Increased carotid intima-media thickness and associations with cardiovascular risk factors in obese and overweight children and adolescents

OBJECTIVE

Overweight and obesity in children and adolescents contribute to the development of overweight and obesity in adulthood and subsequent cardiovascular disease. It was the aim of the trial to assess vascular status and associations with cardiovascular risk factors.

PATIENTS AND METHODS

Eighty-one overweight or obese children and adolescents (age 13.6 +/- 2.7 years, 62% females) hospitalised for weight reduction were consecutively recruited. In all subjects carotid intima-media thickness (IMT), body-mass index (BMI), body composition, serum lipid and blood glucose concentrations, CRP, TSH, uric acid and blood pressure values were measured.

RESULTS

Mean IMT was 0.48 +/- 0.09 mm. Twenty-nine subjects (36%) had an IMT <0.45 mm, 32 (40%) an IMT > or =0.45<or =0.50 mm, and 20 (24%) an IMT >0.50 mm. Comparing children with low carotid IMT (<0.45 mm, n = 29 (36%)) with those with higher values (> or =0.45 mm, n = 52 (64%)), there were significant differences: Those with higher IMT had higher weight (73.5 +/- 17.6 vs 91.1 +/- 24.0 kg, p = 0.001), higher BMI (28.6 +/- 4.4 vs 32.7 +/- 5.5 kg/m(2), p = 0.001) and BMI-SDS (2.23 +/- 0.57 vs 2.61 +/- 0,50, p = 0.002), higher fatmass (26.3 +/- 9.5 vs 37.1 +/- 15.2 kg, p = 0.001) and a higher percentage of fat in relation to total body weight (35.2 +/- 5.5 vs 39.5 +/- 7.8 %, p = 0.010), as well as higher systolic (117.7 +/- 6.9 vs 124.6 +/- 10.6 mmHg, p = 0.004) and diastolic blood pressure values (64.4 +/- 5.5 vs 68.6 +/- 6.7 mmHg, p = 0.008), and higher serum uric acid concentrations (385.6 +/- 91.7 vs 439.9 +/- 100.5 micromol/l, p = 0.023). There was a correlation between IMT and height (r = 0.237, p = 0.033), weight (r = 0.442, p<0.001), BMI (r = 0.482, p<0.001), BMI-SDS (r = 0.449, p<0.001), fatmass (r = 0.482, p <0.001), percentage of fat (r = 0.412, p<0.001), TSH (r = 0.238, p = 0.037), uric acid (r = 0.238, p = 0.040) as well as systolic (r = 0.359, p = 0.001) and diastolic blood pressure values (r = 0.359, p = 0.001) measured spontaneously and systolic blood pressure values registered during 24 h monitoring (r = 0.344, p = 0.004). Performing multivariate analysis, an association between IMT and BMI was found (R-square = 0.263, beta = 0.525, p<0.001).

CONCLUSIONS

In overweight and obese children and adolescents there is a significant association between carotid IMT and weight, BMI, BMI-SDS, blood pressure, as well as various other metabolic parameters. Based on these and other epidemiological data, demonstrating the continuing and significant increase in incidence of overweight and obesity in childhood and adolescence, comprehensive strategies for the long-term prevention and the treatment of risk factors should be emphasized with an early start in childhood.

A randomized trial of prophylactic cranial irradiation (PCI) versus no PCI in extensive disease small cell lung cancer after a response to chemotherapy (EORTC 08993–22993)

