Leptin/adiponectin ratio in overweight patients - gender differences.

OBJECTIVE: Obesity-related atherosclerosis is a systemic disease with a background connected to multiple metabolic-neurohumoral pathways. The leptin/adiponectin ratio has been suggested as an atherosclerotic marker in obese patients. The aim of this study was to assess (1) the significance of the L/A ratio in overweight subjects, (2) the relation with anthropometric/metabolic parameters and (3) gender difference. METHOD: The study included 80 adult males and females, overweight, non-diabetic patients. Biochemical blood analysis and anthropometric and cardiovascular measurements were performed. Serum leptin levels were measured with a radioimmunoassay test and total adiponectin levels with enzyme-linked immunosorbent assay. Leptin/adiponectin ratios were calculated as ratios between total serum concentrations of leptin and adiponectin. RESULTS: Differences between leptin, adiponectin serum levels and leptin/adiponectin ratios are presented in overweight persons, where females have a significantly higher leptin/adiponectin ratio than men ( p < 0.001). In men, the leptin/adiponectin ratio showed a positive correlation with total cholesterol levels ( p = 0.011), low-density lipoprotein ( p = 0.013) and triglycerides ( p = 0.032). In females, the leptin/adiponectin ratio correlated with anthropometric parameters of visceral obesity: waist circumference ( p = 0.001) and waist-to-hip ratio ( p = 0.025). CONCLUSION: The leptin/adiponectin ratio could represent an atherosclerotic risk marker of the early stage of obesity. Gender plays a significant role in pathophysiological changes, with different clinical manifestations, where sex hormones have a crucial effect on neurohumoral adipose tissue activity.

Distal tibiofibular radiological overlap: Does it always exist?

OBJECTIVES: Overlap between the distal tibia and fibula has always been quoted to be positive. If the value is not positive then an injury to the syndesmosis is thought to exist. Our null hypothesis is that it is a normal variant in the adult population. METHODS: We looked at axial CT scans of the ankle in 325 patients for the presence of overlap between the distal tibia and fibula. Where we thought this was possible we reconstructed the images to represent a plain film radiograph which we were able to rotate and view in multiple planes to confirm the assessment. RESULTS: The scans were taken for reasons other than pathology of the ankle. We found there was no overlap in four patients. These patients were then questioned about previous injury, trauma, surgery or pain, in order to exclude underlying pathology. CONCLUSION: We concluded that no overlap between the tibia and fibula may exist in the population, albeit in a very small proportion.

[Physical and psychological therapy of adolescents with deformities of spinal cord and other inborn anomalies]. / Fizikalna i psiholoska terapija kod adolescenata sa deformitetima kicmenog stuba i drugim urodenim anomalijama.

A group of 103 adolescents who have been exposed to war trauma was examined by a specialist of physical medicine and rehabilitation and pedagogue-psychologist, in relation to deformities of spinal cord and other inborn anomalies. Repeated screening and retest on the level of stress and depression was done after two years. In the meantime, majority of adolescents was on physical and psychological treatment. It was established that 47 adolescents (45.6%) have simultaneously had flat back and flat feet, and that 12 of them (25.5%) from the same group had had 4 traumatic experiences. During the first testing, the medium stress level was established with 48 adolescents (46.6%), and during the retest this was established with 60 adolescents (58.2%). At the same time, we used Birleson scale of depression and established that 57 (55.3%) adolescents have had normal results; after the retest 66 (64.1%) adolescents have had normal result and this difference is statistically significant (p<0.002). When we analyzed diagnosis after the two screenings we did not found significant differences. Based on the results of this research, better programs for the team work with adolescents with deformities of spinal cord and depression can be made.

The osmotic gradient in kidney medulla: a retold story.

This article is an attempt to simplify lecturing about the osmotic gradient in the kidney medulla. In the model presented, the kidneys are described as a limited space with a positive interstitial hydrostatic pressure. Traffic of water, sodium, and urea is described in levels (or horizons) of different osmolarity, governed by osmotic forces and positive interstitial pressure. In this way, actions of the countercurrent multiplier in nephron tubules and of the countercurrent exchanger in vasa recta are integrated in each horizon. We hope that this approach can help students to better accept conventional presentations in their textbooks.

Ultrasound measurement in defining the regional distribution of subcutaneous fat tissue.

The aim of this research is to determine the significance of ultrasound diagnostics in measuring the thickness of subcutaneous fat tissue as well as to point out sex and age differences in regional distribution of subcutaneous fat tissue. The research included 37 men and 33 women with different body mass indexes. Ultrasound measuring of subcutaneous fat tissue was conducted on 16 measuring points. The thickness of subcutaneous fat tissue measured by ultrasound and estimated proportion of fat tissue obtained by comparative methods coincided mostly on the back side of the upper arm, lower abdominal region in interspinal line and the front side of the forearm. Analysis of the subcutaneous fat tissue distribution indicates that there is more equal accumulation of fat tissue in women than in men. BMI limit value for obesity is not the same for men and women because the point at which abdominal region becomes the main storage of subcutaneous fat in body depends on sex. That BMI value represents the physiological beginning of obesity since it marks the change in distribution pattern of subcutaneous fat tissue in different body regions.

Cancer incidences in the digestive tube: is cobalamin a small intestine cytoprotector?

Malignancies are common in the digestive tube, although with unequal distribution among segments. The aim of this paper was to compare available interpretations of the low cancer incidence in the small bowel and high in the large bowel. Supposed mechanisms include relatively small bacterial population, large secretion of liquid and rapid transit in the small bowel. Small bowel mucosa is the main absorptive part of the digestive tube with absorption rates for various nutrients so high that they can even be considered as clearances from the intestinal content. Consequently, these nutrients are not present in the large bowel. An alternative explanation is that an absorbable protective substance from the intraluminal content, might protect the mucosa from malignant transformations. It can be speculated that if there are any cytoprotective substances in the digested food their effect would be expressed mostly in the absorptive small intestine, leaving the large bowel mucosa unprotected. Vitamin B12 might be a possible candidate for this role. Cobalamin molecules are initially bound to haptocorrin (Hc) in the stomach, but in the small intestine B12 is transferred to intrinsic factor (IF) after the action of pancreatic trypsin on Hc. Cobalamin-IF complexes are absorbed in the terminal ileum leaving only a small fraction of B12 to enter the large bowel. We have tried to summarize available data regarding cancer incidences in digestive tube, segmental length and transit times of tube content. Cancer density is calculated as incidence per length and transit speed as length per transit time. Cancer incidences for seven intestinal segments were considered low if they were below one case per 100 000 inhabitants annually, while the low cancer density meant less than six cases per 100 000 inhabitants per metre. For instance, transverse colon was considered as a high cancer incidence place (2.15 cases), with low cancer density (4.3 cases/m). Transit speed more than 0.3 metre/hour was associated with low cancer incidences (accuracy 0.85) and low cancer density segments (accuracy 1.00). Cobalamin availability showed similar distribution, available in low incidence segments and unavailable in high incidence segments. Experimental studies are needed to quantify B12 availability in the large bowel and to determine whether small amounts of B12-IF or, perhaps, B12-haptocorrin complexes are absorbed by the small bowel mucosa. Without that, no cytoprotective effects of B12 in the digestive tube can be expected.