Sealing ability, water sorption, solubility and toothbrushing abrasion resistance of temporary filling materials

AIM

To evaluate marginal seal, water sorption, solubility and loss of mass after brushing of several temporary filling materials.

METHODOLOGY

For marginal seal, Class I cavities, including endodontic access preparations, were made in human molar teeth and restored using one or other of several temporary filling materials (n = 10): zinc oxide/calcium sulphate-based cement (Cavit, 3M,ESPE, St. Paul, MN, USA), zinc oxide/eugenol cement (IRM, Dentsply Caulk, Milford, DE, USA), glass ionomer cement (Vidrion R, SSWhite, Rio de Janeiro, RJ, Brazil) or a dimethacrylate-based filling (Bioplic, Biodinâmica, Londrina, PR, Brazil). Dye penetration was assessed after thermocycling and immersion in 0.5% basic fuchsine solution. For water sorption, solubility and loss of mass analyses, disc-shaped specimens were made. Water sorption and solubility were evaluated by mass alteration after storage in distilled water for 7 days (n = 7). Loss of mass was calculated based on the difference of mass after abrasion with a toothbrush (n = 5), and surfaces were analysed by SEM. Data of water sorption, solubility and loss of mass were submitted to anova and Tukey's test, and marginal sealing data to Kruskal-Wallis test (P < 0.05).

RESULTS

Statistically significant differences were observed for marginal sealing (P < 0.0001), water sorption (P < 0.01), solubility (P < 0.01) and loss of mass (P < 0.05). Bioplic had the best marginal seal. Cavit had the greatest water sorption and solubility. Vidrion R and Bioplic had the lowest solubility. Loss of mass after brushing was higher for Cavit, followed by Bioplic, IRM and Vidrion R. Cavit and Vidrion R were worn aggressively by brushing.

CONCLUSIONS

The resin-based temporary filling Bioplic produced the best marginal seal, and was associated with the lowest water sorption, solubility and loss of mass.

Toward the acoustical characterization of asphalt pavements: analysis of the tire/road sound from a porous surface

Sound level in close proximity to the contact patch of the tire and road (L(CPtr)) is analyzed as a function of the vehicle speed in the acoustic frequency range, showing different behavior depending on frequency. At least two regions are observed; one at low frequencies, where the variation in sound with speed (coefficient B) increases with frequency, and the other at higher frequencies, where such sound/speed variation does not increase significantly with frequency. The dependence of B at low frequencies seems to be correlated with the high sound absorption of this porous surface.

Biologic diversity of polyomavirus BK genomic sequences: Implications for molecular diagnostic laboratories

Data on polyomavirus genomic diversity has greatly expanded in the past few years. The implications of viral DNA sequence variation on the performance of molecular diagnostic assays have not been systematically examined. 716 BK, 1626 JC, and 73 SV40 virus sequences available in GenBank were aligned using Clustal-X. Five different published BKV PCR assays currently in use at major medical centers were evaluated for primer and probe mismatches with available GenBank sequences. Coverage of naturally occurring BKV strains varied amongst different assay methods. Targeted viral sequences showed major mismatch with primer or probe sequence in up to 30.7% of known BKV strains. BKV subtypes IVa, IVb, and IVc were more prone to this problem, reflecting common use of Type I Dun sequence for assay design. Despite the known polymorphism of this gene, 484 VP-1 sequences with conserved areas potentially suitable for PCR assay design are available. Assay targets in the Large T-antigen and agnogene are less subject to genetic variation, but sequence information corresponding to the latter two genes is available only for 164 and 174 published strains, respectively. Cross reactivity of appropriately selected BKV primers with JCV and SV40 sequences available in current databases was not a significant problem.

