after which time differences between treatment groups were no longer significant. Thus, the results of this study suggest that the benefits as well as costs of having siblings must be weighed against each other when considering the manner in which sibling presence influences individual development and survival.

To stay or not to stay: the contribution of tactile and thermal cues to coming to rest in newborn rabbits

Newborn rabbits, like other altricial mammals, demonstrate thermotaxis and when placed on a thermal gradient locate and come to rest at physiologically appropriate temperatures. Little is known, however, about the sensory-motor components contributing to the in energetic terms important decision of the young to cease locomotion and come to rest. We investigated the behavior of newborn rabbits on two thermal gradients; linear in which pups could use tactile cues from the arena wall, and concentric in which pups were unable to use such cues. On both gradients pups located the warm, thermal-neutral area within the 200-s test time, thereby demonstrating their ability to orient appropriately using thermal cues alone. Unexpectedly, however, pups on the concentric gradient failed, or took significantly longer, to come to rest than pups on the linear gradient. Since the speed of locomotion of pups on the linear gradient was significantly slowed when they were in contact with the arena wall, and in most cases they came to rest in contact with it, we suggest that not only thermal but also tactile cues may be important in bringing young mammals to rest in a thermally appropriate environment.

Caffeine ingestion decreases glucose disposal during a hyperinsulinemic-euglycemic clamp in sedentary humans

The purpose of this investigation was to examine the effect of caffeine (an adenosine receptor antagonist) on whole-body insulin-mediated glucose disposal in resting humans. We hypothesized that glucose disposal would be lower after the administration of caffeine compared with placebo. Healthy, lean, sedentary (n = 9) men underwent two trial sessions, one after caffeine administration (5 mg/kg body wt) and one after placebo administration (dextrose) in a double-blind randomized design. Glucose disposal was assessed using a hyperinsulinemic-euglycemic clamp. Before the clamp, there were no differences in circulating levels of methylxanthines, catecholamines, or glucose. Euglycemia was maintained throughout the clamp with no difference in plasma glucose concentrations between trials. The insulin concentrations were also similar in the caffeine and placebo trials. After caffeine administration, glucose disposal was 6.38 +/- 0.76 mg/kg body wt compared with 8.42 +/- 0.63 mg/kg body wt after the placebo trial. This represents a significant (P < 0.05) decrease (24%) in glucose disposal after caffeine ingestion. In addition, carbohydrate storage was 35% lower (P < 0.05) in the caffeine trial than in the placebo trial. Furthermore, even when the difference in glucose disposal was normalized between the trials, there was a 23% difference in the amount of carbohydrate stored after caffeine administration compared with placebo administration. Caffeine ingestion also resulted in higher plasma epinephrine levels than placebo ingestion (P < 0.05). These data support our hypothesis that caffeine ingestion decreases glucose disposal and suggests that adenosine plays a role in regulating glucose disposal in resting humans.

Judgement of odor intensity is influenced by subjects' knowledge of the odor source

Odor perception, including intensity, is affected by knowledge of odor source. For 76 subjects tested with 24 everyday odorants, ratings of intensity, pleasantness and familiarity were enhanced when subjects either could identify the odor source themselves or were provided with the name by the experimenter. Ratings were highest when subjects judged that the names provided matched their own perception, suggesting an interaction between individuals' cognitive representation of odors and their immediate perceptual experience.

Diversity and development of circadian rhythms in the European rabbit

Three main concerns underlie this review: 1) The need to draw together the widely dispersed information available on the circadian biology of the rabbit. Although the rabbit is a classic laboratory mammal, this extensive body of information is often overlooked by chronobiologists, and despite several advantages of this species. In terms of its general biology the rabbit is the best studied laboratory mammal in the wild, it demonstrates a wide variety of robust circadian functions, and being a lagomorph, it provides a useful comparison with more commonly studied rodent species. 2) The need to more fully exploit a developmental approach to understanding circadian function, and the particular suitability of the rabbit for this. Female rabbits only visit their altricial young for a few minutes once every 24 h to nurse, and survival of the young depends on the tight circadian-controlled synchronization in behavior and physiology of the two parties. Patterns of circadian rhythmicity in neonatal pups associated with nursing do not form a smooth continuum into weaning and adult life, and may reflect the action of separate mechanisms operating in their own right. 3) Using information from the first two points, to emphasize the diversity and complexity of circadian rhythms underlying behavioral and physiological functions in adult and developing mammals. Information accruing on circadian functions in the rabbit makes it increasingly difficult to account for these in terms of one or two regulatory mechanisms or "oscillators." Thus, it is argued that in addition to the reductionist, molecular approaches currently dominating much of chronobiology, the study of circadian systems as emergent characteristics of whole organisms operating in complex environments merits special attention.

