Changes in body mass index, leptin and adiponectin in Japanese children during a three-year follow-up period: a population-based cohort study

Objective

The study examined changes in and relationship between body mass index (BMI), leptin and adiponectin levels over a 3-year period in a pediatric population-based cohort.

Study design

A 3-year prospective cohort study of 268 boys and 251 girls aged 9–10 in Ina, Saitama, Japan.

Results

Median body mass index (BMI) significantly increased from baseline (age 9–10) to follow up (age 12–13) in boys from 17.1 to 18.3 kg/m² (P < 0.001) and in girls from 16.5 to 18.5 kg/m² (P < 0.001), respectively. Adiponectin values significantly decreased from baseline to follow up in boys (13.5 to 8.9 μg/ml, respectively) (P < 0.001) and in girls (12.4 to 9.5 μg/ml, respectively) (P < 0.001). Leptin values at follow up significantly decreased from baseline in boys (4.9 to 2.3 ng/dl, respectively) (P < 0.001) and also in girls (5.3 to 5.1 ng/dl, respectively) (P = 0.049).

A relatively strong correlation was seen in BMI (Spearman's correlation coefficient, r = 0.864, P < 0.001 in boys; r = 0.873, P < 0.001 in girls), adiponectin (r = 0.705, P < 0.001 in boys; r = 0.695, P < 0.001 in girls), and leptin (r = 0.449, P < 0.001 in boys; r = 0.610, P < 0.001 in girls) before and after the three-year period.

The ratio of follow up to baseline BMI was negatively correlated with that for adiponectin (r = -0.224, P < 0.001 in boys; r = -0.165, P = 0.001 in girls) and positively correlated with that for leptin (r = 0.518, P < 0.001 in boys; r = 0.609, P < 0.001 in girls).

Conclusion

This study demonstrated that baseline adiponectin, leptin and BMI values measured at ages 9–10 correlated with those measured three years later. However, adiponectin values decreased and leptin values increased in those subjects whose BMI increased during over this period.

Role of intraventricular sodium nitroprusside in vasospasm secondary to aneurysmal subarachnoid haemorrhage: a 5-year prospective study with review of the literature

OBJECTIVE

Cerebral vasospasm remains an important cause of permanent neurological injury and death following aneurysmal subarachnoid haemorrhage, despite the best current medical therapy. Sodium nitroprusside was recently suggested as a treatment option for cerebral ischaemia in patients with severe medically refractive vasospasm after subarachnoid haemorrhage.

METHODS

Twenty patients of aneurysmal SAH with severe vasospasm, corroborated on transcranial Doppler (TCD), were included in this prospective study. The neurological condition of all patients was classified as Hess and Hunt grade II or higher. The diagnosis of severe delayed cerebral vasospasm refractory to conventional treatment (HHH therapy and nimodipine) was established before treatment. Ten patients received intraventricular sodium nitroprusside (SNP), while the other 10 had either major systemic illness or did not consent, formed the control group of the study. SNP was instilled in escalating doses with a starting dose of 4 mg/mL and reversal of vasospasm was monitored on neurological examination along with TCD in a basic ICU setting without the need for neurophysiological or invasive monitoring.

RESULTS

All patients in the study group showed an improvement in TCD velocities post-SNP instillation. Adverse effects were vomiting and hypotension in the SNP group which responded to medical management. The overall neurological outcome was good or excellent in 7/10 patients in the SNP group. Comparison between the two groups revealed improvement in TCD velocities and GCS in the SNP group thus affecting the long-term prognosis.

CONCLUSION

Intraventricular sodium nitroprusside represents a promising method of treatment for established delayed cerebral vasospasm and cerebral ischaemia refractory to conventional treatment.