Metabolic risk-factor clustering estimation in obese children

The purpose of this study was to apply the new approach for Metabolic Individual Risk-factor And Clustering Estimation (MIRACLE) score in a group of Spanish obese children and adolescents and to describe its relationship with other metabolic risk factors. 153 children with simple obesity were studied: 79 males and 74 females, mean age 11.2 +/- 2.2. Obesity was defined when BMI was higher than the age and sex specific equivalent to 30 kg/m2 in adults. MIRACLE score included: family history (early cardiovascular disease, type 2 diabetes, and hypertension), individual history (small for gestational age and ethnic origin), clinical features (BMI, waist circumference > 90th percentile and blood pressure > 95th percentile) and metabolic abnormalities (glucose intolerance or type 2 diabetes). It was assigned a value of 1 to "presence" and 0 to" absence" in every patient. The children were considered as having metabolic risk when at least 5 items were present. Triglycerides, HDL-cholesterol, apolipoprotein B, apolipoprotein A1, glucose and HOMA index, were measured too. The most frequent clinical features of MIRACLE score were: excess waist circumference (95.4%) and hypertension (41.8%). Family history criteria were frequent (55.3% for type 2 diabetes, 39.1% for hypertension and 31.3% for early cardiovascular disease). Individual risk factors were not frequent. Glucose intolerance was detected in 22.2% of the obese patients. A MIRACLE score > or = 5 was found in 37.4% of the children studied, being associated with a significant risk of dyslipidemia (triglycerides, p = 0.040; HDL-cholesterol, p = 0.006; LDL-cholesterol p = 0.038; apolipoprotein B, p = 0.008) only in females. In conclusion, the MIRACLE score is useful in order to detect metabolic risk in obese children but it seems necessary to improve the score, by including other features of the metabolic syndrome like lipid profile or indirect indicators of insulin resistance.

Zinc supplementation in infants with asymmetric intra uterine growth retardation; effect on growth, nutritional status and leptin secretion

OBJECTIVES

To analyse the effect of zinc supplementation in growth and nutritional status of a homogeneous group of newborns with intra uterine growth retardation and asymmetric growth. The effect of changes of zinc status on growth and leptin serum concentrations was also analysed.

POPULATION AND METHODS

A double blind, randomised clinical trial was designed in order to detect differences in growth between zinc and placebo groups during the first 6 months of life. 31 infants were included either to the zinc group (n = 14) (38.8+/-1.4 weeks GA, 2,171+/-253 g body weight) or the placebo group (n = 17) (38.9+/-1.1 weeks GA, 2,249+/-220 g body weight). The zinc group received a supplement of 3 mg elemental zinc per day (as zinc sulphate).

RESULTS

There were not significant differences between groups for anthropometric measurements through the study period. We found a significant effect of the study group, in hair zinc concentrations, but not in serum zinc concentrations; post-hoc comparisons for hair zinc revealed that there were significant differences between groups at 1, 2, and 6 months of age. Changes in serum and hair zinc concentrations from baseline to 6 months, showed significant correlations with changes in weight/age and length/age z-scores, in the supplement group. Changes in leptin serum concentrations during follow-up, showed significant correlations with changes in sum of 4 skinfolds and weight/age z-score, in the placebo group. Changes in hair zinc concentration through the study period showed significant correlations with changes in leptin serum concentrations from baseline to 6 months of follow-up.

CONCLUSIONS

In a homogeneous group of intra uterine growth retardation infants with asymmetric growth, 3 mg/day zinc supplementation do not show significant improvements in weight and length growth. Changes in zinc status were related with changes in weight and length during the first 6 months of life. Changes in leptin serum concentrations were related with changes in the anthropometric indices of body fat accretion.

Assessment of asphalt concrete acoustic performance in urban streets

Geo-referenced close proximity rolling noise and sound absorption measurements are used for acoustical characterization of asphalt concrete surfaces in an urban environment. A close proximity noise map of streets with low speed limits is presented for a reference speed of 50 km/h. Different pavements and pavement conditions, common in urban streets, are analyzed: dense and semidense asphalt concrete, with Spanish denomination D-8 and S-12, respectively, and on the other hand, dense pavement at the end of its service life (D-8(*)). From the acoustics point of view, the most favorable surface, by more than 4 dB(A) compared with the S-12 mix, is the smoothest surface, i.e., the D-8 mix, even though it presents a minor absorption coefficient in normal incidence. Noise levels from dense surfaces (D-8) increase significantly over time, principally due to the appearance of surface defects such as cracks and ruts. Longitudinal variability of the close proximity tire/pavement noise emission and surface homogeneity are also analyzed.

