Dietary and sociodemographic factors associated with nonalcoholic fatty liver in obese pediatric patients.

INTRODUCTION: Obesity is associated with nonalcoholic fatty liver disease (NAFLD) in children. Our aim was to analyze the association of dietary and sociodemographic factors with NAFLD in obese children and adolescents. MATERIALS AND METHODS: Thirty-three obese patients from 6-16 years of age were included in the present analytic cross-sectional study. Obesity was diagnosed with a body mass index z-score > 2 SD. NAFLD was estimated by liver ultrasound, serum amino transferases, and elastography. The sociodemographic variables were evaluated using validated questionnaires. Diet was estimated through two 24-h recall dietary surveys focused on the quantity of food energy, simple sugars, polyunsaturated fatty acids (PUFAs), and antioxidants. RESULTS: Hepatic steatosis was identified by abdominal ultrasound in 13 patients (39.4%) and the serum alanine aminotransferase level was above the upper reference value in 54.2%. A higher educational level in both parents, greater monthly food expenditure, and a higher socioeconomic level were associated with NAFLD. Overall, simple sugar and saturated fat consumption was above the recommended daily intake, whereas vitamin E and PUFA consumption was below those parameters. CONCLUSIONS: NAFLD was identified in one-third of the cases. There was an association between NAFLD and sociodemographic variables. Both groups had an increased intake of simple sugars and a reduced intake of PUFAs. The selective occurrence of NAFLD could be related to a genetic predisposition that has been demonstrated in a Mexican population.

Hemispheric asymmetry in ocean change and the productivity of ecosystem sentinels.

Climate change and other human activities are causing profound effects on marine ecosystem productivity. We show that the breeding success of seabirds is tracking hemispheric differences in ocean warming and human impacts, with the strongest effects on fish-eating, surface-foraging species in the north. Hemispheric asymmetry suggests the need for ocean management at hemispheric scales. For the north, tactical, climate-based recovery plans for forage fish resources are needed to recover seabird breeding productivity. In the south, lower-magnitude change in seabird productivity presents opportunities for strategic management approaches such as large marine protected areas to sustain food webs and maintain predator productivity. Global monitoring of seabird productivity enables the detection of ecosystem change in remote regions and contributes to our understanding of marine climate impacts on ecosystems.

Prolonged breastfeeding and delayed introduction of whole cow's milk into the diet are factors associated with egg sensitization: a matched case-control study

BACKGROUND: Both breastfeeding and the moment at which introduction to solid food occurs have been associated with food allergy. OBJECTIVE: To evaluate whether prolonged breastfeeding and the delayed introduction of whole cow's milk into an infant's diet are factors that can be associated with egg sensitization. METHODS: This was a hospital-based case-control study, matched by age and sex: each study group comprised 97 atopic children. Additionally, logistic regression was used to identify the factors associated with egg protein sensitization. RESULTS: The most common type of allergic disease among both groups was allergic rhinitis. After adjusting for possible confounding variables, a delayed introduction to whole cow's milk decreased the odds of egg protein sensitization; OR = 0.16 (95% CI: 0.07-0.36, p < 0.0001). Notably, breastfeeding during the first six months of life, regardless of whether it was the only milk an infant drank, increased the risk for sensitization to chicken eggs; OR = 5.54 (95% CI: 2.41-12.7, p < 0.0001). CONCLUSION: Prolonged breastfeeding, regardless of whether it was the only milk an infant drank, greatly increased the risk of egg sensitization. Interestingly, a delayed introduction to whole cow's milk was associated with a reduced possibility of becoming sensitized to eggs. Further studies are required to elucidate these findings

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Prolonged breastfeeding and delayed introduction of whole cow's milk into the diet are factors associated with egg sensitization: A matched case-control study.

