Parkinson's disease cerebrovascular reactivity pattern: A feasibility study

A mounting body of research points to cerebrovascular dysfunction as a fundamental element in the pathophysiology of Parkinson's disease (PD). In the current feasibility study, blood-oxygen-level-dependent (BOLD) MRI was used to measure cerebrovascular reactivity (CVR) in response to hypercapnia in 26 PD patients and 16 healthy controls (HC), and aimed to find a multivariate pattern specific to PD. Whole-brain maps of CVR amplitude (i.e., magnitude of response to CO2) and latency (i.e., time to reach maximum amplitude) were computed, which were further analyzed using scaled sub-profile model principal component analysis (SSM-PCA) with leave-one-out cross-validation. A meaningful pattern based on CVR latency was identified, which was named the PD CVR pattern (PD-CVRP). This pattern was characterized by relatively increased latency in basal ganglia, sensorimotor cortex, supplementary motor area, thalamus and visual cortex, as well as decreased latency in the cerebral white matter, relative to HC. There were no significant associations with clinical measures, though sample size may have limited our ability to detect significant associations. In summary, the PD-CVRP highlights the importance of cerebrovascular dysfunction in PD, and may be a potential biomarker for future clinical research and practice.

Amplitude-determined seizure-threshold, electric field modeling, and electroconvulsive therapy antidepressant and cognitive outcomes

Electroconvulsive therapy (ECT) pulse amplitude, which dictates the induced electric field (E-field) magnitude in the brain, is presently fixed at 800 or 900 milliamperes (mA) without clinical or scientific rationale. We have previously demonstrated that increased E-field strength improves ECT's antidepressant effect but worsens cognitive outcomes. Amplitude-determined seizure titration may reduce the E-field variability relative to fixed amplitude ECT. In this investigation, we assessed the relationships among amplitude-determined seizure-threshold (STa), E-field magnitude, and clinical outcomes in older adults (age range 50 to 80 years) with depression. Subjects received brain imaging, depression assessment, and neuropsychological assessment pre-, mid-, and post-ECT. STa was determined during the first treatment with a Soterix Medical 4×1 High Definition ECT Multi-channel Stimulation Interface (Investigation Device Exemption: G200123). Subsequent treatments were completed with right unilateral electrode placement (RUL) and 800 mA. We calculated Ebrain defined as the 90th percentile of E-field magnitude in the whole brain for RUL electrode placement. Twenty-nine subjects were included in the final analyses. Ebrain per unit electrode current, Ebrain/I, was associated with STa. STa was associated with antidepressant outcomes at the mid-ECT assessment and bitemporal electrode placement switch. Ebrain/I was associated with changes in category fluency with a large effect size. The relationship between STa and Ebrain/I extends work from preclinical models and provides a validation step for ECT E-field modeling. ECT with individualized amplitude based on E-field modeling or STa has the potential to enhance neuroscience-based ECT parameter selection and improve clinical outcomes.

Comparison of automated and manual quantification methods for neuromelanin-sensitive MRI in Parkinson's disease

Neuromelanin-sensitive magnetic resonance imaging quantitative analysis methods have provided promising biomarkers that can noninvasively quantify degeneration of the substantia nigra in patients with Parkinson's disease. However, there is a need to systematically evaluate the performance of manual and automated quantification approaches. We evaluate whether spatial, signal-intensity, or subject specific abnormality measures using either atlas based or manually traced identification of the substantia nigra better differentiate patients with Parkinson's disease from healthy controls using logistic regression models and receiver operating characteristics. Inference was performed using bootstrap analyses to calculate 95% confidence interval bounds. Pairwise comparisons were performed by generating 10,000 permutations, refitting the models, and calculating a paired difference between metrics. Thirty-one patients with Parkinson's disease and 22 healthy controls were included in the analyses. Signal intensity measures significantly outperformed spatial and subject specific abnormality measures, with the top performers exhibiting excellent ability to differentiate patients with Parkinson's disease and healthy controls (balanced accuracy = 0.89; area under the curve = 0.81; sensitivity =0.86; and specificity = 0.83). Atlas identified substantia nigra metrics performed significantly better than manual tracing metrics. These results provide clear support for the use of automated signal intensity metrics and additional recommendations. Future work is necessary to evaluate whether the same metrics can best differentiate atypical parkinsonism, perform similarly in de novo and mid-stage cohorts, and serve as longitudinal monitoring biomarkers.

Reduced and Delayed Cerebrovascular Reactivity in Patients with Parkinson's Disease

BACKGROUND

Cerebrovascular dysfunction in Parkinson's disease (PD) is heterogeneous and may contribute to disease pathophysiology or progression. There is a need to understand the mechanisms by which cerebrovascular dysfunction is altered in participants with PD.

OBJECTIVES

The objective of this study is to test the hypothesis that participants with PD exhibit a significant reduction in the ability of the cerebral vessels to dilate in response to vasoactive challenges relative to healthy controls (HC).

METHODS

The current study uses a vasodilatory challenge while participants undergo functional magnetic resonance imaging to quantify the amplitude and delay of cerebrovascular reactivity in participants with PD relative to age and sex-matched HC. An analysis of covariance was used to evaluate differences in cerebrovascular reactivity amplitude and latency between PD participants and HC.

RESULTS

A significant main effect of group was observed for whole-brain cerebrovascular reactivity amplitude (F(1, 28)  = 4.38, p = 0.046, Hedge's g = 0.73) and latency (F(1, 28)  = 16.35, p < 0.001, Hedge's g = 1.42). Participants with PD exhibited reduced whole-brain amplitude and increased latencies in cerebrovascular reactivity relative to HC. The evaluation of regional effects indicates that the largest effects were observed in the cuneus, precuneus, and parietal regions.

CONCLUSIONS

PD participants exhibited reduced and delayed cerebrovascular reactivity. This dysfunction may play an important role in chronic hypoxia, neuroinflammation, and protein aggregation, mechanisms that could lead to disease progression. Cerebrovascular reactivity may serve as an important biomarker and target for future interventions. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Electric Field, Ictal Theta Power, and Clinical Outcomes in Electroconvulsive Therapy

BACKGROUND

Electroconvulsive therapy (ECT) is efficacious for treatment-resistant depression. Treatment-induced cognitive impairment can adversely impact functional outcomes. Our pilot study linked the electric field to ictal theta power from a single suprathreshold treatment and linked ictal theta power to changes in phonemic fluency. In this study, we set out to replicate our findings and expand upon the utility of ictal theta power as a potential cognitive biomarker.

METHODS

Twenty-seven participants (18 female and 9 male) received right unilateral ECT for treatment-resistant depression. Pre-ECT magnetic resonance imaging and finite element modeling determined the 90th percentile maximum electric field in the brain. Two-lead electroencephalographs were digitally captured across the ECT course, with the earliest suprathreshold treatment used to determine power spectral density. Clinical and cognitive outcomes were assessed pre-, mid-, and post-ECT. We assessed the relationship between the electric field in the brain, ictal theta power, clinical outcome (Inventory of Depressive Symptomatology), and cognitive outcomes (phonemic and semantic fluency) with linear models.