Monitoring road surfaces by close proximity noise of the tire/road interaction

Applied acoustics is becoming an important field for civil infrastructure and environmental assessment, and road maintenance or rehabilitation strategies. In this research LA(2)IC has developed a GPS-based measurement techniques and apparatus on a test vehicle, for monitoring the acoustical properties of different road pavement surfaces with a reference tire. A field test on PA-12 Spanish porous pavement found in Ciudad Real is developed. The test procedure, a modification based upon the close-proximity method (CPX), relies on the use of three standard microphones situated very close to the tire/road contact patch. This procedure allows the simultaneous measurement of the sound emission synchronized to a GPS receiver, which permits tracking of the position of the sound emission. Geo-referenced sound spectra for every 10 m during individual passes of the test vehicle are analyzed to determine the tire/road noise emissions from tire/PA-12 pavement interaction. Noise levels of around 102 dB(A), with a variability of approximately 0.6 dB(A), are found at a reference vehicle speed of 85 kmh. The frequency spectrum analysis over the test section shows noticeable differences for frequencies above 1 kHz, where the tire/road noise generation mechanisms are dominated by air pumping.

Body fat distribution reference standards in Spanish adolescents: the AVENA Study

OBJECTIVE

To present body fat patterning reference standards to identify children with a predominant distribution of body fat in the abdominal or truncal region of the body.

DESIGN

Cross-sectional study in a representative sample of Spanish adolescents aged 13-18 years.

SUBJECTS

A total of 2160 adolescents with a complete set of anthropometric measurements (1109 males and 1051 females).

MEASUREMENTS

Weight, height, body mass index, skinfold thickness (biceps, triceps, subscapular, suprailiac, thigh, calf) and waist and hip circumferences.

RESULTS

In the majority of the age groups, subscapular/triceps skinfolds ratio, trunk-to-total skinfolds percent (TTS%)and waist circumference values were significantly higher in males than in females; hip circumference was higher in females than in males, except at 15.5 years. In males, age showed a significant effect for all the body fat distribution indices; however, in females, the effect was only significant for triceps skinfold, waist and hip circumferences and waist-to-hip ratio. Smoothed age- and sex-specific triceps skinfold, subscapular skinfold, subscapular/triceps skinfolds ratio, TTS%, waist circumference and hip circumference, waist-to-hip and waist-to-height ratio percentile values for male and female adolescents have been established.

CONCLUSION

These reference data for waist circumference and the other fat patterning indices, together with data from other countries, will help to establish international central obesity criteria for adolescents. The presented percentile values will give the possibility to estimate the proportion of adolescents with high or low regional adiposity amounts.

Diversity of metabolic syndrome risk factors in obese children and adolescents

The aim of this study was to investigate the frequency of metabolic syndrome (MS) variables in a group of spanish obese children and adolescents, to asses MS prevalence in this population and to describe it's relationship with other metabolic risk factors. 103 children were studied : 54 male and 49 female, mean age 10.08+/-2.3 with exogenous obesity. Obesity was defined when BMI was higher than the age and sex specific equivalent to 30 kg/m(2) in adults. MS variables considered were waist circumference, blood pressure, fasting blood triglycerides, fasting glucose/insulin and HDL-cholesterol. The children were considered as having the MS when three or more characteristics showed abnormal values according to Cook and De Ferranti definitions. HOMA index, ApoB and ApoA1 were studied too. The most frequent features of the metabolic syndrome were excess waist circumference and hypertension. The MS markers with the lowest frequency were dyslipidemia and fasting hyperglicemia. MS prevalence was 29,9% (Cook et al. criteria) and 50% (De Ferranti et al. criteria). Fasting insulin and HOMA index values increased significantly (p < 0.05) when three or more abnormalities of the MS variables were present. Apo B increased significantly only in females (p < 0.05) and Apo Al decreased significantly (p < 0.05) in both sexes when MS was present. Adequate metabolic syndrome risk factors criteria, mainly cut-off values, need to be defined in the European paediatric population.