BACKGROUND: Both breastfeeding and the moment at which introduction to solid food occurs have been associated with food allergy. OBJECTIVE: To evaluate whether prolonged breastfeeding and the delayed introduction of whole cow's milk into an infant's diet are factors that can be associated with egg sensitization. METHODS: This was a hospital-based case-control study, matched by age and sex: each study group comprised 97 atopic children. Additionally, logistic regression was used to identify the factors associated with egg protein sensitization. RESULTS: The most common type of allergic disease among both groups was allergic rhinitis. After adjusting for possible confounding variables, a delayed introduction to whole cow's milk decreased the odds of egg protein sensitization; OR=0.16 (95% CI: 0.07-0.36, p<0.0001). Notably, breastfeeding during the first six months of life, regardless of whether it was the only milk an infant drank, increased the risk for sensitization to chicken eggs; OR=5.54 (95% CI: 2.41-12.7, p<0.0001). CONCLUSION: Prolonged breastfeeding, regardless of whether it was the only milk an infant drank, greatly increased the risk of egg sensitization. Interestingly, a delayed introduction to whole cow's milk was associated with a reduced possibility of becoming sensitized to eggs. Further studies are required to elucidate these findings.

Preclinical evaluation of the combination of mTOR and proteasome inhibitors with radiotherapy in malignant peripheral nerve sheath tumors.

About one half of malignant peripheral nerve sheath tumors (MPNST) have Neurofibromin 1 (NF1) mutations. NF1 is a tumor suppressor gene essential for negative regulation of RAS signaling. Survival for MPNST patients is poor and we sought to identify an effective combination therapy. Starting with the mTOR inhibitors rapamycin and everolimus, we screened for synergy in 542 FDA approved compounds using MPNST cells with a native NF1 loss in both alleles. We further analyzed the cell cycle and signal transduction. In vivo growth effects of the drug combination with local radiation therapy (RT) were assessed in MPNST xenografts. The synergistic combination of mTOR inhibitors with bortezomib yielded a reduction in MPNST cell proliferation. The combination of mTOR inhibitors and bortezomib also enhanced the anti-proliferative effect of radiation in vitro. In vivo, the combination of mTOR inhibitor (everolimus) and bortezomib with RT decreased tumor growth and proliferation, and augmented apoptosis. The combination of approved mTOR and proteasome inhibitors with radiation showed a significant reduction of tumor growth in an animal model and should be investigated and optimized further for MPNST therapy.

Advantage of rapamycin over mycophenolate mofetil when used with tacrolimus for simultaneous pancreas kidney transplants: randomized, single-center trial at 10 years.

Simultaneous pancreas kidney transplantation (SPKT) is the treatment of choice for patients with type 1 diabetes and end-stage renal disease. Rapamycin and mycophenolate mofetil (MMF) have been used for maintenance immunosuppression with tacrolimus in SPKT; however, long-term outcomes are lacking. From September 2000 through December 2009, 170 SPKT recipients were enrolled in a randomized, prospective trial receiving Rapamycin (n = 84) or MMF (n = 86). All patients received dual induction therapy with thymoglobulin and daclizumab, and low-dose maintenance tacrolimus and corticosteroids. Compared to MMF, rates of freedom from first biopsy-proven acute kidney or pancreas rejection were superior for Rapamycin at year 1 (kidney: 100% vs. 88%; P = 0.001; pancreas: 99% vs. 92%; P = 0.04) and at year 10 (kidney: 88% vs. 71%, P = 0.01; pancreas: 99% vs. 89%, P = 0.01). The higher rates of rejection were associated with withholding MMF (vs. Rapamycin, p = 0.009), generally for gastrointestinal or bone marrow toxicity. There was no significant difference in creatinine, proteinuria, c-peptide, viral infections, lymphoproliferative disorders or posttransplant diabetes. HbA1C and lipid levels were normal in both groups, although higher in the Rapamycin arm. There were no significant differences in patient or allograft survival. In this 10-year SPKT study, Rapamycin in combination with tacrolimus was better tolerated and more effective than MMF. Overall, the patient and allograft survival were equivalent.

[Blood pressure variability in 24 hours in obese and non-obese adolescents with breast development 4 and 5 of Tanner's criteria]. / Variabilidad de la presión arterial en 24 horas en adolescentes obesas y no-obesas con desarrollo mamario 4 y 5 de los criterios de Tanner.