219 APPLICATION OF A MICROFLUIDIC SPERM SORTER TO THE IN VITRO PRODUCTION OF PORCINE EMBRYOS

In porcine in vitro fertilization (IVF), polyspermy is a persistent obstacle to the efficient production of normal embryos. A microfluidic sperm sorter (MFSS; Strex Inc., Osaka, Japan) was developed to isolate motile human spermatozoa (from diluted semen by two laminar flows in the microchannel). The motile spermatozoa can gradually accumulate in a chamber of the MFSS. We previously reported that the monospermy rate was higher when oocytes were co-cultured with isolated spermatozoa in an MFSS for 5 min than when spermatozoa were co-cultured traditionally in drops for 8 h (P < 0.05; Reprod. Fertil. Dev. 20, 187 abst). The present study was undertaken to compare the effect of oocyte location within the MFSS chamber on early development after IVF in the MFSS. A sperm-rich fraction from Berkshire boars was diluted at 1 × 108 cells mL–1 with modified Modena solution containing 20% seminal fluid. In the first experiment, a diluted semen sample was flowed with modified TCM-199 containing 5 mm caffeine (mm199-caf) for 5 min at room temperature. Before flowing, porcine IVM oocytes were positioned in a part of the MFSS chamber where motile spermatozoa would accumulate with mm199-caf. After flowing for 5 min, those oocytes were cultured in caffeine-free mm199 for 8 h and then in a chemically defined medium (PZM-5) for 7 days. In the second experiment, denuded oocytes were co-cultured with isolated spermatozoa at several locations in the MFSS chamber, and the penetration and monospermy rates were estimated. The concentration of motile spermatozoa was also measured at each place in the MFSS chamber after isolation for 5 min. Statistical analyses of results based on 4 to 5 replicates were carried out by ANOVA and Fisher’s PLSD post hoc test (significance, P < 0.05). When IVM oocytes were co-cultured with spermatozoa gradually accumulated in the chamber of the MFSS for 5 min, the cleavage rate (83.7 ± 6.3% of 121 oocytes) was not different from that of control oocytes co-cultured with spermatozoa (5.7 × 105 cells mL–1) in 100-μL drops for 5 min (84.6 ± 6.6% of 126 oocytes). However, the blastocyst formation rate (38.2 ± 3.3%) was higher than for the controls (20.6 ± 6.8%; P < 0.05). After flowing for 5 min, the distance from the inflow opening of the MFSS chamber to the location of the oocytes did not affect the sperm penetration rate, but did affect the monospermy rate (14.0 ± 4.0% of 48 oocytes at the nearest position to 50.0 ± 5.6% of 43 oocytes at the furthest position; P < 0.05). After flowing for 5 min, the concentration of motile spermatozoa was also different at each location (57.5 ± 5.6 × 104 cells mL–1 at the nearest position to 0.8 ± 0.5 × 104 cells mL–1 at the furthest position; P < 0.05). These observations demonstrate that co-culturing oocytes with spermatozoa that gradually accumulated in the MFSS chamber improved the efficiency of blastocyst formation in the pig, whereas efficiency was affected by the position where oocytes were located in the chamber.

[Current evidence-based medicine for early intervention in diabetes]

The management of diabetes has changed recently with the early intervention, including diet, exercise, various pharmacological agents and education. In this review, we have provided current evidences of early intervention in various treatments. For example, sulfonylureas, metformin, alpha-glucosidase inhibitors, pioglitazone and glinides appear to be some of the drugs of choice to start with early pharmacological treatment when type 2 diabetic patients continue to have hyperglycemia despite diet and exercise. Clinical studies have shown that insulin therapy should be started sooner at an early stage in the natural progression of the diabetes. Moreover, recent data have demonstrated that treatment with early intervention of lifestyle adjustments as well as some pharmacological agents resulted in greater improvement of glycemic control. Further studies are expected to show the best point of intervention during diabetic course in preventing from progression of diabetic stage and diabetic complications.