Equilibrium Φ-Analysis of a Molten Globule: The 1-149 Apoflavodoxin Fragment

The apoflavodoxin fragment comprising residues 1-149 that can be obtained by chemical cleavage of the C-terminal alpha-helix of the full-length protein is known to populate a molten globule conformation that displays a cooperative behaviour and experiences two-state urea and thermal denaturation. Here, we have used a recombinant form of this fragment to investigate molten globule energetics and to derive structural information by equilibrium Phi-analysis. We have characterized 15 mutant fragments designed to probe the persistence of native interactions in the molten globule and compared their conformational stability to that of the equivalent full-length apoflavodoxin mutants. According to our data, most of the mutations analysed modify the stability of the molten globule fragment following the trend observed when the same mutations are implemented in the full-length protein. However, the changes in stability observed in the molten globule are much smaller and the Phi-values calculated are (with a single exception) below 0.4. This is consistent with an overall and significant debilitation of the native structure. Nevertheless, the fact that the molten globule fragment can be stabilised using as a guide the native structure of the full-length protein (by increasing helix propensity, optimising charge interactions and filling small cavities) suggests that the overall structure of the molten globule is still quite close to native, in spite of the lowered stability observed.

Homeostatic model assessment (HOMA) index cut-off values to identify the metabolic syndrome in children

The aim of the study was to establish the best cut-off value for the homeostatic model assessment (HOMA) index in identifying children and adolescents with the metabolic syndrome. The study included 72 non-obese and 68 obese children aged 7 to 16 years. Obesity is defined using the criteria proposed by Cole et al., being included as metabolic syndrome variables waist circumference, systolic blood pressure, diastolic blood pressure and seric values of glucose, uric acid, fasting insulin, leptin, triglycerides and HDL-cholesterol. Children were considered as having the metabolic syndrome when four or more characteristics showed abnormal values. The HOMA index was calculated as the product of the fasting plasma insulin level (microU/mL) and the fasting plasma glucose level (mmol/L), divided by 22.5. HOMA index cut-offs from the 5th to the 95th percentile were used. A receiver operating characteristic (ROC) curve was generated using the different HOMA cut-offs for the screening of the metabolic syndrome. The areas under the ROC curve, 95% confidence intervals, and the point to the ROC curve closest to 1, were calculated. The area under the ROC curve was 0.863 (95% C.I.: 0.797, 0.930). The point closest to 1 corresponds to the 60th percentile of the HOMA index distribution in our sample. HOMA index value at the 60th percentile was 2.28. Cut-off values corresponding to a range of HOMA index from the 50 to the 75 percentile, showed similar distances to 1. HOMA index values for percentiles 50 to 75 ranged from 2.07 to 2.83. In conclusion, HOMA index could be a useful tool to detect children and adolescents with the metabolic syndrome. HOMA cut-off values need to be defined in the paediatric population; however, values near to 3 seem to be adequate.

Carbamide peroxide bleaching agents: effects on surface roughness of enamel, composite and porcelain

This study examined the effect of 10 and 35% carbamide peroxide bleaching agents on the surface roughness of enamel, feldspathic porcelain, and microfilled and microhybrid composite resins. Standardized cylindrical specimens were prepared for restorative materials. Enamel samples were obtained from buccal and lingual surfaces of human molars. Samples from each substrate were divided in three subgroups (n=10), according to surface treatment: distilled water (control), and 10 and 35% carbamide peroxide. The 10% agent was applied 3 h daily and the 35% agent was applied for 30 min/week, at 37 degrees C, during 21 days. Control samples remained stored in distilled water, at 37 degrees C. Roughness measurements (Ra, microm) were made at 24 h and repeated after 7, 14 and 21 days of exposure. Data were analyzed using ANOVA (split-plot design) and Tukey's test (5% significance level). Samples from control groups showed no significant alteration during all test periods, while for exposure to 10% agent, only the porcelain presented a rougher surface after 21 days (p<0.05). For the 35% product, roughness means significantly increased during the first and second weeks for enamel (p<0.05), and after 21 days for porcelain (p<0.05) and for the microhybrid composite (p<0.05). Microfilled samples showed no significant alteration throughout the 21-day period, regardless of the surface treatment.