RESULTS

Ictal theta power in the Fp1 and Fp2 channels was associated with the electric field, antidepressant outcome, and phonemic and semantic fluency. The relationship between ictal theta power and phonemic fluency was strengthened in the longitudinal analysis. The electric field in the brain was directly associated with phonemic and semantic fluency but not with antidepressant outcome.

CONCLUSIONS

Ictal theta power is a potential cognitive biomarker early on in the ECT course to help guide parameter changes. Larger studies are needed to further assess ictal theta power's role in predicting mood outcome and changes with ECT parameters.

Longitudinal hippocampal subfields, CSF biomarkers, and cognition in patients with Parkinson disease

Objective

Hippocampal atrophy is an indicator of emerging dementia in PD, though it is unclear whether cerebral spinal fluid (CSF) Abeta-42, t-tau, or alpha-syn predict hippocampal subfield atrophy in a de novo cohort of PD patients. To examine whether levels of CSF alpha-synuclein (alpha-syn), beta-amyloid 1-42 (Abeta-42), or total-tau (t-tau) are associated with hippocampal subfield volumes over time.

Methods

We identified a subset of Parkinson's Progression Markers Initiative (PPMI) de novo PD patients with longitudinal T1-weighted imaging (baseline plus at least two additional visits across 12, 24, and 48 months) and CSF biomarkers available at baseline. We performed cross-sectional, regression, and linear mixed model analyses to evaluate the baseline and longitudinal CSF biomarkers, hippocampal subfields, and cognition. A false discovery rate (FDR) was used to correct for multiple comparisons.

Results

88 PD-CN and 21 PD-MCI had high quality longitudinal data. PD-MCI patients exhibited reduced bilateral CA1 volumes relative to PD-CN, though there were no significant differences in CSF biomarkers between these groups. Relationships between CSF biomarkers and hippocampal subfields changed over time, with a general pattern that lower CSF Abeta-42, higher t-tau and higher alpha-syn were associated with smaller hippocampal subfields, primarily in the right hemisphere.

Conclusion

We replicated prior reports that demonstrated reduced CA1 volumes in PD-MCI in a de novo PD cohort. CSF biomarkers were associated with individual subfields, with evidence that the increased CSF t-tau was associated with smaller subiculum volumes at baseline and over time, though there was no clear indication that the subfields associated with cognition (CA1 and HATA) were associated with CSF biomarkers.

Associations between depression and diabetes among Latinx patients from low-income households in New Mexico

Depression and diabetes are co-occurring epidemics. This article explores the association between depression and diabetes in a cohort of Latinx patients with diabetes from low-income households. Data were gathered in Albuquerque, New Mexico (U.S.) between 2016 and 2020 as part of a patient-engaged comparative effectiveness trial comparing two culturally appropriate diabetes self-management programs-the Chronic Care Model (CCM) and the standard of care, Diabetes Self-Management Support Empowerment Model (DSMS). We proposed that the program most culturally and contextually situated in the life of the patient would have the greatest impact on diabetes self-management. Participants were enrolled as dyads-226 Latinx diabetes patient participants (PPs) from low-income households and 226 social support participants (SSPs). Data gathered at baseline, 3, 6, and 12 months included a measure of depression and A1c testing. Outcomes between programs were analyzed using longitudinal linear mixed modeling, adjusted for patient demographic characteristics and other potential confounding covariates. Patient A1c had an initial slight decrease at 3 months in both programs. At CCM, patients with a very high A1c (greater than 10%) demonstrated a clinically meaningful decrease in A1c over time. Patients at CCM experienced a large initial decrease in depression and continued to decrease throughout the study, while patients at DSMS showed a slight initial decrease through 6 months, but depression increased again by 12 months, nearly rebounding to baseline levels. A subgroup analysis revealed that a higher baseline A1c was associated with higher depression, and patients with higher A1c achieved greater reductions in depression at CCM than at DSMS. CCM scored higher on Consumer Assessment of Healthcare Providers and Systems cultural competence (CAHPS-CC). Interpretation of results suggests that the more culturally, contextually situated program, CCM, had better outcomes. This study demonstrates that culturally and contextually situating a diabetes intervention can deliver improved benefits for Latinx patients.

A patient-centered comparative effectiveness research study of culturally appropriate options for diabetes self-management

This project compared the effectiveness of two evidence-based models of culturally competent diabetes health promotion: The Diabetes Self-Management Support Empowerment Model (DSMS), and The Chronic Care Model (CCM). Our primary outcome was improvement in patient capacity for diabetes self-management as measured by the Diabetes Knowledge Questionnaire (DKQ) and the Patient Activation Measure (PAM). Our secondary outcome was patient success at diabetes self-management as measured by improvement in A1c, depression sores using the PHQ-9, and Body Mass Index (BMI). We also gathered data on the cultural competence of the program using the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Set (CAHPS-CC). We compared patient outcomes in two existing sites in Albuquerque, New Mexico that serve a large population of Latino diabetes patients from low-income households. Participants were enrolled as dyads-a patient participant (n=226) and a social support participant (n=226). Outcomes over time and by program were analyzed using longitudinal linear mixed modeling, adjusted for patient participant demographic characteristics and other potential confounding covariates. Secondary outcomes were also adjusted for potential confounders. Interactions with both time and program helped to assess outcomes. This study did not find a difference between the two sites with respect to the primary outcome measures and only one of the three secondary outcomes showed differential results. The main difference between programs was that depression decreased more for CCM than for DSMS. An exploratory, subgroup analysis revealed that at CCM, patient participants with a very high A1c (>10) demonstrated a clinically meaningful decrease. However, given the higher cultural competence rating for the CCM, statistically significant improvement in depression, and the importance of social support to the patients, results suggest that a culturally and contextually situated diabetes self-management and education program design may deliver benefit for patients, especially for patients with higher A1c levels.

Electroconvulsive therapy, electric field, neuroplasticity, and clinical outcomes

Electroconvulsive therapy (ECT) remains the gold-standard treatment for patients with depressive episodes, but the underlying mechanisms for antidepressant response and procedure-induced cognitive side effects have yet to be elucidated. Such mechanisms may be complex and involve certain ECT parameters and brain regions. Regarding parameters, the electrode placement (right unilateral or bitemporal) determines the geometric shape of the electric field (E-field), and amplitude determines the E-field magnitude in select brain regions (e.g., hippocampus). Here, we aim to determine the relationships between hippocampal E-field strength, hippocampal neuroplasticity, and antidepressant and cognitive outcomes. We used hippocampal E-fields and volumes generated from a randomized clinical trial that compared right unilateral electrode placement with different pulse amplitudes (600, 700, and 800 mA). Hippocampal E-field strength was variable but increased with each amplitude arm. We demonstrated a linear relationship between right hippocampal E-field and right hippocampal neuroplasticity. Right hippocampal neuroplasticity mediated right hippocampal E-field and antidepressant outcomes. In contrast, right hippocampal E-field was directly related to cognitive outcomes as measured by phonemic fluency. We used receiver operating characteristic curves to determine that the maximal right hippocampal E-field associated with cognitive safety was 112.5 V/m. Right hippocampal E-field strength was related to the whole-brain ratio of E-field strength per unit of stimulation current, but this whole-brain ratio was unrelated to antidepressant or cognitive outcomes. We discuss the implications of optimal hippocampal E-field dosing to maximize antidepressant outcomes and cognitive safety with individualized amplitudes.