Anterior communicating artery aneurysms: an overview

AComA aneurysms are most commonly found at the A1-A2 junction on the dominant side. The angle of the arteries at the bifurcation and the direction of blood flow are factors of hemodynamic stress in the apical region where these aneurysms often develop. They exist at the bifurcation of dominant A1, A2 and AComA and usually point in the direction away from the dominant A1. They are more prone to rupture and demonstrate the highest incidence of post-operative morbidity among anterior circulation aneurysms. Consideration of aneurysm morphology may be used to guide approaches in AComA aneurysms. Resection of the gyrus rectus in combination with a pterional approach was popularized by Yasargil and it became the standard for treatment or exposure of AComA aneurysms, although other skull base approaches are also widely used. Clip selection is of extreme importance and the preservation of blood flow to the perforators should be emphasized. Adequate dissection and exposure of the entire "H" complex prior to clipping is the key to a successful outcome. Separating the perforators from the neck or dome of the artery and preserving the parent vessel presents a substantial challenge to the surgeon when the aneurysm is behind the parent artery, making it difficult to achieve a good outcome.

Minimally invasive surgery for cerebral AVM in the eloquent cortex

The treatment of arteriovenous malformation (AVM) is still a challenging problem in the neurosurgical field. The usual operative procedure has been the removal of the AVM by sucking the gliosis which surrounds it. However, by using such a method in the functional area, especially the sensory and motor cortex, it has been impossible to remove the AVM without postoperative neurological deficit. Recent reports have shown that a 1 mm thickness of the brain around a large AVM is non-functioning;(1,2) therefore, we aimed to remove only the AVM without sucking the brain.

Traumatic deltoid rupture caused by seatbelt during a traffic accident: a case report

A right-handed 53-year-old man presented with a subcutaneous bruise on his right shoulder caused by a seatbelt during a traffic accident. He had no history of shoulder pain or hydrocortisone injections. The contour of the anterior deltoid was deformed and its belly was retracted distally. The active range of movement of the shoulder was limited to 120 degrees and the strength weakened to 3/5. Magnetic resonance imaging demonstrated detachment of the anterior fibres of the deltoid. Surgical repair of the deltoid and supraspinatus tendon was performed 2 months later using a pull-out suture technique. After 12 months of follow-up, the patient had returned to work without any problems. Both the range of movement and muscle strength had recovered completely.

215 APPLICATION OFA MICROFLUIDIC SPERM SORTER TO THE IN VITRO FERTILIZATION OF PORCINE OOCYTES

In porcine IVF, polyspermy is a persistent obstacle to the efficient production of normal embryos in vitro. A microfluidic sperm sorter (MFSS; Strex Inc., Osaka, Japan) has been developed to isolate motile human spermatozoa (from diluted semen by 2 laminar flows in the microchannel). The motile spermatozoa can gradually accumulate in a chamber of the MFSS. In addition, we have succeeded in reducing the incidence of polyspermic penetration by a transient coincubation of oocytes with spermatozoa in the presence of caffeine, followed by culture of the oocytes in the absence of caffeine (2004 Reproduction 128, 789–800). If porcine oocytes could be cocultured with motile spermatozoa in the chamber of the MFSS, the gradual accumulation of motile spermatozoa might further improve the efficiency of production of monospermic fertilized porcine embryos. The current study was undertaken to apply the MFSS technology to porcine IVF. The sperm-rich fraction from 3 Berkshire boars was diluted at 1 � 108 cells mL–1 with modified Modena containing 20% seminal fluid, cooled to 15�C for 4 h, and kept at the same temperature until use within 2 days. Stored, diluted semen with greater than 80% viability was flowed with Tyrode lactate-HEPES-polyvinyl alcohol medium for 5 or 10 min at room temperature. The concentration and viability of spermatozoa mixed in the flowed medium were determined. In the next experiment, a diluted semen sample was flowed with modified TCM-199 containing 5 mm caffeine for 5 min at room temperature. Before flowing, porcine IVM oocytes were put into the chamber of the MFSS, where motile spermatozoa will accumulate with modified TCM-199 containing 5 mm caffeine. After flowing for 5 min, those oocytes were transferred into a 500-µL droplet of caffeine-free modified TCM-199, and culture was continued for 8 h. Statistical analyses were carried out by ANOVA and Fisher's PLSD post hoc test. After flowing for 5 min, the concentration of spermatozoa recollected from the chamber was 5.7 � 105 cells mL–1. The viability of recollected spermatozoa was significantly higher than the original flowed semen. However, when spermatozoa were flowed for 10 min, the viability of recollected spermatozoa was not different from the original flowed semen, whereas the concentration of recollected spermatozoa was 9.7 � 105 cells mL–1. When IVM oocytes were cocultured with spermatozoa gradually accumulated in the chamber of MFSS for 5 min, 35% (22 to 48%) of oocytes were penetrated, and 95% (90 to 100%) of the penetrated oocytes were monospermic. These observations demonstrate that the MFSS can separate penetrable boar spermatozoa with a high viability and sufficient concentration for IVF. Furthermore, the current data suggest the possibility of improving the efficiency of monospermic fertilization of porcine IVM oocytes by a transient coculture with MFSS.