Anthropometric body fat composition reference values in Spanish adolescents. The AVENA Study

OBJECTIVE

To determine reference values for body mass index (BMI), sum of six skinfolds (sigma6 skinfolds) and body fat percentage (BF%) in Spanish adolescents aged 13-18 years, included in the AVENA Study (Alimentación y Valoración del Estado Nutricional en Adolescentes: Food and Assessment of the Nutritional Status of Adolescents).

DESIGN

Multicentre cross-sectional study.

SETTING

Representative sample of Spanish adolescents.

SUBJECTS

The population was selected by means of a multiplestep, simple random sampling. The final number of subjects included in the AVENA Study was 2859 adolescents; 2160 adolescents had a complete set of anthropometric measurements and were then included in this study (1109 males and 1051 females).

INTERVENTIONS

Weight, height and six skinfold thicknesses were measured. As indices of total adiposity, we calculated BMI, summation sigma6 skinfolds and BF% with the formulas described by Slaughter et al.

RESULTS

Sigma6 skinfolds and BF% in each age group were significantly higher in females than in males. In males, age showed a significant effect for BMI, sigma6 skinfolds and BF%; however, in females, the effect was only significant for BF%. The percentile distribution was more disperse towards higher sigma6 skinfolds and BF% values in males when compared with females.

CONCLUSIONS

The presented percentile values will help us to classify adolescents in comparison with a well-established reference population, and to estimate the proportion of adolescents with high or low adiposity amounts.

SPONSORSHIP

The AVENA-Study was supported by the Spanish Ministry of Health (FIS 00/0015), and grants from Panrico SA, Madaus SA and Procter and Gamble SA. This study was also supported by Instituto de Salud Carlos III (Spain), RCESP (C03/09) and Spanish Ministry of Education (AP2003-2128).

Secular trends in waist circumference in Spanish adolescents, 1995 to 2000-02

Two studies, in 1995 and 2000-02, were compared to assess changes in waist circumference in adolescents. Between the two time periods, waist circumference increased significantly in males at 13 years and in females at 14 years. Significant changes in waist circumference were observed during the study period; the rates of change were 0.53 and 0.86 cm/y in boys and 0.67 and 0.87 cm/y in girls. Future morbidity in adolescents may be affected due to accumulation of excess central fat.

Body fat measurement in adolescents: comparison of skinfold thickness equations with dual-energy X-ray absorptiometry

OBJECTIVE

To compare the most commonly used equations to predict body fatness from skinfold thickness, in male and female adolescents, with dual-energy X-ray absorptiometry (DXA) as a reference method of fatness measurement.

DESIGN

Cross-sectional nutrition survey.

SETTING

General adolescent population from Zaragoza (Spain).

SUBJECTS AND METHODS

A total of 238 Caucasian adolescents (167 females and 113 males), aged 13.0-17.9 y, were recruited from 15 school groups in 11 public and private schools. The percentage fat mass (%FM) was calculated by using skinfold-thickness equations. Predicted %FM was compared with the reference %FM values, measured by DXA. The lack of agreement between methods was assessed by calculating the bias and its 95% limits of agreement.

RESULTS

Most equations did not demonstrate good agreement compared with DXA. However, in male adolescents, Slaughter et al equations showed relative biases that were not dependent on body fatness and the limits of agreement were narrower than those obtained from the rest of equations. In females, Brook's equation showed nonsignificant differences against DXA and the narrowest 95% limits of agreement. Only biases from Brook and Slaughter et al equations were not dependent on body fatness in female adolescents.