Electroconvulsive Therapy Pulse Amplitude and Clinical Outcomes

INTRODUCTION

Electroconvulsive therapy (ECT) pulse amplitude, which determines the induced electric field magnitude in the brain, is currently set at 800-900 milliamperes (mA) on modern ECT devices without any clinical or scientific rationale. The present study assessed differences in depression and cognitive outcomes for three different pulse amplitudes during an acute ECT series. We hypothesized that the lower amplitudes would maintain the antidepressant efficacy of the standard treatment and reduce the risk of neurocognitive impairment.

METHODS

This double-blind investigation randomized subjects to three treatment arms: 600, 700, and 800 mA (active comparator). Clinical, cognitive, and imaging assessments were conducted pre-, mid- and post-ECT. Subjects had a diagnosis of major depressive disorder, age range between 50 and 80 years, and met clinical indication for ECT.

RESULTS

The 700 and 800 mA arms had improvement in depression outcomes relative to the 600 mA arm. The amplitude groups showed no differences in the primary cognitive outcome variable, the Hopkins Verbal Learning Test-Revised (HVLT-R) retention raw score. However, secondary cognitive outcomes such as the Delis Kaplan Executive Function System Letter and Category Fluency measures demonstrated cognitive impairment in the 800 mA arm.

DISCUSSION

The results demonstrated a dissociation of depression (higher amplitudes better) and cognitive (lower amplitudes better) related outcomes. Future work is warranted to elucidate the relationship between amplitude, electric field, neuroplasticity, and clinical outcomes.

SAT0313 CORRELATION BETWEEN PROGRESSION OF SKIN FIBROSIS AND PROGRESSION OF INTERSTITIAL LUNG DISEASE (ILD) IN PATIENTS WITH SSC-ILD: DATA FROM THE SENSCIS TRIAL

Background:

In the SENSCIS trial in patients with SSc-ILD, nintedanib reduced the rate of decline in FVC over 52 weeks vs placebo, with no difference between groups in change in mRSS.

Objectives:

Analyse correlation between progression of skin fibrosis and progression of SSc-ILD in the SENSCIS trial.

Methods:

Patients with SSc-ILD were randomised to receive nintedanib or placebo until the last patient reached week 52 but for ≤100 weeks. We calculated Spearman correlation coefficients between FVC (mL) at baseline and change from baseline in mRSS, mRSS at baseline and change from baseline in FVC (mL), and changes from baseline in mRSS and FVC at weeks 52 and 100 in all patients. We analysed the rate of decline in FVC (mL/year) in patients who did and did not have progression of skin fibrosis (relative change from baseline in mRSS >25% and absolute change from baseline >5 points) at week 52.

Results:

In the nintedanib (n=288) and placebo (n=288) groups, respectively, mean (SD) baseline FVC (mL) was 2459 (736) and 2541 (816) and mRSS was 11.3 (9.2) and 10.9 (8.8); 53.1% and 50.7% had dcSSc;18.4% and 16.0% had progression of mRSS at week 52. No meaningful correlations were observed in analyses between mRSS and FVC (Table). The mean (SE) annual rate of decline in FVC in the placebo group was similar in patients who did and did not have progression of mRSS (-95.2 [27.1] and -91.4 [15.7] mL/year, respectively). The effect of nintedanib vs placebo on reducing the rate of decline in FVC was numerically more pronounced in patients who did not have progression of mRSS vs those who did (difference [95% CI] 44.3 mL/year [0.6, 88.1] vs 24.6 [-53.7, 102.9]), but the interaction p-value (0.66) did not indicate heterogeneity in treatment effect between subgroups.

Conclusion:

In the SENSCIS trial, the proportion of patients who had progression of skin fibrosis over 52 weeks was low, without significant differences between placebo and nintedanib. No meaningful correlations were observed between skin fibrosis at baseline or progression of skin fibrosis and progression of SSc-ILD. The rate of decline in FVC was similar between patients who did and did not have progression of mRSS. These findings suggest that in the overall patient population in the SENSCIS trial, progression of skin fibrosis and progression of ILD were distinct manifestations of disease progression.

Table:FVC at baseline and change from baseline in mRSSmRSS at baseline and change from baseline in FVCChanges from baseline in mRSS and FVCNCorrelation*NCorrelation*NCorrelation*Week 52Nintedanib2470.11 (-0.01, 0.23)241-0.08 (-0.20, 0.05)238-0.07 (-0.19, 0.06)Placebo2540.12 (-0.00, 0.24)257-0.15 (-0.27, -0.03)2520.03 (-0.09, 0.15)Week 100Nintedanib730.21 (-0.02, 0.42)73-0.06 (-0.29, 0.17)700.06 (-0.17, 0.30)Placebo660.28 (0.04, 0.49)730.04 (-0.19, 0.27)66-0.14 (-0.37, 0.10)

*Spearman correlation coefficient (95% CI)

Disclosure of Interests:

Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche, Kristin Highland Grant/research support from: Boehringer Ingelheim - PI for SENSCIS and SENSCIS-ON trials (paid to my institution), Consultant of: Kristin Highland has acted as a consultant to Boehringer Ingelheim. She was a member of the SENSCIS trial Steering Committee (Boehringer Ingelheim), Speakers bureau: Kristin Highland reports speaker fees from Boehringer Ingelheim, Anna-Maria Hoffmann-Vold Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion, Bayer, GlaxoSmithKline, Speakers bureau: Boehringer Ingelheim, Actelion, Roche, Otylia Kowal-Bielecka Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Inventiva, MSD, Novartis, Speakers bureau: Boehringer Ingelheim, Medac, Novartis, Roche, Sandoz, Ulrich Walker Grant/research support from: Ulrich Walker has received an unrestricted research grant from Abbvie, Consultant of: Ulrich Walker has act as a consultant for Abbvie, Actelion, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, MSD, Novartis, Pfizer, Phadia, Roche, Sandoz, Sanofi, and ThermoFisher, Paid instructor for: Abbvie, Novartis, and Roche, Speakers bureau: Abbvie, Actelion, Bristol-Myers Squibb, Celgene, MSD, Novartis, Pfizer, Phadia, Roche, Sandoz, and ThermoFisher, Francesco Del Galdo: None declared, Madelon Vonk Grant/research support from: Janssen and Ferrer, Consultant of: Boehringer Ingelheim, Janssen and GSK, Speakers bureau: Boehringer Ingelheim, BMS and Roche, Laura Hummers Grant/research support from: Boehringer Ingleheim, Corbus pharmaceuticals, CSL Behring, Cumberland Pharmaceuticals, and GlaxoSmithKline, Consultant of: Boehringer Ingleheim, Corbus pharmaceuticals, and CSL Behring, Elvira Erhardt Employee of: Employee of Boehringer Ingelheim, Manuel Quaresma Employee of: Employee of Boehringer Ingelheim, Margarida Alves Employee of: Employee of Boehringer Ingelheim, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl

Per-Contact Infectivity of Hepatitis C Virus Acquisition in Association With Receptive Needle Sharing Exposures in a Prospective Cohort of Young Adult People who Inject Drugs in San Francisco, California

Background

Sharing needles and ancillary injecting equipment is a primary risk exposure for hepatitis C virus (HCV) infection among people who inject drugs (PWID); however, infectivity of these exposures is not well quantified. We aimed to estimate per-event HCV infectivity associated with receptive needle sharing (RNS) among susceptible PWID.

