EPODE - A Model for Reducing the Incidence of Obesity and Weight-related Comorbidities.

Obesity is a global epidemic: it is estimated that the majority of the world's adults will be overweight or obese by 2030. It is therefore important to reverse trends towards increasing childhood obesity by interventions at the community level. Ensemble Prévenons l'obésité Des Enfants (EPODE, Together Let's Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to address this challenge. EPODE comprises four critical components: political commitment, public and private partnerships, community-based actions, and evaluation. The multi-stakeholder approach promoted through the EPODE methodology has already shown encouraging results in preventing childhood obesity in France and Belgium and has reduced the socioeconomic gap in obesity prevalence in France. The EPODE methodology has now been implemented in a number of countries worldwide, and provides a valuable model that may be applicable to other lifestyle-related diseases.

Recording of electric signal passing through a pylon in direct skeletal attachment of leg prostheses with neuromuscular control.

Direct recordings were made of electrical signals emanating from the muscles in a rabbit's residuum. The signals were transmitted via wires attached on one end to the muscles, and on the other to an external recording system. The cable was held in a titanium tube inside a pylon that had been transcutaneously implanted into the residuum's bone. The tube was surrounded by porous titanium cladding to enhance its bond with the bone and with the skin of the residuum. This study was the first known attempt to merge the technology of direct skeletal attachment of limb prostheses with the technology of neuromuscular control of prostheses, providing a safe and reliable passage of the electrical signal from the muscles inside the residuum to the outside recording system.

Stable biopassive insulation synthesized by initiated chemical vapor deposition of poly(1,3,5-trivinyltrimethylcyclotrisiloxane).

The permanent implantation of electronic probes capable of recording neural activity patterns requires long-term electrical insulation of these devices by biopassive coatings. In this work, the material properties and neural cell compatibility of a novel polymeric material, poly(trivinyltrimethylcyclotrisiloxane) (poly(V3D3)), are demonstrated to be suitable for application as permanently bioimplanted electrically insulating films. The poly(V3D3) polymeric films are synthesized by initiated chemical vapor deposition (iCVD), allowing for conformal and flexible encapsulation of fine wires. The poly(V3D3) also exhibits high adhesive strength to silicon substrates, a common material of manufacture for neural probes. The poly(V3D3) films were found to be insoluble in both polar and nonpolar solvents, consistent with their highly cross-linked structure. The films are pinhole-free and extremely smooth, having a root-mean-square (rms) roughness of 0.4 nm. The material possesses a bulk resistivity of 4 x 1015 Ohm-cm exceeding that of Parylene-C, the material currently used to insulate neurally implanted devices. The iCVD poly(V3D3) films are hydrolytically stable and are demonstrated to maintain their electrical properties under physiological soak conditions, and constant electrical bias, for more than 2 years. In addition, biocompatibility studies with PC12 neurons demonstrate that this material is noncytotoxic and does not influence cell proliferation.

Benefits of thickened feeds in previously healthy infants with respiratory syncytial viral bronchiolitis.

Infants with respiratory syncytial virus (RSV) bronchiolitis have an increased risk of aspiration. The optimal feeding strategy for these patients has not been described. Fifteen previously healthy and clinically stable infants with RSV bronchiolitis underwent video-fluoroscopy studies to assess swallowing using thin barium. Those with abnormal studies underwent a repeat study, using barium that was thickened with rice cereal. Nine of 15 infants had abnormal studies with thin barium. Laryngeal or tracheal penetration with thin barium was seen in 3 and 2 infants, respectively, but not with thickened barium. Aspiration of thin barium was seen in 4 infants, but it corrected in 3 of these 4 infants with thickened barium. Thickened feeds provide a simple, safe, and cost-effective intervention to improve swallowing dysfunction and prevent aspiration in infants with RSV bronchiolitis.

Effect of cisapride on the QT interval in infants with gastroesophageal reflux.