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Background: Prophylactic cranial irradiation (PCI) significantly reduces the risk of brain metastases (BM) and improves survival in patients with limited disease small cell lung cancer. Development of BM is often accompanied by deterioration of physical and psychological functioning and response to therapy is poor. Patients with extensive disease (ED SCLC) are at high risk for BM. This randomized study assesses PCI in patients with ED SCLC. Methods: Patients (18–75 years; WHO=2) with confirmed ED SCLC and any response to 4–6 cycles of chemotherapy, were randomized to receive PCI (doses ranging from 20 Gy/5 fr to 30 Gy/12 fr) or no PCI. The primary endpoint was the cumulative incidence of symptomatic BM. CT or MRI of the brain was performed whenever any of the pre-defined “key-symptoms” was present at baseline or during follow-up. The study was sized to detect a hazard ratio of 0.44 with 80% power and 2-sided 5% significance (52 events, 287 patients). Results: Between Feb ’01 and Mar ’06, 286 patients entered the trial, 76% with residual disease in the thorax and 71% at distant sites. Baseline characteristics were well balanced. Only 6% of patients in the PCI arm were not treated and 3% interrupted treatment. Acute toxicity was mild: nausea/vomiting was reported by about 30% of PCI-treated cases and about 30% reported late reactions (mostly mild headache). PCI significantly reduced the risk of symptomatic brain metastases (Gray P<0.0001, HR=0.27, CI: 0.16–0.44). The 1-year cumulative incidence of symptomatic BM was 14.6% on PCI (CI 8.3–20.9) versus 40.4% in controls (CI 32.1–48.6). PCI had no impact on extra-cranial progression rates (Gray P>0.1), but it significantly prolonged progression-free survival time (P=0.0218, HR=0.76, CI: 0.59–0.96) and overall survival (P=0.0033, HR=0.68, CI: 0.52–0.88). The 1-year survival rate was 27.1% for the PCI and 13.3% for the control arm. Conclusions: PCI significantly reduces the risk of symptomatic brain metastases, and significantly improves both disease-free and overall survival in patients with ED SCLC. PCI should be offered to all ED patients showing a response to initial chemotherapy.

No significant financial relationships to disclose.

Changes in the redox state and composition of the quinone pool of Escherichia coli during aerobic batch-culture growth

Ubiquinones (UQs) and menaquinones (MKs) perform distinct functions in Escherichia coli. Whereas, in general, UQs are primarily involved in aerobic respiration, the MKs serve as electron carriers in anaerobic respiration. Both UQs and MKs can accept electrons from various dehydrogenases, and may donate electrons to different oxidases. Hence, they play a role in maintaining metabolic flexibility in E. coli whenever this organism has to adapt to conditions with changing redox characteristics, such as oxygen availability. Here, the authors report on the changes in both the size and the redox state of the quinone pool when the environment changes from being well aerated to one with low oxygen availability. It is shown that such transitions are accompanied by a rapid increase in the demethylmenaquinone pool, and a slow increase in the MK pool. Moreover, in exponentially growing cultures in a well-shaken Erlenmeyer flask, it is observed that the assumption of a pseudo-steady state does not hold with respect to the redox state of the quinone pool.

Intracellular distribution of Photofrin in malignant and normal endothelial cell lines

Compared to current treatments including surgery, radiation therapy, and chemotherapy, PDT offers the advantage of an effective and selective method of destroying diseased tissues without damaging surrounding healthy tissues. One of the aspects of antitumour effectiveness of PDT is related to the distribution of photosensitizing drugs. The localization of photosensitizers in cytoplasmic organelles during PDT plays a major role in the cell destruction; therefore, intracellular localization of Ph in malignant and normal cells was investigated. The cell lines used throughout the study were: human malignant A549, MCF-7, Me45 and normal endothelial cell line HUV-EC-C. After incubation with Ph cells were examined using fluorescence and confocal microscopy to visualize the photosensitizer accumulation. For cytoplasm and mitochondria identification, cells were stained with CellTracker Green and MitoTracker Green, respectively. Distribution of Ph was different in malignant and normal cells and dependent on the incubation time. The maximal concentration of Ph in two malignant cell lines (A549 and MCF-7) was observed after 4 hours of incubation, and the most intensive signal was observed around the nuclear envelope. Intracellular distribution of Ph in the Me45 cell line showed that the fluorescence emitted by Ph overlaid that from MitoTracker. This indicates preferential accumulation of the sensitizer in mitochondria. Our results based on the mitochondrial localization support the idea that PDT can contribute to elimination of malignant cells by inducing apoptosis, which is of physiological significance.