Methods

Participants in a prospective cohort study of young adult PWID who were anti-HCV and HCV RNA negative at baseline and attended at least 2 follow-up study visits between 2003 and 2014 were eligible. Data were selected from the first HCV-negative through the first HCV-positive visit (or last HCV-negative among those uninfected). Anti-HCV and HCV-RNA tests were used to determine infection status. A probabilistic exposure model linking observed HCV infection outcomes to self-reported exposure events was applied to estimate infectivity.

Results

Among 344 participants, a maximum likelihood estimate considering RNS yielded a pooled population per RNS event HCV probability of 0.25% (95% confidence interval [CI], 0.10%–0.43%), and 1.12% (95% CI, 0.48%–2.35%) among those who acquired any HCV infection (primary or reinfection).

Conclusions

HCV is highly infectious in association with RNS, a primary injection-related risk exposure. Our infectivity estimate among participants who acquired any HCV infection is 1.7 times higher than that estimated for HIV infection in PWID and 2.24 times higher than that estimated among health care workers exposed through needle sticks. The strengths of this study include the assessment of receptive needle sharing events, the prospective design, and relatively short recall and testing periods. These results can inform transmission models and research to prevent HCV infection.

The spatial chronnectome reveals a dynamic interplay between functional segregation and integration

The brain is highly dynamic, reorganizing its activity at different interacting spatial and temporal scales, including variation within and between brain networks. The chronnectome is a model of the brain in which nodal activity and connectivity patterns change in fundamental and recurring ways over time. Most literature assumes fixed spatial nodes/networks, ignoring the possibility that spatial nodes/networks may vary in time. Here, we introduce an approach to calculate a spatially fluid chronnectome (called the spatial chronnectome for clarity), which focuses on the variations of networks coupling at the voxel level, and identify a novel set of spatially dynamic features. Results reveal transient spatially fluid interactions between intra- and internetwork relationships in which brain networks transiently merge and separate, emphasizing dynamic segregation and integration. Brain networks also exhibit distinct spatial patterns with unique temporal characteristics, potentially explaining a broad spectrum of inconsistencies in previous studies that assumed static networks. Moreover, we show anticorrelative connections to brain networks are transient as opposed to constant across the entire scan. Preliminary assessments using a multi-site dataset reveal the ability of the approach to obtain new information and nuanced alterations that remain undetected during static analysis. Patients with schizophrenia (SZ) display transient decreases in voxel-wise network coupling within visual and auditory networks, and higher intradomain coupling variability. In summary, the spatial chronnectome represents a new direction of research enabling the study of functional networks which are transient at the voxel level, and the identification of mechanisms for within- and between-subject spatial variability.

A Bayesian Approach for Estimating Dynamic Functional Network Connectivity in fMRI Data

Dynamic functional connectivity, i.e., the study of how interactions among brain regions change dynamically over the course of an fMRI experiment, has recently received wide interest in the neuroimaging literature. Current approaches for studying dynamic connectivity often rely on ad-hoc approaches for inference, with the fMRI time courses segmented by a sequence of sliding windows. We propose a principled Bayesian approach to dynamic functional connectivity, which is based on the estimation of time varying networks. Our method utilizes a hidden Markov model for classification of latent cognitive states, achieving estimation of the networks in an integrated framework that borrows strength over the entire time course of the experiment. Furthermore, we assume that the graph structures, which define the connectivity states at each time point, are related within a super-graph, to encourage the selection of the same edges among related graphs. We apply our method to simulated task-based fMRI data, where we show how our approach allows the decoupling of the task-related activations and the functional connectivity states. We also analyze data from an fMRI sensorimotor task experiment on an individual healthy subject and obtain results that support the role of particular anatomical regions in modulating interaction between executive control and attention networks.

Efficacy of Aedes aegypti control by indoor Ultra Low Volume (ULV) insecticide spraying in Iquitos, Peru

BACKGROUND

Aedes aegypti is a primary vector of dengue, chikungunya, Zika, and urban yellow fever viruses. Indoor, ultra low volume (ULV) space spraying with pyrethroid insecticides is the main approach used for Ae. aegypti emergency control in many countries. Given the widespread use of this method, the lack of large-scale experiments or detailed evaluations of municipal spray programs is problematic.

METHODOLOGY/PRINCIPAL FINDINGS

Two experimental evaluations of non-residual, indoor ULV pyrethroid spraying were conducted in Iquitos, Peru. In each, a central sprayed sector was surrounded by an unsprayed buffer sector. In 2013, spray and buffer sectors included 398 and 765 houses, respectively. Spraying reduced the mean number of adults captured per house by ~83 percent relative to the pre-spray baseline survey. In the 2014 experiment, sprayed and buffer sectors included 1,117 and 1,049 houses, respectively. Here, the sprayed sector's number of adults per house was reduced ~64 percent relative to baseline. Parity surveys in the sprayed sector during the 2014 spray period indicated an increase in the proportion of very young females. We also evaluated impacts of a 2014 citywide spray program by the local Ministry of Health, which reduced adult populations by ~60 percent. In all cases, adult densities returned to near-baseline levels within one month.

CONCLUSIONS/SIGNIFICANCE

Our results demonstrate that densities of adult Ae. aegypti can be reduced by experimental and municipal spraying programs. The finding that adult densities return to approximately pre-spray densities in less than a month is similar to results from previous, smaller scale experiments. Our results demonstrate that ULV spraying is best viewed as having a short-term entomological effect. The epidemiological impact of ULV spraying will need evaluation in future trials that measure capacity of insecticide spraying to reduce human infection or disease.

A comparative effectiveness study of two culturally competent models of diabetes self-management programming for Latinos from low-income households

BACKGROUND

Diabetes risk is extremely high for Latinos from low-income households. Health guidelines recommend that individuals learn strategies to self-manage their diabetes, but getting people to adopt required lifestyle changes is challenging and many people are not able to prevent their pre-diabetes from escalating or effectively control their diabetes. Systematic reviews show that culturally competent self-management programs can significantly improve diabetes outcomes and different models for culturally competent programming have been developed.

METHODS

This patient-engaged study will compare the effectiveness of two distinct evidence-based models for culturally competent diabetes health promotion at two sites that serve a large Latino patient population from low-income households: 1) The Diabetes Self-Management Support Empowerment Model, an educational session approach, and 2) The Chronic Care Model, a holistic community-based program. Data collection will involve interviews, focus groups, surveys and assessments of each program; and testing of patient participants for A1c, depression, Body Mass Index (BMI), and chronic stress with hair cortisol levels. We will recruit a total of 240 patient-social support pairs: Patients will be adults (men and women over the age of 18) who: 1.) Enter one of the two diabetes programs during the study; 2.) Self-identify as "Latino;" 3.) Are able to identify a social support person or key member of their social network who also agrees to participate with them; 4.) Are not pregnant (participants who become pregnant during the study will be excluded); and 5.) Have household income 250% of the Federal Poverty Level (FPL) or below. Social supports will be adults who are identified by the patient participants.

PRIMARY OUTCOME

Improved capacity for diabetes self-management measured through improvements in diabetes knowledge and diabetes-related patient activation.