Ratio of high-, medium-, and low-molecular weight serum adiponectin to the total adiponectin value in children

In 760 children age 9 to 10 years, the serum adiponectin composition (high molecular weight [HMW], hexameric medium molecular weight [MMW], and trimeric low molecular weight [LMW]) was found to vary markedly depending on whether the total adiponectin value was high or low. A lower total adiponectin value was associated with a lower ratio of HMW adiponectin.

Extended storage of granulocyte concentrates mobilized by G-CSF with/without dexamethasone and collected by bag separation method

The aim of this study was to examine the extended storage of granulocyte concentrates mobilized by granulocyte-colony-stimulating factor (G-CSF) with/without dexamethasone (DEX) and collected by a bag separation method. Ten healthy adult volunteers donated blood three times: twice after granulocyte mobilization by (1) injecting G-CSF at 3 microg kg(-1) subcutaneously (s.c.) and (2) injecting G-CSF at 3 microg kg(-1) s.c. + DEX at 8 mg per oral and once (3) for a baseline control without any forms of mobilization. Granulocytes were collected by a bag separation method. The functions (phagocytosis and oxidative killing levels), viability and levels of interleukin (IL)-1beta, IL-8, IL-6 and tumour necrosis factor-alpha of granulocytes were measured. The average numbers of granulocytes collected from 200-mL samples of whole blood from the G-CSF and G-CSF + DEX groups were 35.1 x 10(8) and 49.4 x 10(8), respectively. Phagocytosis level, oxidative killing level and the viability of the granulocytes mobilized by G-CSF with/without DEX were well maintained for up to 72 h of storage after collection. The levels of the cytokines increased in a time-dependent manner. The in vitro phagocytosis level, oxidative killing level and the viability of granulocytes mobilized by G-CSF with/without DEX and collected by bag separation method can be maintained for as long as 72 h after collection.

Glycated albumin is low in obese, type 2 diabetic patients

This study is to clarify whether obesity status affects glycated albumin (GA) and HbA1c levels in adults with type 2 diabetes. One hundred and seven individuals with type 2 diabetes without advanced complications participated in this study. The relationship between HbA1c, GA, hemoglobin (Hb), albumin (ALB), absolute value of GA (aGA) and Body Mass Index (BMI) were examined using Pearson's correlation coefficient. The comparison of each parameter was conducted using unpaired t-test between the obese (BMI> or =25) and the non-obese (BMI<25) group. Additionally the multiple regression analyses to find factors related with GA (i.e. BMI, HbA1c, age, ALB and the insulin therapy) were performed. HbA1c level and BMI showed very weak correlation (r=-0.04; p=0.65). However, GA, aGA and BMI showed a significant negative correlation (r=-0.28; p=0.004, r=-0.22; p=0.024). The GA and aGA values of the obese group were significant lower than those in the non-obese group. In multiple regression analysis, BMI (beta=-0.24; p=0.001) was negatively, and HbA1c (beta=3.65; p<0.001) was positively correlated with GA. In conclusion, the current analysis demonstrated a need of careful evaluation of GA values in obese diabetic patients in daily practice. Further researches are required to elucidate the underlying mechanisms.