OBJECTIVE: We prospectively studied the effect of cisapride per se on QT interval in young infants (3-6 months) with gastroesophageal reflux (GER) in a controlled setting. STUDY DESIGN: The infants diagnosed with GER and deemed to require therapy with cisapride were divided into 2 groups. Group A comprised infants with GER who underwent an electrocardiogram (ECG) before initiation of therapy with cisapride in the dose of 1 mg per kg per 24 hours, divided into 3 doses. They were reweighed after 7 to 10 days, and the dose was adjusted for their new weight. A repeat ECG was performed after approximately 2 weeks (12-18 days) of therapy. The QT interval was measured in each ECG and then the corrected QT interval was calculated by Bazett's formula. Group B comprised infants with GER who had already been on therapy with cisapride for over 1 month. All infants in group B received cisapride in an approximate dose of 1 mg per kg per 24 hours (.8-1.1 mg/kg/24 hours) given in 3 divided doses. They underwent only 1 ECG, ie, at 1 to 4 months after initiation of therapy. The measurement of the actual dose of cisapride was demonstrated to every parent and a marked measuring syringe was provided. The following categories of infants were not included: those with any underlying cardiopulmonary, renal, or hepatic problem; those with a history of apnea; those using a macrolide antibiotic or azole antifungal at any stage during the study; and infants hospitalized for any reason during the course of the study. RESULTS: Cisapride therapy in the dose of 1 mg/kg/day frequently resulted in a slight increase in the QT interval (pretreatment: 390 +/- 18 milliseconds; posttreatment: 400 +/- 20 milliseconds) but the increase was still below the accepted upper limit of 440 milliseconds and not statistically significant. Even with prolonged therapy, the pattern of change in QT interval was similar to that with therapy for 2 weeks. Overall, 2 of 100 (2%) infants developed a prolongation of corrected QT interval beyond the normal range (456 and 486 milliseconds). Neither infant had evidence of any arrhythmia or conduction defect on ECG. No additional factor could be identified in either infant to explain prolongation of the QT interval. CONCLUSION: Our experience suggests that cautious cisapride therapy in young infants in a modest dose does not result in arrhythmias or conduction defects. We recommend that: 1) the dose of cisapride in infants be <1.2 mg/kg/day and preferably between.8 and 1 mg/kg/day; 2) the right measure of the dose be actually demonstrated to the parents; and 3) parents be provided a list of drug interactions with cisapride. One should think twice before denying the use of an effective drug simply because of the need for closer monitoring and extra time spent for parent education.

Smaller volume, thickened formulas in the management of gastroesophageal reflux in thriving infants.

BACKGROUND: The effect of smaller volume, thickened formulas on gastroesophageal reflux is not clear. METHODS: The frequency of gastroesophageal reflux and duration of acid pH in the esophagus were determined in six thriving infants using extended esophageal pH monitoring. RESULTS: There was a significant reduction in frequency of emesis and gastroesophageal reflux but not the duration of acid pH in the esophagus with the use of infant formula thickened with rice cereal to provide a nutritionally appropriate intake in a smaller volume. CONCLUSIONS: Thickening of formula with rice cereal in a nutritionally balanced form and smaller volume may be an appropriate strategy for reducing frequency of emesis and gastroesophageal reflux in thriving infants.

Previously healthy infants may have increased risk of aspiration during respiratory syncytial viral bronchiolitis.

OBJECTIVE: Respiratory illnesses may cause feeding difficulties in infants. We studied the safety of oral feeding during respiratory syncytial viral (RSV) bronchiolitis in previously healthy infants. METHODS: Twelve previously healthy infants (3-12 months) with RSV bronchiolitis underwent barium swallow studies during the acute phase of illness. Those with abnormal studies underwent repeat studies 2 to 4 weeks later. RESULTS: The initial barium studies revealed aspiration in 3 infants. All repeat studies, performed 2 to 4 weeks later, were normal. CONCLUSIONS: Even previously healthy infants may be at risk of aspiration during RSV bronchiolitis.

Reduced long-term respiratory morbidity after treatment of respiratory syncytial virus bronchiolitis with ribavirin in previously healthy infants: a preliminary report.

