Comparison of Measured and Estimated Resting Energy Expenditure in Adolescents and Young Adults With Severe Obesity Before and 1 Year After Sleeve Gastrectomy.

Introduction: Resting energy expenditure (REE) is often evaluated in adults and adolescents with obesity to estimate caloric requirements when advising dietary changes. However, data are lacking regarding the accuracy of methods used to clinically assess REE in adolescents with severe obesity. Moreover, there are no data regarding the effects of sleeve gastrectomy (SG) on REE in adolescents. We evaluated the accuracy and error rate between estimated and measured REE in adolescents with severe obesity and changes in REE following (SG). Materials and Methods: Cross-sectional study (CSS): 64 adolescents and young adults, 14-22 years old, with moderate to severe obesity were enrolled. We measured REE (mREE) by indirect calorimetry and estimated REE (eREE) using Derumeaux (Deru), Mifflin-St Jeor (MS), Harris Benedict (HB), and World Health Organization (WHO) equations. DXA was used to determine body composition. Bland Altman analysis evaluated agreement between eREE and mREE. Longitudinal study: 12 subjects had repeat indirect calorimetry and DXA 1 year after SG. Longitudinal analysis was used to assess changes in REE and body composition. Results: CSS: Median BMI was 45.2 kg/m2 and median age was 18.0 (16.3-19.9) years. mREE correlated strongly with eREE . Bland Altman analysis demonstrated that only a few points were beyond the 1.96 SD limit of disagreement. However, there was considerable overestimation of mREE by most equations. Longitudinal Study: In the subset that underwent SG, after 12-months, absolute REE decreased from 1709 (1567.7-2234) to 1580.5 (1326-1862.5) Calories (p = 0.002); however, the ratio of REE/Total Body Weight (TBW) increased from 13.5 ± 2.3 at baseline to 15.5 ± 2.2 at 1 year (p = 0.043). When evaluating parameters affecting % total weight loss, we found that it correlated positively with REE/TBW at 12 months (R = 0.625; p = 0.03) and negatively with % fat mass at 12 months (R = -0.669; p = 0.024). Discussion: In adolescents with moderate-severe obesity, despite a correlation between mREE using indirect calorimetry and eREE using the Deru, MS, HB, and WHO equations, there is significant over-estimation of REE at the individual level, challenging their clinical utility. One year after SG, REE/TBW increased and strongly correlated with % total weight loss in adolescents.

Differential associations between appendicular and axial marrow adipose tissue with bone microarchitecture in adolescents and young adults with obesity.

Marrow adipose tissue (MAT) in humans is distributed differentially across age and skeletal site. We have shown impaired microarchitecture and reduced bone strength at appendicular sites in conditions associated with high MAT of the axial skeleton in adults (including conditions of over- and undernutrition). Data are lacking regarding differences in MAT content of the appendicular versus the axial skeleton, and its relationship with bone microarchitecture and strength. Furthermore, data are conspicuously lacking in adolescents, a time when hematopoietic marrow is progressively converted to fatty marrow. The purpose of our study was to examine differential associations between appendicular (distal tibia) and axial (lumbar spine) MAT and bone microarchitecture and strength estimates of the distal tibia in adolescents with obesity. We hypothesized that compared to MAT of the axial skeleton (lumbar spine), MAT of the appendicular skeleton (distal tibia) would show stronger associations with bone microarchitecture and strength estimates of the appendicular skeleton (distal tibia). We evaluated 32 adolescents and young adults (27 females) with obesity; with a mean age of 17.8 ±â€¯2.1 years and median body mass index (BMI) of 41.34 kg/m2, who underwent dual energy X-ray absorptiometry (DXA) for total fat mass, proton MR spectroscopy (1H-MRS) of the distal tibia and 4th lumbar vertebra for MAT, high resolution peripheral quantitative computed tomography (HR-pQCT) of the distal tibia for volumetric bone mineral density (vBMD) and microarchitecture, and micro finite element analysis (FEA) for distal tibial strength estimates. Linear correlations between bone parameters and MAT were determined using the Spearman or Pearson methods, depending on data distribution. Lumbar spine MAT was inversely associated with age (r = -0.36; p = 0.037). Total and trabecular vBMD and trabecular number at the distal tibia were inversely associated with MAT at the distal tibia (r = -0.39, p = 0.025; r = -0.51, p = 0.003; r = -0.42, p = 0.015 respectively) but not with lumbar spine MAT (r = -0.19, p = 0.27; r = -0.18, p = 0.3; r = 0.005, p = 0.97 respectively). In adolescents and young adults with obesity, the associations between MAT and appendicular bone parameters differ depending on the site of MAT assessment i.e. axial vs. appendicular. Studies evaluating these endpoints in adolescents and young adults with obesity should take the site of MAT assessment into consideration.