SECONDARY OUTCOME

Successful diabetes self-management as measured by improvements in A1c, depression scale scores, BMI, and circulating levels of cortisol to determine chronic stress.

DISCUSSION

Our hypothesis is that the program model that interfaces most synergistically with patients' culture and everyday life circumstances will have the best diabetes health outcomes.

TRIAL REGISTRATION

This study was registered with ClinicalTrials.gov on December 16, 2016 (Registration # NCT03004664 ).

Characterization of long-term gait deficits in mouse dMCAO, using the CatWalk system

Evaluation of functional outcome is widely used across species to assess the recovery process following various pathological conditions, including spinal cord injury, musculo-skeletal injury, mithochondrial disease, neuropathic cancer, Huntington's disease, chronic pain, cortical lesion, and olivocerebellar degeneration among others. The Stroke Therapy Academic Industry Roundtable (STAIR) recommends multiple endpoints for behavioral studies in pre-clinical stroke research, to demonstrate their clinical relevance. One of the more challenging tasks in experimental stroke research is measuring long-term functional outcome in mice. It is, however, becoming more important, since transgenic mice are increasingly used for modeling human neurological disorders. Using CatWalk, we characterized long-lasting gait/locomotion deficits following mouse distal middle cerebral artery occlusion (dMCAO). The post-dMCAO assessment was performed at 7, 14, 21, and 28days after experimental ischemia. When compared to sham-operated mice, dMCAO animals displayed a statistically significant decrease in Spatial parameters (such as Paw Area), while the Temporal parameters (Stand, Initial and Terminal Dual Stances) were significantly increased for three weeks after surgery. Kinetic parameters were significantly decreased in dMCAO animals at 7days after dMCAO. The Interlimb coordination group of parameters displayed the strongest deficits at 21days. While CatWalk variables were altered in all paws, the degree of change was greatest for the parameters measured from the Right Front Paw (contralateral to the lesion). All parameters measured in dMCAO and Sham-operated groups reached similar levels at four weeks after the experimental insult, which reflects a spontaneous post-ischemic recovery. Based on our investigation, we conclude that CatWalk represents a relevant and sensitive analysis, which allows long-term characterization of animal functional recovery in the dMCAO model of experimental ischemia.

Conserved patterns of incomplete reporting in pre-vaccine era childhood diseases

Incomplete observation is an important yet often neglected feature of observational ecological timeseries. In particular, observational case report timeseries of childhood diseases have played an important role in the formulation of mechanistic dynamical models of populations and metapopulations. Yet to our knowledge, no comprehensive study of childhood disease reporting probabilities (commonly referred to as reporting rates) has been conducted to date. Here, we provide a detailed analysis of measles and whooping cough reporting probabilities in pre-vaccine United States cities and states, as well as measles in cities of England and Wales. Overall, we find the variability between locations and diseases greatly exceeds that between methods or time periods. We demonstrate a strong relationship within location between diseases and within disease between geographical areas. In addition, we find that demographic covariates such as ethnic composition and school attendance explain a non-trivial proportion of reporting probability variation. Overall, our findings show that disease reporting is both variable and non-random and that completeness of reporting is influenced by disease identity, geography and socioeconomic factors. We suggest that variations in incomplete observation can be accounted for and that doing so can reveal ecologically important features that are otherwise obscured.

Reference values for leptin and adiponectin in children below the age of 10 based on the IDEFICS cohort

OBJECTIVE

To establish age- and sex-specific reference values for serum leptin and adiponectin in normal-weight 3.0-8.9-year old European children.

SUBJECTS AND METHODS

Blood samples for hormone analysis were taken from 1338 children of the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study cohort. Only normal-weight children aged 3.0-8.9 years were included (n=539) in our analysis. Using the General Additive Model for Location Scale and Shape, age- and sex-specific percentiles were derived. The influence of under/overweight and obesity on the proposed reference curves based on normal-weight children was investigated in several sensitivity analyses using the sample without obese children (n=1015) and the whole study sample (n=1338).

RESULTS

There was a negative age trend of adiponectin blood levels and a positive trend of leptin levels in boys and girls. Percentiles derived for girls were generally higher than those obtained for boys. The corresponding age-specific differences of the 97th percentile ranged from -2.2 to 4.6 μg ml(-1) and from 2.2 to 4.8 ng ml(-1) for adiponectin and leptin, respectively.

CONCLUSIONS

According to our knowledge, these are the first reference values of leptin and adiponectin in prepubertal, normal-weight children. The presented adiponectin and leptin reference curves may allow for a more differentiated interpretation of children's hormone levels in epidemiological and clinical studies.

Zum photochemischen Verhalten einiger N-Alkylacridinium-Kationen und N, N′-Dialkyl-9.9-′-diacridane in äthanolischer Lösung II

Die N-Methyl-, N-Äthyl-, N-n-Propyl- und N-n-Butylacridiniumjodide werden synthetisiert und diese mit AgNO3 in äthanolischer Lösung in die entsprechenden Nitrate umgewandelt. Lösungen der Konzentrationen 2-3 · 10-2-m. in O2-freiem Äthanol werden in Pyrex- oder Quarzgefäßen mit Osram HBO 200- oder Hanau TQ 81-Lampen der Photolyse unterworfen.

Die N-Alkylacridiniumsalze werden dabei im Primärakt unter Übertragung eines H-Atoms vom Lösungsmittel photoreduziert. Dabei bildet sich sehr wahrscheinlich ein N-Alkylacridaniumradikal-Kation. Dieses gibt ein Proton ab, das quantitativ nachgewiesen wird; es bildet sich ein N-Alkylacridanylradikal, das mit sich selbst zu den entsprechenden N,N′-Dialkyl-9.9′-diacridanen dimerisiert. Diese Diacridane sind relativ schwer löslich und fallen bei der Photolyse als Festsubstanzen aus. Das N,N′-Diäthyldiacridan hat im Entstehungszustand die größte Löslichkeit; sie beträgt 4,4 · 10-3-m. bei 30°. Zum N,N′-Dimethyl- bzw. N,N′-Di-n-Propyl- und N,N′-Di-n-Butyldiacridan fällt die Löslichkeit rasch ab und bedingt, daß auch bei höheren Reaktionstemperaturen Umsätze von 80 - 100% vor Einsetzen einer merklichen Rückbildungsreaktion erzielt werden können.

Die N,N′-Dialkyldiacridane sind selbst photochemisch instabil. Sie zerfallen im Primärprozeß heterolytisch in ein N-Alkylacridinium-Kation und ein entsprechendes Anion, das sich rasch, vermutlich zu einem Acridan stabilisiert. Diese photolytische Instabilität der N,N′-Dialkyldiacridane bedingt bei höheren Reaktionstemperaturen und größerer Löslichkeit, daß beim N,N-Diäthyldiacridan die Rückreaktion schon bei einem 40-proz. Umsatz in den Vordergrund kommt und kein festes Diacridan gebildet wird.

