Relationships between vitamin D status and cardio-metabolic risk factors in young European adults.

BACKGROUND/AIMS: To explore associations between vitamin D and cardiovascular disease risk factors in young European adults. METHODS: This was a cross-sectional analysis of serum 25-hydroxyvitamin D [s25(OH)D], intact parathyroid hormone (iPTH) and biomarkers of cardiovascular disease risk in 195 healthy 20- to 40-year-olds (109 women) with a BMI between 27.5 and 32.5 from Iceland (64° N; n = 82), Ireland (51° N; n = 37) and Spain (42° N; n = 76) during mid-late winter. RESULTS: The median s25(OH)D was 52.8 nmol/l (IQR 38.1-69.9) or 21.1 ng/ml (IQR 15.2-28.0) with a latitude-dependent gradient (p ≤ 0.0001): Iceland, 41.7 nmol/l (IQR 32.7-54.2) or 16.7 ng/ml (IQR 13.1-21.7); Ireland, 52.9 nmol/l (IQR 35.3-68.6) or 21.2 ng/ml (IQR 14.1-27.4), and Spain, 67.1 nmol/l (IQR 47.1-87.1) or 26.8 ng/ml (IQR 18.8-34.8). Eleven percent of Icelandic participants had s25(OH)D concentrations <25 nmol/l (10 ng/ml) and 66% of Icelandic, 43% of Irish, and 30% of Spanish volunteers had concentrations <50 nmol/l (20 ng/ml), respectively. Overall, 17% met 3 or more of the NCEP/ATP III criteria for cardio-metabolic syndrome (MetS). Participants in the lowest third of s25(OH)D [≤ 42.5 nmol/l (17 ng/ml)] were more likely to have MetS (OR 2.49, p = 0.045) and elevated TAG (OR 3.46, p = 0.019). Individuals with iPTH concentrations in the lowest third [2.34 pmol/l (22.2 pg/ml)] were more likely to have elevated fasting TAG (OR 4.17, p = 0.039), insulin (OR 3.15, p = 0.029) and HOMA-IR (OR 2.15, p = 0.031), and they were less likely to have elevated IL-6 (OR 0.24, p = 0.003). CONCLUSION: There were interactions between s25(OH)D, iPTH and cardio-metabolic risk factors which, given the increasing prevalence of overweight and obesity and a low vitamin D status among adults, require randomised controlled vitamin D intervention studies in overweight persons.

Intraoperative localization of small intestinal bleeding in an infant by methylene blue injection: a case report.

During the evaluation of patients with profuse gastrointestinal bleeding, it is often difficult to accurately localize bleeding sites in the small intestine. Moreover, during laparotomy, there may be no intraoperative findings to allow identification and resection of the bleeding lesion. Here the authors report a case of severe intestinal bleeding in an infant in whom the intraoperative injection of methylene blue dye into a terminal branch of the superior mesenteric artery was critical in determining the exact location of bleeding. After accurate localization of the bleeding source and segmental intestinal resection, the child recovered uneventfully with no recurrence of gastrointestinal bleeding. To the authors' knowledge, this is the first reported use of this technique in infancy.

"Acute" fat deposition in bowel wall submucosa: CT appearance.

OBJECTIVE: The deposition of submucosal fat in small and large bowel is known to occur in chronic processes such as inflammatory bowel disease, and has been assumed to reflect long disease duration. However, we have observed that submucosal fat deposition can occur in a short period of time. MATERIALS AND METHODS: Four patients were evaluated in whom serial CT examinations showed intramural fat deposition occurring within six months of a normal study. Confirmation of fatty deposition was made by Hounsfield unit measurement in all patients and by pathologic examination of bowel specimens in two patients. RESULTS: All four patients received cytoreductive chemotherapy for treatment of lymphoma or leukemia prior to the development of fat deposition. In all patients, serial CT examination documented the occurrence of fat-attenuation bowel wall thickening that developed in a short time period (12, 36, 67, and 186 days). Three of the four cases were initially misinterpreted as wall thickening from other causes (intussusception or colitis). Pathologic examination of bowel in the two patients with the shortest time intervals confirmed the presence of mature fat confined to the submucosa. CONCLUSION: These cases demonstrate that submucosal fat deposition in bowel wall is not limited to inflammatory bowel disease and other longstanding, chronic diseases; fatty infiltration can occur in a relatively short period of time, and is particularly likely to occur after cytoreductive therapy.

Preservation of venular but not arteriolar smooth muscle alpha-adrenoceptor sensitivity during reduced blood flow.

To compare arteriolar versus venular smooth muscle sensitivity to myogenic and metabolic inhibition during reduced blood pressure and flow, we measured the diameter of first-order venules (diameter, 230 microns) and arterioles (diameter, 156 microns) of the denervated, blood-perfused rat cremaster skeletal muscle that was suspended in a tissue bath. Sensitivity was determined for bath-added norepinephrine in the presence of yohimbine or prazosin to produce alpha 1- and alpha 2-adrenoceptor constriction, respectively, and for KCl to examine non-receptor-mediated sensitivity. To reduce venular pressure and flow, vasopressin, which constricts cremaster arterioles but not venules, was applied locally at a maximally effective concentration. This arteriolar constriction had no effect on venular sensitivity to alpha 1-adrenoceptor and KCl-mediated constriction. Venular sensitivity (-log M EC50) to alpha 1 and to KCl activation was 6.20 +/- 0.10 and 1.20 +/- 0.04 in the absence and 6.34 +/- 0.09 and 1.30 +/- 0.03 in the presence of arteriolar constriction, respectively. Venular sensitivity to alpha 2 activation was actually greater during arteriolar constriction (6.25 +/- 0.11 in the absence of constriction versus 7.06 +/- 0.13 in the presence of constriction, p less than 0.001). In a second series, the effect of reduced cremaster perfusion pressure and flow on both arteriolar and venular sensitivity was examined by mechanically lowering cremaster inflow. Reduction of first-order arteriolar and venular flow by 82-85% attenuated arteriolar alpha 1 and abolished alpha 2 sensitivity but had no effect on venular adrenergic sensitivity; KCl sensitivity was increased. These data indicate that, in contrast to arteriolar smooth muscle, venular smooth muscle alpha-adrenoceptor sensitivity is preserved during reduced pressure and flow and, thus, is little affected by metabolic and myogenic regulation. The selective depressant effect on arteriolar adrenergic but not KCl constriction suggests that myogenic/metabolic inhibition of arterioles is receptor specific.