OBJECTIVE: The aim of the study was to investigate the blood pressure variability during 24 h by using ambulatory blood pressure monitoring (ABPM) in a group of obese and non-obese female adolescents with breast development status 4 and 5 of Tanner´s criteria. METHODS: A cross-sectional study was conducted at the Cardiovascular Research Institute, Mexico. All subjects underwent 24 h non-invasive ABPM recording device. Pubertal status was determined by breast development. MEASUREMENTS: office systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Height, weight, body mass index (BMI), waist and hip circumferences, arm circumference, waist to hip ratio (W/H), and skinfold thickness measurements: triceps, subscapular, abdominal and supraspinal. RESULTS: Fifty-nine adolescents 13-16 years old; 29 obese (BMI 31.2±4.0), and 30 non- obese (BMI 21.2±2.2). Obese vs. non-obese: Office SBP 116.9 vs. 105.9±9.3 mmHg (p<0.001); ABPM in 24 h: SBP 113.8±6.3 vs. 107.6±5.7 mmHg (p<0.001); diurnal SBP 117.3 mmHg vs. 111.2 mmHg (p<0.001); nocturnal SBP 105.5±8 vs. 99.4 mmHg; absolute variability in 24 h DBP 10.0±1.8 vs. 8.7±1.5 (p<0.003); coefficient of variation 24 h DBP 17.3±3 vs. 15.4±2.6% (p<0.05); systolic non-dipper 16 (55.2%) vs. 9 (30%) (p<0.05); pulse pressure 24 h 49.3±8 vs. 43.5±9 mmHg (p<0.01). CONCLUSION: Obese adolescents are presenting changes in BP variability during 24-h in comparison with nonobese adolescents; it also includes higher pulse pressure. Thus, these can be early indicators for the development of hypertension or other cardiovascular diseases in the adult life.

Variabilidad de la presión arterial en 24 horas en adolescentes obesas y no-obesas con desarrollo mamario 4 y 5 de los criterios de Tanner / Blood pressure variability in 24 hours in obese and non-obese adolescents with breast development 4 and 5 of Tanner's criteria

Objetivo: Investigar el comportamiento de la presión arterial (PA) mediante monitoreo ambulatorio de la presión arterial (MAPA) en 24 h en un grupo de adolescentes obesas y no-obesas con estadios mamarios de Tanner 4 y 5. Métodos: Estudio transversal realizado en el Instituto de Investigación Cardiovascular en México, incluyendo 64 adolescentes entre 13 a 16 años de edad con estadios mamarios 4 o 5 de la clasificación de Tanner. Se midió PA en la oficina, frecuencia cardiaca (FC), índice de masa corporal (IMC), índice cintura-cadera, circunferencia de brazo, pliegues cutáneos tricipital, subescapular, abdominal y supraespinal. Se analizaron PA con MAPA en 24 h en obesas y no-obesas. Resultados: Cincuenta y nueve adolescentes, 29 obesas (IMC 31,2 ± 4,0) y 30 no-obesas (IMC 21,2 ± 2,2). Obesas vs no-obesas PAs en la oficina 116,9 vs 105,9 ± 9,3 mmHg (p < 0,001); MAPA en 24 h: PAS 113,8 ± 6,3 vs 107,6 ± 5,7 mmHg (p < 0,001); PAS diurno 117,3 mmHg vs 111,2 mmHg (p < 0,001); PAS nocturna 105,5 ± 8 vs 99,4 mmHg; variabilidad absoluta en 24 h PAD 10,0 ± 1,8 vs 8,7 ± 1,5 (p < 0,003); coeficiente de variación en 24 h PAD 17,3 ± 3 vs 15,4 ± 2,6% (p < 0,05); No-descendedores sistólicos 16 (55,2%) vs 9 (30%) (p < 0,05); presión de pulso en 24 h 49,3 ± 8 vs 43,5 ± 9 mmHg (p < 0,01). Conclusión: Cambios tempranos en la variabilidad de la PA en 24 h en adolescentes obesas, incluyendo presión de pulso, pudieran ser indicadores importantes para hipertensión arterial y riesgo cardiovascular en la edad adulta (AU)