Zur Photooxydation und Dehydrierung einiger N-Alkylacridane bei Tieftemperatur III

Der Verlauf der Photooxydation bei Tieftemperatur wird in quantitativer Sicht am Di- und Triphenylamin aufgezeigt. Diese beiden offenen Arylamine spalten bei der photolytischen Primärreaktion ein Elektron unter Bildung eines Radikalkations ab. Die Kationen absorbieren mit ihrer längstwelligen Bande bei 650 nm und verursachen Blaufärbung der eingefrorenen Lösung; ein höherer Anregungszustand liegt bei 360 nm im Ultraviolett.

Die Tieftemperaturphotolyse der geschlossenen Diarylamine N—CH3-, N—C2H5-, N—C3H7- und N-Phenylacridan ist bezüglich des Primärprozesses den offenen Arylaminen analog. Es werden zunächst blaugefärbte N-Radikalkationen mit Absorptionsbanden bei 650 und 360 nm gebildet. Bei ansteigender Konzentration und zunehmender Belichtungsdauer wird die Bildung eines neuen, orangen Radikals mit einer längstwelligen Absorptionsbande bei 520 nm nachgewiesen. Dabei sinkt die Konzentration des blauen Radikalkations laufend ab. — Durch Einfluß von OH⊖-Ion wird gezeigt, daß es sich dabei um ein durch H⊕-Abspaltung aus dem Radikalkation entstandenes C-Radikal handeln muß.

Beim Tauen der Lösung auf —140 bis —150 °C rekombiniert ab —170 °C zuerst das Radikalkation reversibel zum Ausgangsacridan zurück, während das orange C-Radikal, beginnend ab —155 °C, in drei stabile Molekeln umgewandelt wird. Einerseits entstehen durch Disproportionierung aus diesem C-Radikal N-Alkylacridiniumkation und N-Akylacridananion, und andererseits bildet sich besonders bei O2-Anwesenheit ein N-Alkylacridon. Die Acridonbildung stellt einen Konkurrenzprozeß zur Disproportionierung des C-Radikals dar.

Es wird daraus gefolgert, daß das C-Radikal Semichinoncharakter hat.

Uncoupling protein-2 gene polymorphisms are associated with obesity in Hungarian children

AIM

To determine the frequency of common polymorphisms of genes associated with energy metabolism among normal weight and overweight/obese children to look for effects on childhood obesity.

METHODS

Among 709 overweight/obese and 637 normal weight children (age 6-17 years), anthropometric measurements were carried out and genotyping for the following gene polymorphisms: β3 -adrenoreceptor Trp64Arg, uncoupling protein (UCP) -1 -3826 A/G, UCP-2 -866 G/A and exon 8 del/ins, UCP-3 -55 C/T and peroxisome proliferator-activated receptor-γ Pro12Ala.

RESULTS

On multivariate regression analysis adjusted for age and gender heterozygosity and homozygosity for the UCP-2 -866 A variant was associated with an odds ratio (OR) for obesity of 0.69 (95% CI: 0.52-0.92; p = 0.013) and 0.50 (95% CI: 0.32-0.79; p = 0.003), respectively, compared with G/G homozygotes. Heterozygotes and homozygotes for the UCP-2 exon 8 ins allele had an OR for obesity of 1.66 (95% CI: 1.24-2.23; p = 0.001) and 2.12 (95% CI: 1.23-3.63; p = 0.006), respectively, compared with del/del homozygotes. There were no significant differences in obesity risk in association with the other examined gene polymorphisms.

CONCLUSION

Common polymorphisms of the UCP-2 gene might influence the propensity to overweight/obesity in Hungarian children.

Low contribution of n-3 polyunsaturated fatty acids to plasma and erythrocyte membrane lipids in diabetic young adults

Hypoinsulinemia characteristic to type 1 diabetes may theoretically inhibit the conversion of essential fatty acids to their longer-chain metabolites. Fatty acids were determined in plasma and erythrocyte membrane lipids in young diabetic adults (n=34) and in age-matched healthy controls (n=36). Values of linoleic acid (56.01 [5.02] versus 51.05 [7.32], % by wt, median [range from the first to the third quartile], P<0.00l) and arachidonic acid (AA) (11.17 [2.98] versus 9.69 [1.95] P<0.001) were significantly higher in diabetic subjects than in controls. However, alpha-linolenic acid values did not differ, and docosahexaenoic acid (0.43 [0.12] versus 0.57 [0.29], P<0.01) values were significantly lower in diabetic than in control subjects. Significant inverse correlations were found between AA and hemoglobin A(1c) values in the phospholipid (r=-0.40, P<0.05) and sterol ester (r=-0.40, P<0.05) fractions. The data obtained in the present study suggest that the availability of n-3 long-chain polyunsaturated fatty acid may be reduced in young diabetic adults.

Plasma levels of acylated ghrelin during an oral glucose tolerance test in obese children

OBJECTIVE

Ghrelin is an acylated peptide with octanoyl modification, which is essential for its GH-releasing ability. Coexpression of GH secretagogue receptor (GHS-R) and ghrelin in the pancreas suggests that this peptide is involved in glucose metabolism. The other form of the molecule, the non-acylated ghrelin, has been reported to be devoid of any pituitaric endocrine activities. Previous reports demonstrated that plasma total ghrelin levels decrease after oral glucose administration in obese children, but no data are available about the plasma levels of acylated ghrelin. Therefore, in the present study the plasma levels of acylated ghrelin were measured in obese and control children during oral glucose tolerance test (OGTT).

MATERIALS AND METHODS

Acylated ghrelin response to OGTT was evaluated in 11 obese and 9 age-matched control children. All subjects received 0.75 g/kg (maximum 75 g) glucose solution orally after an overnight fast. Acylated ghrelin, insulin, glucose, and GH were determined at 0, 30, 60 and 120 min, and leptin at 0 min of the OGTT.

RESULTS

Plasma basal levels of acylated ghrelin were significantly lower in the obese children than in the controls (66.3+/-6.7 vs 97.2+/-14.4 pg/ml, p<0.05). The plasma acylated ghrelin concentration decreased significantly at 30 and 60 min in the control group (53.3+/-9.9 and 57.4+/-7.0 pg/ml, p<0.05), but not in the obese group (64.7+/-9.6 and 49.3+/-4.6 pg/ml) as compared to the basal value. In the obese group the acylated ghrelin level was significantly higher at 120 min, than at 0 min (91.6+/-9.8 vs 66.3+/-6.7 pg/ml, p<0.05).

CONCLUSIONS

There was no rapid fall in plasma levels of acylated ghrelin in obese children after OGTT at 30 min, but there was an increase at 120 min, suggesting that the dynamic of the response to OGTT is slower and there is an upregulation of active ghrelin in the second half of OGTT in obese children.

Behavioral changes induced by cocaine in mice are modified by a hyperlipidic diet or recombinant leptin

The objective of the present study was to determine if the acute behavioral effects of cocaine acutely administered intraperitoneally (ip) at doses of 5, 10 and 20 mg/kg on white male CF1 mice, 90 days of age, would be influenced by leptin acutely administered ip (at doses of 5, 10 and 20 microg/kg) or by endogenous leptin production enhanced by a high-fat diet. The acute behavioral effects of cocaine were evaluated in open-field, elevated plus-maze and forced swimming tests. Results were compared between a group of 80 mice consuming a balanced diet and a high-fat diet, and a group of 80 mice fed a commercially available rodent chow formula (Ralston Purina) but receiving recombinant leptin (rLeptin) or saline ip. Both the high-fat-fed and rLeptin-treated mice showed decreased locomotion in the open-field test, spent more time in the open arms of the elevated plus-maze and showed less immobility time in the forced swimming test (F(1,68) = 7.834, P = 0.007). There was an interaction between diets and cocaine/saline treatments in locomotion (F(3,34) = 3.751, P = 0.020) and exploration (F(3,34) = 3.581, P = 0.024). These results suggest that anxiolytic effects and increased general activity were induced by leptin in cocaine-treated mice and that low leptin levels are associated with behavioral depression. Chronic changes in diet composition producing high leptin levels or rLeptin treatment may result in an altered response to cocaine in ethologic tests that measure degrees of anxiety and depression, which could be attributed to an antagonistic effect of leptin.