CONCLUSIONS

Accuracy of most of the skinfold-thickness equations for assessment of %FM in adolescents was poor at the individual level. Nevertheless, to predict %FM when a relative index of fatness is required in field or clinical studies, Slaughter et al equations may be used in adolescents from both sexes and the Brook equation in female adolescents.

Micro-environmental and socio-demographic determinants of childhood obesity

AIM

To review the available data in Spain about the socio-demographic and home environmental determinants in children and adolescents.

METHOD

Review of the main studies conducted in Spain that have analysed the relationship between overweight and socio-economic and environmental determinants in children and adolescents.

RESULTS

In children aged 6-7 y from Aragon (Spain), the socio-demographic determinants of childhood overweight were size of municipality, year of examination, gender, and province; in adolescents aged 13-14 y, the socio-demographic determinants were year of examination, type of school, size of municipality, gender, and province; overweight showed a significant positive main effect with public schools and low municipality size. In a nationally representative sample of Spanish adolescents from 13 to 18.5 y (AVENA Study), there was a significant relationship between overweight and socio-economic status in males but not in females; in males, the lowest overweight prevalences were observed in both extreme socio-economic groups; moreover, overweight prevalences increased when socio-economic status decreased, from the high to the medium-low socio-economic group. The studied variables related with family environment did not show any significant effect in overweight prevalence.

CONCLUSION

Better knowledge of the relationship between social class and childhood obesity would lead to clearer hypotheses for the relationship in adults and might improve the preventive measures by identifying children at risk.

Body composition in adolescents: measurements and metabolic aspects

INTRODUCTION

Adolescence is a decisive period in human life in which important body composition changes occur. Increase of total body mass and its relative distribution are mainly related to gender and pubertal development.

OBJECTIVE

This review explores the specific measurements that may be used in this age group to assess excess body fat and to define obesity and overweight.

RESULTS

Identification of subjects at risk for adiposity requires simple anthropometric cutoffs for the screening of overweight and obesity. In this context, BMI criterion is the most frequently used but, in spite of its high sensitivity and specificity, an important number of adolescents classified as overweight or obese do not have really high adiposity (32.1% of females and 42% of males). Excess total body fat and intra-abdominal visceral fat are related to metabolic abnormalities that increase the risk of cardiovascular diseases. Waist circumference seems to be the best simple anthropometric predictor for the screening of the metabolic syndrome in children and adolescents.

CONCLUSIONS

Early identification of adolescents at risk for adiposity and its related metabolic complications requires reliable, simple and specific measures of excess body fat for this age group.

Insulin resistance and impaired glucose tolerance in obese children and adolescents

In developed countries, obesity prevalence has strongly increased in the last decades. This has also been observed in children and adolescents. Until recently, type 2 diabetes mellitus was considered very rare among children and adolescents; however, in the last decades, some cases have been observed mainly in obese adolescents of some minority populations. The aim of our study was to assess the prevalence of type 2 diabetes, impaired glucose tolerance (IGT) and insulin resistance, and the metabolic features, in obese children and adolescents. We have studied 95 obese children and adolescents, 53 males and 42 females, aged 4-16 years. The prevalence of IGT in obese children and adolescents studied was 7.4%; there was not any child with type 2 diabetes. Fasting glucose and insulin serum concentrations did not show significant differences between obese children with or without IGT; however, 120 minutes after an oral glucose tolerance test, glucose and insulin serum concentrations showed statistically significant differences between both groups. Insulin resistance is defined as a HOMA index higher than 4. The prevalence of insulin resistance in obese children studied was 35.8%. Trygliceride serum concentrations were higher and HDL-C serum concentrations were lower in obese children with IGT than in those without IGT, but the differences were not statistically significant. IGT and insulin resistance are frequent in obese children and adolescents; early treatment in obese children and adolescents with IGT constitutes a strategy of reversing progression to beta-cell failure and in preventing type 2 diabetes.