[Usefulness of nuclear medicine in Erdheim-Chester disease: A Lille experience]. / Intérêt de la médecine nucléaire dans la maladie d'Erdheim-Chester : une expérience lilloise.

INTRODUCTION: Erdheim-Chester disease is a rare form of non-langerhans histiocytosis and its etiology is still not well established. The aims of the study were to assess the value of the bone scintigraphy and the 18F-FDG PET/CT for the diagnostic and for the latter in the therapeutic evaluation. METHODS: We retrospectively reviewed 49 patients suspected of Erdheim-Chester disease between 2004 and 2016. Bone scintigraphy was compared with histopathology and PET-CT to conventional morphological examinations and bone scintigraphy. For therapeutic evaluation, thresholds similar to PERCIST 1.0 were used. RESULTS: Forty-nine bone scintigraphy were evaluated with a sensitivity of 100%, a specificity 97%, a positive predictive value 90% and a negative predictive value of 100%. Eight patients had at least an initial PET-CT. The sensitivity compared to conventional morphological examinations differed from the location but was excellent for orbital, bone and vascular involvements. Specificity was comparable between the different examinations. Six patients treated with interferon® and three with vemurafenib® were followed by PET-CT. PET-CT, in agreement to clinicobiological data, identified 4 partial responses and one complete response with interferon® et two partial responses and one complete response with vemurafenib®. CONCLUSION: Our retrospective study suggests that bone scintigraphy and 18F-FDG PET/CT could be useful in the initial assessment of Erdheim-Chester disease but also for the latter in the therapeutic evaluation.

Note: Electrostatic detection of stainless steel dust particles for fusion applications.

Dust accumulation inside next-step fusion devices poses a significant safety concern and dust diagnostics will be needed to assure safe operations. An electrostatic dust detection device has been successfully demonstrated in the National Spherical Torus Experiment, Tore Supra, and the Large Helical Device, and the detector's response to carbon particles was previously characterized in laboratory experiments. This paper presents laboratory results showing that detection of stainless steel particles at levels as low as several µg/cm(2) is also possible.

Interphase Transport of Benzoic Acid in Emulsions.

The kinetics of transport of benzoic acid in triglyceride-in-water emulsions stabilized by Tween 80 was measured by a continuous flow kinetic apparatus. The determination of the liquid-liquid partitioning of the solute in two-phase systems enabled estimation of the retention of benzoic acid by the triglycerides and the micellar solution and calculation of the solute theoretical distribution in emulsions. The initial rates of release of benzoic acid from 2 to 5 mmol m-2 s-1 were found proportional to the initial concentration of benzoic acid in the emulsions. Copyright 1998 Academic Press.

Neurological sequelae of minor head and neck injuries.

The objective was to determine why some people who are involved in minor motor vehicle accidents, without loss of consciousness, have persisting headaches and neckache, and to suggest management of these symptoms. Between 1954 and 1994, over 4400 cases were referred for medico-legal opinions. A group has been selected for discussion. During the period 1954-1966, 414 cases following closed head injuries were seen with varying periods of post traumatic amnesia (PTA) from nil to greater than 72 h. The average time between the accident and the examination was 21 months. The shortest period was 3 months and the longest 7 years. The age at the time of the accident varied from 2.5 to 72 years. The largest group fell between the ages of 20 and 40 years. The main complaints were headache, giddiness, loss of concentration and poor memory. 380 were reviewed by questionnaire after settlement of the case. 112 cases of extension/flexion injuries of the neck were seen between 1985 and 1989 and their symptoms and resolution were compared with 50 cases seen over the same period following significant head or neck injury. The results showed that the more severe the head or neck injury, the less likely were the cases to suffer symptoms of post-traumatic headaches or persisting neck symptoms. In conclusion, while 70% of minor head and neck injuries settle within a few weeks of a motor vehicle accident, about 30% continue to complain of headaches and/or neck pain. The prolonged management, extensive physiotherapy and slow court settlement lead to excessive introspection and prolongation of symptoms.