The frequency of Trp64Arg polymorphism of the β3-adrenergic receptor gene in healthy and obese Hungarian children and its association with cardiovascular risk factors

OBJECTIVE

To estimate the frequency of Arg64 allele of the beta(3)-adrenergic receptor (3-BAR) gene in healthy (H) and obese (O) Hungarian children, and to look for possible associations between this polymorphism and some clinical and metabolic characteristics of obese children.

PATIENTS/METHODS

In all, 147 healthy (male: 68) and 295 obese (male: 168) children were examined. The average age of the children in the two groups was 12.4+/-1.7 vs 12.6+/-3.2, respectively. Exon 1 of 3-BAR was amplified by polymerase chain reaction and the fragments were digested with BstN1. In obese children, oral glucose tolerance test was carried out and blood pressure (BP) was checked.

RESULTS

The frequency of Trp64Arg polymorphism in normal and obese Hungarian children was similar (H vs O: n=14/9.5% vs n=35/11.8%). Obese children carrying the Arg64 allele (n=35, male: 23) were compared to randomly chosen, obese children without the Arg64 allele (n=35, male: 20). A significant difference was found between the body weight (81.2+/-23.2 vs 75.6+/-17.7 kg; mean+/-s.d.; P<0.01), body fat (38.8+/-3.9 vs 36.5+/-2.3%; mean+/-s.d.; P<0.05), mean fasting insulin levels (31.4+/-16.7 vs 16.9+/-7.6 microIU/ml; P<0.001) and mean systolic BP values (125.2+/-10.1 vs 114.5+/-8.3 mmHg; P<0.001) of the two obese groups.

CONCLUSIONS

The frequency of Trp64Arg polymorphism was similar in Hungary as compared to other European countries. Although the prevalence of this polymorphism was similar in H and O children, the presence of Arg64 allele seems to be associated with increased adiposity, elevated systolic BP and higher fasting insulin levels.

Polyunsaturated fatty acids in plasma and erythrocyte membrane lipids of diabetic children

While insulin is a potent activator of essential fatty acid metabolism, portal hypoinsulinemia is common in Type 1 diabetes. Fatty acids were determined by high-resolution capillary gas-liquid chromatography in plasma and erythrocyte membrane lipids in diabetic children (n = 40) and in age-matched healthy controls (n = 40). In plasma phospholipids, values of linoleic acid (23.00 [2.35] vs. 18.13 [2.54], % by wt, median [range from the first to the third quartile], P<0.000l) and alpha-linolenic acid (0.12 [0.06] vs. 0.07 [0.07], P<0.05) were significantly higher in diabetic children than in controls. In contrast, values of arachidonic acid (10.73 [2.34] vs. 11.53 [2.50], P<0.05) and docosahexaenoic acid (2.23 [0.63] vs. 2.77 [0.98], P<0.01) were significantly lower in diabetic children than in controls. Reduced availability of long-chain polyunsaturates in diabetic children suggests that an enhanced dietary supply of long-chain polyunsaturates may be beneficial.

Safety and efficacy of treatment with an ephedrine/caffeine mixture. The first double-blind placebo-controlled pilot study in adolescents

OBJECTIVE

The present study was performed to investigate the efficacy and safety of a caffeine/ephedrine (CE) mixture in obese adolescents.

SUBJECTS

Thirty-two (m/f = 16/16) obese children were included into the study. They were treated by diet (calculated daily energy requirement minus 500 kcal) and either CE or placebo (PL) for 20 weeks in a randomized double-blind placebo-controlled trial. Those weighing less than 80 kg took one tablet three times (100 mg/10 mg), whereas those weighing more than 80 kg took two tablets three times per day. There were three dropouts (girls) from the PL group. The age, weight body mass index (BMI) values (mean (range)) of the PL and CE groups were 16.0 (14.3-17.6) and 16.0 (14.2-17.7) y, 103.0 (77.2-126.4) and 104.8 (69.8-150.2) kg, 35.2 (28.3-42.3) and 36.5 (31.3-51.8) kg/m2, respectively.

RESULTS

The decrease in relative body weight, BMI and body fat (measured by bioelectric impedance) was significantly (P < 0.05) greater in the CE group (mean +/- s.d.; 14.4 +/- 10.5%, 2.9 +/- 1.9 kg/m2, 6.6 +/- 6.0 kg) than in the PL group (2.2 +/- 5.8%, 0.5 +/- 1.6 kg/m2, 0.5 +/- 2.7 kg). Relative body weight decreased by more than 5% in 81% of the CE group, out only in 31% of the PL group. Adverse events were negligible and did not differ between the CE and PL groups. Withdrawal symptoms were mild, transient and their frequency and severity were not different between the placebo and active groups.

CONCLUSION

According to the present pilot study, CE can be a safe and effective compound for the treatment of obesity in adolescents.

Polyunsaturated fatty acids in plasma lipids of obese children with and without metabolic cardiovascular syndrome

Previously we reported significantly higher values of gamma-linolenic acid (GLA, 18:3n-6), dihomo-gamma-linolenic acid (DHGLA, 20:3n-6), and arachidonic acid (20:4n-6) in plasma lipid classes in obese children than in nonobese controls. In the present study, fatty acid composition of plasma phospholipids (PL) and sterol esters (STE) was determined by high-resolution capillary gas-liquid chromatography in obese children with and without metabolic cardiovascular syndrome [MCS: defined as simultaneous presence of (i) dyslipidemia, (ii) hyperinsulinemia, (iii) hypertension, and.(iv) impaired glucose tolerance] and in nonobese controls. Fatty acid composition of PL and STE lipids did not differ between obese children without MCS and controls. Obese children with MCS exhibited significantly lower linoleic acid (LA, 18:2n-6) values in PL (17.43 [2.36], % wt/wt, median [range from the first to the third quartile]) than obese children without MCS (19.14 [3.49]) and controls (20.28 13.80]). In contrast, PL GLA values were significantly higher in obese children with (0.13 [0.08]) than in those without MCS (0.08 [0.04]), whereas STE GLA values were higher in obese children with MCS (1.04 [0.72]) than in controls (0.62 [0.48]). DHGLA values in PL were significantly higher in obese children with MCS (4.06 [0.74]) than in controls (2.69 [1.60]). The GLA/LA ratio was significantly higher, whereas the AA/DHGLA ratio was significantly lower in obese children with MCS than in obese children without MCS and in controls. In this study, LA metabolism was affected only in obese children with but not in those without MCS. In obese children with MCS, delta6-desaturase activity appeared to be stimulated, whereas delta5-desaturase activity appeared to be inhibited. Disturbances in LA metabolism may represent an additional health hazard within the multifaceted clinical picture of MCS.