Gender differences in the relationship between percent body fat (%BF) and body mass index (BMI) in Japanese children

The purpose of the present study was to examine whether gender differences exist in the relationship between percent body fat (%BF) and body mass index (BMI) in Japanese children using a population-based cohort. Subjects are comprised of 187 boys and 163 girls aged 9-10, and 137 boys and 155 girls aged 12-13. Percent BF was measured using a bipedal biometrical impedance analysis (BIA) device. The relationship between %BF and BMI was investigated as a function of age and gender with Pearson's correlation coefficient. Strong linear relationships existed between %BF and BMI, especially in girls (9-10-year-old boys: r=0.779, P<0.0001; 9-10-year-old girls: r=0.975, P<0.0001; 12-13-year-old boys: r=0.786, P<0.0001; 12-13-year-old girls: r=0.975, P<0.000l). These results indicate that %BF can be predicted from BMI in Japanese children aged 9-10 and 12-13 years. The correlations in boys were not as strong as those observed in girls, that is, less variability was explained for girls than for boys. Further study will be necessary to ascertain whether the strong correlation seen among girls will be observed in different age or ethnic groups, and to ascertain the mechanism that produces this gender difference.

A Classification of Unruptured Middle Cerebral Artery Bifurcation Aneurysms that can Help in Choice of Clipping Technique

Middle cerebral artery (MCA) aneurysms comprise 20-25% of all intracranial aneurysms. The majority of middle cerebral artery aneurysms are treated by microsurgical clipping. Most of the classifications of aneurysms at present are based on size, location or pathology which are effective for the description but are less useful in preoperative planning and also in deciding on the technique or type of clip application. The aim of our study was to examine the morphological features of unruptured MCA bifurcation aneurysms which influence the techniques of clipping of these aneurysms and to attempt to subclassify unruptured middle cerebral artery aneurysms based on their preoperative 3D CTA and intraoperative characteristics so as to help in the intraoperative choice of technique and clip application, respectively. Preoperative 3D CT angiography and intraoperative images along with the record of technique and type of clips used for 141 unruptured MCA aneurysms operated at our center were studied retrospectively. Unruptured MCA bifurcation aneurysms could be subclassified into 5 types based on the similarities in their morphological features which influenced the techniques of clipping as recorded from their preoperative 3D CTA and intraoperative view. These types and the distinctive feature of each type are described. The various techniques of clipping are discussed based on these subgroups. The groups outlined make possible the establishment of a common technical approach to clipping within the groups. This classification, based on preoperative 3D CTA and intraoperative morphological features of the aneurysm and parent vessels, helps in the intraoperative choice of technique and type of clip application to tackle these lesions.

Childhood obesity and its relation to serum adiponectin and leptin: a report from a population-based study

This study examined the relationships between serum adiponectin (AD) and leptin (LP) levels, and obesity using a population-based cohort consisted of 315 (9-10 year olds: G1) and 308 (12-13 year olds: G2) school children. Serum AD, LP and other markers were compared according to the presence of obesity. The prevalence rates of obesity were 14.9% in G1 and 9.4% in G2. The medians of serum AD (microg/dl: non-obese/obese) were statistically lower in obese children (9.6/8.3 in G1, p<0.05; 8.9/6.6 in G2, p<0.05), and the medians of serum LP (ng/dl) were statistically higher in obese children (3.7/12.5 in G1, p<0.05; 2.9/8.4 in G2, p<0.05). The serum LP levels were significantly positively correlated with percent overweight (POW) irrespective of age and sex, and the serum AD levels were significantly negatively correlated with POW except for boys in G1. Multivariate regression analyses revealed that LP, LDL-cholesterol and gender in G1, and LP, AD, blood pressure and gender in G2 were significantly correlated with POW. A large-scale, population-based study revealed that AD was lower and LP higher in obese children, and that the obese status in G2 was related to a worse metabolic profile than the case in G1.

