Potential solutions for pediatric weight loss programs in the treatment of obesity in rural communities

Pediatric obesity remains disproportionately more prevalent in rural communities; however, multidisciplinary, pediatric weight loss programs, which are often located in tertiary-care centers, may not be accessible to rural families. Limited models to specifically address pediatric obesity in rural communities exist. Therefore, innovative solutions are required for expanded treatment of pediatric obesity in rural communities. This article discusses potential solutions for multidisciplinary, tertiary-care pediatric weight loss programs to improve access and treatment of pediatric obesity in rural communities. A selected review of the literature suggests that strategies to overcome barriers to treatment in rural communities include telephone calls and telemedicine conferencing by obesity specialists from academic centers (obesity medicine specialists, endocrinologists, dietitians, and psychotherapists) as well as training local primary care providers in rural communities to screen, diagnose, and treat patients with obesity. Multidisciplinary, tertiary-care pediatric weight loss programs have a profound opportunity to impact the treatment of pediatric obesity in rural communities by training practicing rural primary care providers as well as strengthening their commitment to educate future generations of clinicians on the treatment of pediatric obesity through medical training including physician assistant, nurse practitioner, and pediatric and family medicine resident education and skill building. This article identifies potential mechanisms for expansive treatment of pediatric obesity in rural communities by multidisciplinary, tertiary-care weight loss programs and highlights areas of specific focus needed for future investigation.

A strategy for dual inhibition of the proteasome and fatty acid synthase with belactosin C-orlistat hybrids

The proteasome, a validated cellular target for cancer, is central for maintaining cellular homeostasis, while fatty acid synthase (FAS), a novel target for numerous cancers, is responsible for palmitic acid biosynthesis. Perturbation of either enzymatic machine results in decreased proliferation and ultimately cellular apoptosis. Based on structural similarities, we hypothesized that hybrid molecules of belactosin C, a known proteasome inhibitor, and orlistat, a known inhibitor of the thioesterase domain of FAS, could inhibit both enzymes. Herein, we describe proof-of-principle studies leading to the design, synthesis and enzymatic activity of several novel, β-lactone-based, dual inhibitors of these two enzymes. Validation of dual enzyme targeting through activity-based proteome profiling with an alkyne probe modeled after the most potent inhibitor, and preliminary serum stability studies of selected derivatives are also described. These results provide proof of concept for dual targeting of the proteasome and fatty acid synthase-thioesterase (FAS-TE) enabling a new approach for the development of drug-candidates with potential to overcome resistance.

Analysis of malignancy detected by needle-localized breast biopsy

The medical records of 192 women with nonpalpable mammographically detected breast lesions who underwent needle-localized breast biopsy between January 1989 and January 1991 and between March 1992 and March 1994 were reviewed. Of the 192 patients examined, 100 underwent biopsy for evaluation of microcalcifications suggestive of malignancy. Ninety-two biopsies were performed for non-specific radiodensities not inclusive of microcalcifications. This study examines the radiographic characteristics of the nonpalpable breast lesion. Although presence of microcalcifications on mammograms are an important finding in detection of breast carcinoma, it must not be considered pathognomonic. Other distinguishing factors require evaluation to assess the indication for biopsy. Central to this study was the presence of microcalcifications alone or as detected in association with a dominant mass. Cancer was discriminated in 38 (20%) of the patients studied. Mammographic findings with microcalcification, regardless of the presence of a mass, were found to be malignant in 20% of patients undergoing biopsy. Nine percent of biopsies done to evaluate microcalcifications alone were malignant. The finding of microcalcification associated with a dominant mass proved malignant in 34% of patients who had a biopsy done. The authors include guidelines for increasing the effectiveness of needle-localized biopsies of the breast.

A follow-up study of disturbed children treated in a Re-ED program

In 1974 the authors undertook an evaluation of the children's program at Marshall I. Pickens Hospital in Greenville, South Carolina. The program, based on the Re-ED model, accepts only boys of normal intelligence between the ages of six and 12; most are referred because of disruptive behavior in the classroom and at home and low academic achievement. To evaluate the program, questionnaires were mailed to the families of all children who had been discharged from the program six months or longer a total of 123. Sixty-three of the 101 parents responding said the program had provided very much help for their child. At follow-up 89 children were enrolled in some kind of school program, and one had graduated from high school. However, 66 parents reported their child continued to have academic problems. The authors compare the findings with follow-up studies of three other Re-ED programs and discuss possible modifications that might make such programs more effective for children who fail to adjust.