High prevalence of factor V Leiden mutation in mothers of premature neonates

The prevalence of the Leiden mutation was tested in 50 mothers of premature infants and in 56 mothers of intrauterine-growth-retarded neonates. The prevalence of the Leiden mutation was 7.2% in the mothers of growth-retarded neonates and 18% in the group of mothers of premature infants, the latter being significantly higher than the 6.3% prevalence of this mutation in healthy Hungarian subjects (p < 0.01). In spite of the relatively small number of mothers examined, the unexpected finding may call attention to a hitherto unknown relationship.

Correlation of blood-spot 17-hydroxyprogesterone daily profiles and urinary steroid profiles in congenital adrenal hyperplasia

OBJECTIVE

To compare the value of blood-spot 17-hydroxyprogesterone (17-OHP) daily profiles and urinary steroid excretion in untreated and treated patients with congenital adrenal hyperplasia (CAH).

PATIENTS

Ten patients with CAH were investigated during steroid replacement therapy (Group 1), and 11 patients were investigated without treatment (Group 2).

METHODS

Capillary blood samples were collected for measurement of blood-spot 17-OHP values by non-chromatographic radioimmunoassay. Steroid profiles of 24-h urine samples were analyzed by gas chromatography.

RESULTS

There was a close correlation between the individual daily means of blood-spot 17-OHP measurements and the pregnanetriol/ tetrahydrocortisone ratio in both groups of patients (Group 2: r=0.839, p<0.001; Group 1: r=0.686, p<0.001). Almost the same correlation was found between the blood-spot 17-OHP value and the sum of three 17-hydroxyprogesterone metabolites/the sum of three cortisol/cortisone metabolites ratio (Group 2: r=0.918, p<0.001; Group 1: r=0.741, p<0.001).

CONCLUSIONS

Blood-spot 17-OHP measurements and 24-h urinary steroid profile have the same impact in identification and monitoring therapy of children with CAH.

[Role of intrauterine growth in later cardiovascular risk factors in children 6-10 years of age]

There has been considerable interest in the possibility that prenatal events could influence the adult life. Adults who were small at birth have been reported to have higher blood pressure and increased risk of death from ischaemic heart disease, although there are some contradictory results. The aim of the present study was to determine the association between size at birth and later risk factors (hypertension, hyperinsulinism, hyperglycaemia and dyslipidaemia) in prepubertal children. The authors examined 205 children (121 boys, 84 girls) at the age of 6-10. They compared children born full term with normal weight, height and head circumference (1st group), the children born full term with birthweight, height and head circumference less than 10th centile (2nd group), children born full term with birthweight less than 10th centile and with normal length and head circumference (3rd group) and children who were preterm at birth (4th group). The age of children at the time of investigation was comparable in the four groups. Weight and height of the children in the 2nd group were significantly lower than in the 1st and 4th groups (2nd group vs 4th group: p < 0.01; 2nd group vs 1st group: p < 0.001). Dyslipidaemia was found 21% in the 1st group, 17% in the 2nd group, 16% in the 3rd group and 28% in prematures. The mean of the systolic and diastolic blood pressures were similar in the four groups. Hypertension was 12.5% in the 1st and 3rd groups, 5.6% in the 2nd group and 8.9% among prematures. According to the results cardiovascular risk factors can not be proved among children at the age of 6-10 who were born with low birthweight. Further studies are required to determine whether which stage of pregnancy might influence birthweight and later risk factors.

Plasma lipids, phospholipid fatty acids and indices of glycaemia in 10-year-old children born as small-for-gestational-age or preterm infants

Low birthweight has been epidemiologically associated with unfavourable plasma lipid profiles and enhanced risk of cardiovascular morbidity in adulthood. Plasma lipids, lipoprotein cholesterols, apolipoproteins, fatty acid composition of plasma phospholipids and basic indices of glycaemia were investigated in 10-y-old children born with similarly low birthweights as small-for-gestational-age (SGA; n = 16) or preterm infants (n = 16). Plasma total cholesterol (4.32 +/- 0.57 vs 4.60 +/- 0.52, mmol l(-1), mean +/- SD, SGA vs preterm subjects), low-density lipoprotein cholesterol (2.54 +/- 0.51 vs 2.65 +/- 0.51) and high-density lipoprotein cholesterol (1.61 +/- 0.25 vs 1.76 +/- 0.18) concentrations did not differ between the 2 groups. There was no difference in plasma triacylglycerol, apolipoprotein A-I and B, insulin and glucose concentrations or phospholipid fatty acid values. There was no correlation between indices of lipid and carbohydrate metabolism. In conclusion, plasma lipid profiles and basic indices of glycaemia are not different in 10-y-old children born with similarly low birthweights as SGA or preterm infants.

Two cases of musculoskeletal syndrome associated with acne

We report two cases of musculoskeletal syndrome (myalgia, arthralgia, arthritis, hyperostosis) that developed in male adolescents who had severe acne (acne conglobata and acne fulminans). In both patients the hyperostosis of the right clavicle aroused the suspicion of a bone tumor or osteomyelitis, which was excluded by histologic examination. Radiologic and laboratory characteristics of musculoskeletal syndrome associated with acne conglobata and acne fulminans are reviewed as well as isotretinoin therapy. The problems of differential diagnosis are also discussed.

Measured and predicted resting metabolic rate in obese and nonobese adolescents

OBJECTIVES

The validity of equations for the calculation of resting metabolic rate (RMR) were studied and new predictive equations were developed.

STUDY DESIGN

The RMR was measured in a sample of 371 10- to 16-year-old prepubertal and postpubertal children. The study group included 193 male (116 nonobese and 77 obese) and 178 female (119 nonobese and 59 obese) subjects; for each group the RMRs predicted from five equations recommended for this age group were compared. The RMR was assessed by indirect calorimetry with a ventilated hood system for 45 minutes after an overnight fast. Body composition was estimated from skin-fold measurements.

RESULTS

The mean +/- SD RMR was found to be 5600 +/- 972 kJ/24 hr and 7223 +/- 1220 kJ/24 hr in nonobese and obese boys, and 5112 +/- 632 kJ/24 hr and 6665 +/- 1106 kJ/24 hr in nonobese and obese girls, respectively. All five equations applicable to 10- to 16-year-old children overestimated RMR by 7.5% to 18.1% (p < 0.001 for each equation). Stepwise regression analysis, with independent variables such as age, weight, height, and gender, allowed development of new predictive equations for the calculation of RMR in 10- to 16-year-old boys (RMR = 50.9 Weight (kg) + 25.3 Height (cm) -50.3 Age (yr) + 26.9; R2 = 0.884, p < 0.0001) and girls (RMR = 51.2 Weight (kg) + 24.5 Height (cm) - 207.5 Age (yr) + 1629.8; R2 = 0.824, p < 0.0001). These predictive equations were tested in a second, independent cohort of children (80 male and 61 female subject) and were found to give a reliable estimate of RMR in 10- to 16-year-old obese and nonobese adolescents.

CONCLUSIONS

The currently used predictive equations overestimate RMR in 10- to 16-year-old children. The use of the newly developed equations is recommended.