Psyllium fibre and the metabolic control of obese children and adolescents

In children and adolescents from developed countries, obesity prevalence has strongly increased in the last decades and insulin resistance and impaired glucose tolerance are frequently observed. Some dietary components such as low glycemic index foods and dietary fibre could be used in order to improve glucose homeostasis in these children. Psyllium or ispaghula husk (the husk of the seeds of Plantago ovata) is a mixture of neutral and acid polysaccharides containing galacturonic acid with a ratio of soluble/insoluble fibre of 70/30. Some foods could potentially be enriched with psyllium, like breads, breakfast cereals, pasta and snack foods. The aim of this review was to assess the usefulness of psyllium in the management of obese children and adolescents with abnormalities of carbohydrate and lipid metabolism. After psyllium supplementation, the percentage change in postprandial glucose in type 2 diabetes patients, ranged from -12.2 to -20.2%. In hypercholesterolemic children, the effect of psyllium in LDL-cholesterol serum concentrations ranged from 2.78 to -22.8%; the effect in HDL-cholesterol from -4.16 to 3.05%; and the effect on triglycerides from 8.49 to -19.54%. The reviewed evidence seems to show that psyllium improves glucose homeostasis and the lipid and lipoprotein profile; however, more well controlled trials and further studies are needed to clarify it's effects and the mechanisms involved.

Waist circumference for the screening of the metabolic syndrome in children

AIM

To identify the best anthropometric predictor of the metabolic syndrome in children.

METHODS

Screening performance was evaluated in a clinical setting. The study included 140 children: 72 non-obese and 68 with non-syndromal obesity. Body mass index (BMI), waist circumference and triceps/subscapular skinfolds ratio were used as predictor variables, and systolic blood pressure, diastolic blood pressure, glucose, uric acid, fasting insulin, triglycerides and HDL-C as metabolic syndrome variables.

RESULTS

The areas under the receiver operating characteristic (ROC) curves were 0.849 (95% CI: 0.780, 0.919) for BMI, 0.868 (95% CI: 0.801,0.934) for waist circumference and 0.834 (95% CI: 0.757,0.910) for the triceps/subscapular skinfolds ratio. No statistically significant differences were found for the three areas under the ROC curves. The point on the ROC curve closest to 1 corresponded to the 65th percentile for BMI, to the 70th percentile for waist, and to the 40th percentile for the triceps/subscapular skinfolds ratio.

CONCLUSION

Waist circumference seems to be the best predictor of children with the metabolic syndrome in paediatric clinical settings.

T(H)1/T(H)2 cytokine profile, metalloprotease-9 activity and hormonal status in pregnant rheumatoid arthritis and systemic lupus erythematosus patients

During the course of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), several immune and neuroendocrine changes associated with pregnancy may exert positive (amelioration) or negative (exacerbation) effects on the clinical outcome. In order to shed light on the mechanisms underlying these responses, we performed a prospective longitudinal study in RA and SLE pregnant women, including healthy pregnant women as a control group. Cytokine messenger RNA (mRNA) expression assessed by quantitative competitive polymerase chain reaction (PCR) in peripheral blood mononuclear cells (PBMC), cytokine levels and lymphocyte proliferation responses (LPR) following phytohaemagglutinin (PHA) stimulation of PBMC, plasma metalloprotease-9 activity (MMP-9) and hormonal status during pregnancy were determined. TNFa was the most abundant cytokine mRNA expressed in PBMC in all groups studied (healthy pregnant women, RA and SLE pregnant patients). However, a general TH2 response reflected by high IL-10 levels was found in RA, as well as SLE, patients. A significant change in IFN-gamma was observed in RA patients but only during the first trimester of pregnancy. This compared with a major TH1 response in healthy pregnant women. Interestingly, our study showed a homogeneous hormonal pattern in RA and SLE patients. Although decreased cortisol levels were observed in all patients studied, this is possibly related to the remission of disease activity status brought about by steroid treatment before and during pregnancy. In summary, we suggest that complex immune and hormonal networks are involved in pregnancy and that rheumatic diseases are very dynamic immune processes that cannot be described with a clear-cut cytokine profile. Furthermore, the observations in this study may reflect treatment-related immune effects more than those associated with disease.