Effects of dietary energy intake and cold exposure on kinetics of plasma glucose metabolism in sheep

An isotope dilution method using [U-(13)C]glucose injection was applied to determine the effects of dietary energy intake and cold exposure on plasma glucose metabolism in sheep. The sheep were assigned to two dietary treatments and were fed on diets containing either 100% or 160% of ME and both containing 150% of dietary crude protein intake for maintenance. The sheep were exposed from a thermoneutral environment (23 degrees C) to a cold environment (2-4 degrees C) for 5 days. The isotope dilution method was performed on the 18th day in the thermoneutral environment and on the fifth day of cold exposure. Plasma concentrations of glucose and NEFA increased (p < 0.05) during cold exposure for both diets. Plasma glucose pool size remained unchanged (p = 0.67), but plasma glucose turnover rate tended to increase (p = 0.07) with increased energy intake. Both pool size and turnover rate of plasma glucose increased (p = 0.01 and p = 0.0001, respectively) during cold exposure. No significant diet x environment interaction was detected. It is concluded that plasma glucose metabolism was influenced by both dietary energy intake and cold exposure, and plasma glucose metabolism in response to cold exposure was not modified by energy intake in sheep under the conditions (2-4 degrees C on the fifth day) of the present experiment.

Bonding characteristics of newly developed all-in-one adhesives

This study evaluated the microtensile bond strength and the interfacial morphology of newer adhesives. The occlusal surfaces of extracted teeth were ground flat for random allocation to four equal groups. Resin composite was bonded to each surface using either Clearfil SE Bond [SEB], Clearfil Protect Bond [PB], G-Bond [GB], or an experimental adhesive, SSB-200 [SSB]. After storage for 24 h in water at 37 degrees C, they were sectioned into beams (cross-sectional area 1 mm(2)) for microtensile bond strength testing (muTBS) at a crosshead speed of 1 mm/min. The load at failure of each was recorded; the data were analyzed by one-way ANOVA and Games Howell tests. The surfaces of the fractured specimens were observed using SEM. For the ultra-morphology of the interface, the occlusal surfaces of four more teeth were prepared as before and a thin layer of flowable resin composite was bonded to each surface using one of the four adhesives. The mean muTBS ranged from 39.68 MPa (GB) to 64.97 MPa (SEB). There were no statistical differences between SEB and SSB, or between PB and GB (p > 0.05). The muTBS of SEB and SSB were significantly greater than that of PB and GB (p < 0.05). SEMs of the fractured surfaces revealed a mixed (cohesive/interfacial) failure. TEM examination highlighted differences in the hybrid layer; SEB had a thicker layer than the others. In conclusion, the newer all-in-one adhesives produced a thin hybrid layer but varied in their bond strengths. The 2-step self-etching adhesives do not necessarily produce higher bond strengths than that of the all-in-one systems.

Radicals produced by blue-light–resin interactions alter the redox status of THP1 human monocytes

Resin composites are widely used in dentistry, and are polymerized in situ using a blue-light activated, free-radical polymerization mechanism. Blue light (400-500nm) is used to activate camphoroquinone (CQ), which decomposes to form free radicals that are stabilized by dimethyl-p-toludine (DMPT). CQ and DMPT are applied near tooth pulpal tissues and are irradiated during restorative procedures, suggesting that pulpal cells are exposed to free radicals. Because glutathione is a major component of the cellular redox management system, we tested the hypothesis that blue light irradiation would shift cellular glutathione redox balance of cells exposed to CQ and DMPT. We also measured NFkappaB activation, a redox-sensitive transcription factor that regulates inflammatory responses and glutathione synthetic enzyme levels. THP1 human monocytes were exposed to sublethal levels of CQ (0.4 mM) or DMPT (1.0 mM), with or without blue light exposure (25 J/cm(2)) from a quartz-tungsten-halogen source. The ratio of reduced to oxidized glutathione was measured using as assay based on 5,5'-dithio-bis(2-nitrobenszoic acid). NFkappaB transactivation was measured by transfection of an NFkappaB-containing plasmid linked to a luciferase reporter. Our results showed that blue light, CQ, or DMPT alone had no significant effect on cellular glutathione redox balance, but that the combination of these agents induced a marked oxidative bias, and reduced total glutathione levels up to 50%. On the other hand, light, CQ, and DMPT alone or in combination suppressed NFkappaB transactivation by >70%. Our results suggest that CQ and DMPT pose risks to pulpal tissues with or without blue light irradiation, and that multiple, interacting mechanisms shape the response to these agents.