Relation of depot-specific adipose inflammation to insulin resistance in human obesity.

BACKGROUND: A low-grade state of adipose tissue inflammation associated with obesity has been linked to mechanisms of systemic metabolic dysfunction. However, the relation of clinical phenotypes to depot-specific inflammation has not been well examined in human obesity. OBJECTIVE: To characterize the inflammatory status of subcutaneous and visceral fat depots, as assessed by tissue presence of macrophage crown-like structures (CLS) as a hallmark of chronic inflammation, and determine the relation of systemic insulin resistance to inflammatory abnormalities in subcutaneous and visceral fat. METHODS: We collected adipose tissue simultaneously from subcutaneous and visceral (omental and mesenteric) depots in 92 obese participants (age 42±11 years; BMI30 kg m(-2)) during planned bariatric surgery. Using immunohistochemistry, we categorized individuals as CLS(+) or CLS(-) based on the presence or absence, respectively, of macrophage CLS in subcutaneous (CLSs), omental (CLSo) and mesenteric (CLSm) adipose depots. RESULTS: The majority of participants exhibited adipose tissue inflammation manifest by the presence of CLS (CLS(+)) in both subcutaneous and intra-abdominal visceral depots. CLS status in subcutaneous fat was highly sensitive and modestly specific for inflammation of visceral fat. In multivariable models, plasma insulin and homeostatis model assessment levels were positively associated with CLS(+) status in all depots independent of age, waist circumference, BMI and type 2 diabetes, and worsened with the increasing number of adipose regions involved. CONCLUSIONS: In severely obese participants, systemic insulin resistance is linked to adipose inflammation in both subcutaneous and visceral depots. The findings suggest that examination of subcutaneous regions that are more easily accessible by transcutaneous biopsy may prove useful in clinical studies designed to investigate adipose phenotypes in relation to human disease.

Growth of the human optic disk and nerve during gestation, childhood, and early adulthood.

We measured vertical and horizontal diameters of the optic disk and retrobulbar optic nerve in eyes from 95 patients on whom autopsies were performed at the UCLA Medical Center over a 20-year period. Ages at death ranged from 4.8 months' gestation to 21.9 years. Optic disk surface area and nerve cross-sectional area were calculated for each subject by using the formula for an ellipse. Approximately 50% of the growth of the optic disk and nerve occurs by 20 weeks' gestation, and 75% by birth; 95% of the growth occurs before the age of 1 year. All optic disk and nerve measurements correlate strongly (correlations > .67; P < .0001) with subject height and globe anteroposterior diameter. We applied our results to the current understanding of optic disk and nerve development, and compared them to previous clinical and pathologic studies of optic nerve dimensions in adults and older children.

Corneal ulcers associated with daily-wear and extended-wear contact lenses.

Over a 21-month period, we treated corneal ulcers in 11 patients using daily-wear contact lenses and 29 patients using extended-wear contact lenses. Since more patients use daily-wear than extended-wear lenses, this suggests that patients using extended-wear lenses are at greater risk for the development of corneal ulcers. Positive bacterial cultures were obtained from the corneal scrapings of nine of 11 patients using daily-wear lenses and 20 of 29 patients using extended-wear lenses. In the daily-wear group, all 11 patients failed to exercise satisfactory care in using and disinfecting their contact lenses: three did not wash their hands before manipulating the contact lenses, eight wore them overnight, two did not use any disinfecting system, and four had contaminated contact lens cases, solutions, or drops. In the extended-wear group, 17 patients failed to exercise satisfactory care in using and disinfecting their contact lenses: 12 had contaminated contact lens care systems, two did not use any disinfection system, five reported not washing their hands before contact lens manipulation, and two disinfected their contact lenses at intervals of more than a month. We were unable to identify any defect in the way 12 patients took care of their extended-wear lenses, suggesting that there may be a problem with these contact lenses even when care is satisfactory.

Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries.

A semi-structured interview for assessing the knowledge and attitude of health workers concerning mental health problems was applied in seven developing country areas within the context of a World Health Organization coordinated collaborative study. The results indicate a lack of basic mental health training associated with a failure to recognize mental health problems, restricted knowledge concerning psychotropic drug therapy, and an inability to visualize practical forms of mental health care which could be introduced at primary care level. The results were used to design appropriate training programs, and the observations will be repeated to assess the effectiveness of training.