The ocular impression: A review of the literature and presentation of an alternate technique

Improved fit is one advantage of a custom ocular prosthesis. Numerous methods exist to gain intimate tissue adaptation. This article reviews the literature concerning such methods and presents an improved technique for fabrication of a custom ocular impression tray.

[Neurovegetative diseases in dementia]

Dementia is the result of the dysfunction and death of cells in the central and peripheral nervous system. Of diverse etiology, these processes are insidious in their onset and are characterized by a progressive neural depletion resulting in a range of cognitive deficits, including a deterioration in the capacity to learn and a tendency to forget what has been learned. Neurodegenerative diseases resulting in dementia include: Alzheimer, Parkinson, Huntington, Pick, and Creutzfeld Jakob, as well as dementias with multiple etiologies. The population with the highest probability of suffering from one of these diseases are those over 50 years of age, because they have reduced circulating levels of gonadal hormones, one of several risk factors associated with the onset of dementia. Anatomical areas most commonly affected include the hippocampus, the primary motor and somatosensory areas, various limbic structures, and the parieto-temporal, frontal, and entorhinal corticies. Affliction of this last area has been suggested to account for the early olfactory dysfunction often shown by patients after the onset of Alzheimer and Parkinson, leading to the suggestion that olfactory testing could be useful in the early diagnosis of such neurodegenerative diseases.

Morphology of developing olfactory axons in the olfactory bulb of the rabbit (Oryctolagus cuniculus): a Golgi study

Transient expression of axon collaterals plays an important role in enabling neurons to find appropriate targets during development. In the olfactory bulb, the numbers of both sensory neurons and their targets, the glomeruli, increase markedly during the postnatal period. In the present study, the morphology of developing olfactory axons in the olfactory bulb of 1-21-day-old rabbits was analyzed using stereological methods and the rapid Golgi technique. The findings demonstrated a change in axon morphology from the olfactory nerve layer to the glomeruli suggestive of a sequence in axon development. In the olfactory nerve layer, axons typically had knob-like growth cones and a few collateral branches. Close to glomeruli, axons increased in thickness, formed rather complex and irregular growth cones, and typically gave off many collaterals. Within glomeruli, the axons formed terminal branches and boutons. Extraglomerular branches were apparently removed once axons had entered a glomerulus, insofar as these branches often displayed morphological signs of degeneration. In contrast, collateral branches ending in the same glomerulus remained, indicating that formation of collaterals may assist olfactory axons in locating glomerular targets.

Plasma leptin in moderately obese men: independent effects of weight loss and aerobic exercise

The independent effects of weight loss and exercise on plasma leptin and total (AT), subcutaneous (SAT), and visceral (VAT) adipose tissue were investigated in 52 obese men. Subjects were randomly assigned to four 12-wk protocols: 1) control (C, n = 8), 2) diet-induced weight loss (DWL, n = 14), 3) exercise-induced weight loss (EWL, n = 14), and 4) exercise with weight maintenance (EWS, n = 16). Plasma leptin was unchanged in C (from 7.8 +/- 1.3 to 7.7 +/- 1.0 ng/ml). Equivalent weight loss (7.5 kg) decreased leptin significantly but similarly (DWL, from 8.5 +/- 1.0 to 4.8 +/- 0.6 ng/ml; EWL, from 10.1 +/- 1.0 to 5.0 +/- 0.6 ng/ml). Exercise in the absence of weight loss did not alter leptin levels (from 10.1 +/- 1. 3 to 9.2 +/- 1.2 ng/ml). Changes in leptin correlated with changes in AT and SAT (both P < 0.05) but not in VAT. We conclude that reduction in adipose tissue after weight loss results in a collateral decrease in circulating leptin, and exercise, independent of its effects on weight loss, has no profound influence on leptin secretion.

Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial

BACKGROUND

The independent effects of diet- or exercise-induced weight loss on the reduction of obesity and related comorbid conditions are not known. The effects of exercise without weight loss on fat distribution and other risk factors are also unclear.

OBJECTIVE

To determine the effects of equivalent diet- or exercise-induced weight loss and exercise without weight loss on subcutaneous fat, visceral fat skeletal muscle mass, and insulin sensitivity in obese men.

DESIGN

Randomized, controlled trial.

SETTING

University research center.

PARTICIPANTS

52 obese men (mean body mass index [+/-SD], 31.3 +/- 2.0 kg/m2) with a mean waist circumference of 110.1 +/- 5.8 cm.

INTERVENTION

Participants were randomly assigned to one of four study groups (diet-induced weight loss, exercise-induced weight loss, exercise without weight loss, and control) and were observed for 3 months.