Embolization of hepatic artery pseudo-aneurysm facilitated by selective injection of thrombin and thrombin-soaked coils.

A case of recurrent haemobilia due to a pseudo-aneurysm of the right hepatic artery is presented. The patient required long-term anticoagulant therapy and, in order to achieve rapid haemostasis, thrombin was used as an adjunct to coil embolization. Rapid thrombosis of the pseudo-aneurysm occurred after selective injection of 200 units of thrombin, and thrombin-soaked coils were employed to occlude the arterial supply.

The epidemiology of multiple sclerosis in Queensland, Australia.

An epidemiological survey of multiple sclerosis (MS) in the State of Queensland was undertaken with its prevalence day being the national census day on June 30th, 1981, 20 years after a regional survey within the State. The relationship between increasing prevalence of MS and increasing south latitude within the State of Queensland which was suggested by the 1961 study was confirmed in the present study. The prevalence rate had increased significantly over the 20-year period between the studies but the State remained a medium frequency zone for MS (prevalence rate between 5 and 29 per 100,000 of population). Although a real increase in disease frequency could not be excluded as a contributing factor to the rise in prevalence, it was most likely due predominantly to an increase in life expectancy amongst the MS population and also in differential migration of a population at a greater risk of developing MS than the indigenous population. The proportions of Australian-born patients who had migrated to Queensland from the higher risk southern regions of Australia or travelled overseas to countries known to be high-risk for MS prior to disease onset, had fallen between the two surveys thus exerting, if anything, a negative influence on the change in prevalence. Analysis of MS prevalence rates amongst migrant populations in Queensland as compared to the more southerly city of Perth in Western Australia, suggested that the risk of acquisition of MS may extend over a wider age range than is generally accepted. Finally, there was an absence of MS cases amongst the Aboriginal population in Queensland but it can only cautiously be concluded from this study that the disease is rare in these peoples.

IgA nephritis with nephrotic range proteinuria.

Nephrotic range proteinuria is uncommon in patients with IgA nephritis. For this reason we compared the clinical and pathologic features in 63 non-nephrotic patients with those in 8 patients who had nephrotic range proteinuria at the time of biopsy. Both the mean age and the mean duration of the disease at the time of diagnosis were not significantly different in the 2 groups of cases. Significant associations were found between nephrotic range proteinuria and the following: the extent of glomerular hyalinization, the severity of interstitial fibrosis and tubular atrophy and the degree of foot process effacement and mesangial matrix increase. A significant association was also noted with nephrotic range proteinuria had elevated levels of serum creatinine on follow-up compared with 20% of non-nephrotic cases. The results of our study suggest that patients with nephrotic range proteinuria have a more severe type of IgA nephritis from the outset and that a marked degree of proteinuria is not merely a consequence of the duration of disease.

A prospective study of the risk of developing multiple sclerosis in optic neuritis in a tropical and sub-tropical area.

110 cases of optic neuritis were prospectively studied. 62 (56%) developed multiple sclerosis, 13 were lost to survey. However, eight of these had recurrent episodes of optic neuritis. If recurrent episodes of optic neuritis are accorded the same significance as demyelination elsewhere in the CNS, then the incidence of multiple sclerosis in the series rose to 71%, similar to that predicted on an actuarial basis.

Factors likely to affect the development of multiple sclerosis in patients presenting with optic neuritis in a tropical and subtropical area.

The relationship between optic neuritis (ON) and multiple sclerosis (MS) in a subtropical climate is examined. 105 cases of ON were followed for varying periods over 26 years. The factors studied included place of birth, sex, age at onset, presence of recurrent ON, the interval to the onset of MS, and HLA antigen typing. 55% of cases developed evidence of definite MS. The majority of cases who went on to develop MS had their onset of ON between 21 and 40 years of age. The subtropical climate did not cause any significant variation in incidence. However those case who had HLA Bw4 appear to be protected from developing MS.

Herpes simplex encephalitis.

In this paper seven cases of severe viral encephalitis seen over a four year period at the Princes Alexandria Hospital, Brisbane, are presented. Four of these cases were proven cases of Herpes simplex encephalitis on the basis of viral culture, and three were probable cases of Herpes simplex encephalitis on the basis of rising serum antibody titres. A summary of the clinical aspects and laboratory investigations of the cases is followed by a brief discussion of the diagnostic and therapeutic problems of this condition.