Previously healthy infants less than 6 months of age with severe respiratory syncytial virus bronchiolitis who required hospitalization were identified from hospital records. Infants had been treated either conservatively (control group, n = 19) or with ribavirin added to conservative management (study group, n = 22). All infants underwent a 1-year follow-up after the initial illness. There was a significant reduction in the prevalence of reactive airway disease in the group treated with ribavirin (P < 0.05) compared with the control group, both in terms of the proportion of patients developing airway reactivity (59% vs. 89%) and the number of episodes of reactive airway disease (31 vs. 70). Our data suggest that ribavirin reduces the prevalence of airway reactivity.

Lymphoproliferative disorder involving the liver following transplantation: CT appearance.

OBJECTIVE: Our goal is to report the CT findings of liver involvement in lymphoproliferative disease in immunosuppressed patients. MATERIALS AND METHODS: We report CT findings in two cases of lymphoproliferative disease involving the liver. RESULTS: The findings of this disorder are nonspecific both clinically and radiographically. CONCLUSION: Nonspecific nodular pattern in the liver on CT may represent unrestricted lymphocytic infiltration in the immunosuppressed patient.

A common presentation of an uncommon cause of neonatal respiratory distress: pneumonia alba.

While lung involvement is an uncommon presentation of congenital syphilis, respiratory distress is a common leading symptom in sick newborns. We describe an infant who presented with respiratory distress thought to be secondary to congenital syphilis and discuss the findings suggestive of an etiology other than respiratory distress syndrome (RDS).

Factors influencing the biocompatibility of insertable silicon microshafts in cerebral cortex.

Insertable microelectrode arrays can be used to activate neurons or to sense neural signals for use in prosthetics. The relationship of the microelectrodes to the neurons is determined by random alignment and by biocompatibility. Issues that determine the biocompatibility of insertable microelectrode arrays were investigated. Arrays were implanted into the cortex of rabbit brain and fixed to the skull. Following six-month survival, neuron density as a function of distance from the shafts of the arrays was measured to assess destruction of neurons. Results from a limited number of tests indicated that there was minimal tissue response along the sides of the shafts when shafts were well sharpened, had sufficiently small tip angles, and were clean. Tissue was usually more reactive at the tips of the shafts. It was concluded that silicon microshafts of appropriate shaft and tip design were biocompatible along the sides of the shaft, but that relatively severe reactions could be anticipated at the tips. Recording or stimulation sites should be located away from the tips on the sides of the shafts for better coupling with individual neurons. Measurement of neuron density as a function of distance from the shafts was a sensitive and quantitative technique for assessing biocompatibility. Additional measures such as glial density as a function of distance from the shafts, and incidence of microhematoma formation were proposed.

Unusual manifestation of Stevens-Johnson syndrome involving the respiratory and gastrointestinal tract.

There are many recognized acute complications of Stevens-Johnson syndrome: however, long-term sequelae involving the respiratory and gastrointestinal tracts are exceedingly rare. We present an 8-year-old girl who developed esophageal stricture and chronic lung disease while recovering from Stevens-Johnson syndrome and discuss these complications with possible mechanisms for their occurrence.

Time delays in propagation of cardiac action potential.

Recent work has suggested that discrete time delays could occur between cardiac cells under physiological conditions. To investigate the existence of such time delays, monolayers of 10-day chick-embryo ventricular myocytes were grown in cell culture on arrays of extracellular microelectrodes. The most closely spaced recording electrodes were on 20-microns centers. Some pairs of electrodes recorded from different points on the same cell, whereas other pairs straddled intercellular junctions. The preparation was electrically paced to obtain a repeatable propagation pathway. Arrival times of activation at each microelectrode were measured. After control recordings, the preparation was exposed to medium containing 20 mM NH4Cl for 15 min and then returned to normal medium. This intervention produces transient intracellular acidification that decreases intercellular coupling. After acidification, the average (multicellular) conduction velocity decreased to about two-thirds of the control value. Propagation velocity measured between most electrode pairs decreased proportionately. However, disproportionately long propagation delays of up to 410 microseconds were observed between some pairs of electrodes in various experiments. The delays recovered as pH returned to normal. The localized long delays were thought to be due to decreased intercellular coupling at gap junctions.