MEASUREMENTS

Change in total, subcutaneous, and visceral fat; skeletal muscle mass; cardiovascular fitness; glucose tolerance and insulin sensitivity.

RESULTS

Body weight decreased by 7.5 kg (8%) in both weight loss groups and did not change in the exercise without weight loss and control groups. Compared with controls, cardiovascular fitness (peak oxygen uptake) in the exercise groups improved by approximately 16% (P < 0.01). Although total fat decreased in both weight loss groups (P < 0.001), the average reduction was 1.3 kg (95% CI, 0.3 to 2.3 kg) greater in the exercise-induced weight loss group than in the diet-induced weight loss group (P = 0.03). Similar reductions in abdominal subcutaneous, visceral, and visceral fat-to-subcutaneous fat ratios were observed in the weight loss groups (P < 0.001). Abdominal and visceral fat also decreased in the exercise without weight loss group (P = 0.001). Plasma glucose and insulin values (fasting and oral glucose challenge) did not change in the treatment groups compared with controls (P = 0.10 for all comparisons). Average improvement in glucose disposal was similar in the diet-induced weight loss group (5.6 mg/kg skeletal muscle per minute) and in the exercise-induced weight loss group (7.2 mg/kg skeletal muscle per minute) (P > 0.2). However, these values were significantly greater than those in the control and exercise without weight loss groups (P < 0.001).

CONCLUSIONS

Weight loss induced by increased daily physical activity without caloric restriction substantially reduces obesity (particularly abdominal obesity) and insulin resistance in men. Exercise without weight loss reduces abdominal fat and prevents further weight gain.

Metabolic correlates of the circadian pattern of suckling-associated arousal in young rabbits

Young rabbits (Oryctolagus cuniculus) are only nursed for 3-5 min every 24 h. They show a circadian increase in activity in anticipation of this, which is entrained by suckling. Our aim was to determine whether serum and liver metabolites show diurnal fluctuations which could act to regulate this circadian pattern. Stomach weight, liver glycogen and serum metabolites were measured every 3 h in 7- to 8-day-old pups when normally nursed (up to 24 h after suckling) and fasted (up to 48 h after suckling). The results suggest: 1. Energy balance between feeds was maintained by a cascade in the use of fuels, first glucose from the milk, then glycogen stores and gluconeogenesis from circulating products of proteins and triglycerides, and finally, in late-fasted animals, the mobilization of free fatty acids. 2. The empty stomach and depletion of glycogen 23-24 h after the last feed could act to trigger anticipatory arousal in normally nursed pups, and the release of free fatty acids 45 48 h after the last feed could trigger this in fasted pups. 3. Unmasking of rhythmicity by fasting in serum levels of glucose and proteins suggests their regulation by endogenous oscillators, which may also be the case for the mobilization of free fatty acids.

Immediate postnatal sucking in the rabbit: its influence on pup survival and growth

This study was aimed at characterising the impact of immediate postnatal sucking on pup survival and development. The interactive effects of postnatal success with the day 0 weight of pups, the nest-access regimen (controlled or free) or parity of females was investigated. Pups (n = 900) were categorised according to their initial ingestion of colostrum. In primiparous does: (1) pup mortality between d0-d10 was higher for unsuccessful than for successful early suckers; (2) lighter d0-weight reduced survival for unsuccessful but not for successful pups; (3) free nest-access of females annihilated the survival advantage fostered by the initial sucking success. In secondiparous does, these impacts waned. Finally, whatever the does' parity, only d0-weight influenced pup weight-gain between d0-21. Thus, pup survival seemed to depend (at least in primiparae) on their ability to suck right after birth, and to display a pattern of energy saving without being disturbed by the females' nest entries.

Expression of c-fos in the main olfactory bulb of neonatal rabbits in response to garlic as a novel and conditioned odour

Expression of c-Fos was examined in the olfactory bulbs of 3-day-old rabbits after they had been presented with the odour of garlic as a novel stimulus, as a learned odour, or during conditioning, and this expression compared with baseline levels in non-stimulated controls. Exposure to garlic odour resulted in substantial and widespread increases in c-Fos expression in the olfactory bulbs of all animals. However, although conditioned pups showed a specific behavioural response to the learned garlic odour, neither the amount nor pattern of c-Fos expression differed compared to pups exposed to garlic as a novel odour. The odour-induced expression of c-Fos was not well localised, although there was a significant increase in the number of granule cells expressing c-Fos in the ventrolateral region of the bulb. These results support previous reports that the response to odours in the olfactory bulb of new-born animals is not as spatially distinct as that in adults. Nevertheless, the immature olfactory system of these young animals is clearly capable of very specific odour learning.