Objective: The aim of the study was to investigate the blood pressure variability during 24 h by using ambulatory blood pressure monitoring (ABPM) in a group of obese and non-obese female adolescents with breast development status 4 and 5 of Tanner´s criteria. Methods: A cross-sectional study was conducted at the Cardiovascular Research Institute, Mexico. All subjects underwent 24 h non-invasive ABPM recording device. Pubertal status was determined by breast development. Measurements: office systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Height, weight, body mass index (BMI), waist and hip circumferences, arm circumference, waist to hip ratio (W/H), and skinfold thickness measurements: triceps, subscapular, abdominal and supraspinal. Results: Fifty-nine adolescents 13-16 years old; 29 obese (BMI 31.2 ± 4.0), and 30 non- obese (BMI 21.2 ± 2.2). Obese vs. non-obese: Office SBP 116.9 vs. 105.9 ± 9.3 mmHg (p < 0.001); ABPM in 24 h: SBP 113.8 ± 6.3 vs. 107.6 ± 5.7 mmHg (p < 0.001); diurnal SBP 117.3 mmHg vs. 111.2 mmHg (p < 0.001); nocturnal SBP 105.5 ± 8 vs. 99.4 mmHg; absolute variability in 24 h DBP 10.0 ± 1.8 vs. 8.7 ± 1.5 (p < 0.003); coefficient of variation 24 h DBP 17.3 ± 3 vs. 15.4 ± 2.6% (p < 0.05); systolic non-dipper 16 (55.2%) vs. 9 (30%) (p < 0.05); pulse pressure 24 h 49.3 ± 8 vs. 43.5 ± 9 mmHg (p < 0.01). Conclusion: Obese adolescents are presenting changes in BP variability during 24-h in comparison with nonobese adolescents; it also includes higher pulse pressure. Thus, these can be early indicators for the development of hypertension or other cardiovascular diseases in the adult life (AU)

Time-dependent effects of leptin on food intake and locomotor activity in goldfish.

The present study investigates the possible circadian dependence of leptin effects on food intake, locomotor activity, glycemia and plasma cortisol levels in goldfish (Carassius auratus). Fish were maintained under 12L:12D photoperiod and subjected to two different feeding schedules, one group fed during photophase (10:00) and the other one during scotophase (22:00). Leptin or saline were intraperitoneally injected at two different times (10:00 or 22:00), coincident or not with the meal time. To eliminate the entraining effect of the light/dark cycle, goldfish maintained under 24h light (LL) were fed and leptin-injected at 10:00. A reduction in food intake and locomotor activity and an increase in glycemia were found in goldfish fed and leptin-injected at 10:00. No significant changes in circulating cortisol were observed. Those effects were not observed when leptin was administered during the scotophase, regardless the feeding schedule; neither in fish maintained under LL, suggesting that a day/night cycle would be necessary to observe the actions of leptin administered during the photophase. Changes in locomotor activity and glycemia were only observed in goldfish when leptin was injected at daytime, coincident with the feeding schedule, suggesting that these leptin actions could be dependent on the feeding time as zeitgeber. In view of these results it appears that the circadian dependence of leptin actions in goldfish can be determined by the combination of both zeitgebers, light/dark cycle and food. Our results point out the relevance of the administration time when investigating regulatory functions of hormones.

Serotonin-induced contraction in isolated intestine from a teleost fish (Carassius auratus): characterization and interactions with melatonin.

BACKGROUND: Serotonin (5-HT) plays a critical role in several gastrointestinal functions in vertebrates. In teleosts lacking enterochromaffin cells, intestinal 5-HT originates from serotonergic enteric neurons. In the present study, the foregut of a stomachless teleost, the goldfish (Carassius auratus), was used to evaluate the in vitro effect of 5-HT on fish intestinal motility. We also studied the role of melatonin (MEL), an indoleamine sharing the biosynthetic pathway with 5-HT, as regulator of serotonergic activity. METHODS: An organ bath system, with longitudinal strips from the goldfish intestinal bulb attached to an isometric transducer was used to record foregut smooth muscle contractions. KEY RESULTS: Concentration-dependent curves of the contractile response exerted by 5-HT and its agonists, 5-methoxytryptamine (5-MT) and 5-carboxamidotryptamine (5-CT), suggest a receptor-mediated action, supported by the blockade by a general 5-HT antagonist, methysergide. The 5-HT-induced contraction was abolished in the presence of atropine, revealing the involvement of cholinergic transmission in gut actions of 5-HT. Furthermore, MEL inhibited the contractile effect of 5-HT and its agonists by up to 50%, which was counteracted by MEL antagonists. CONCLUSIONS & INFERENCES: We can provisionally propose that at least two different 5-HT receptor subtypes are involved in fish intestinal motility, a 5-HT4-like (5-MT-preferring) and a 5-HT7-like (5-CT- and fluphenazine-sensitive) receptor. In summary, our results indicate that 5-HT regulates the contractile activity of goldfish foregut through specific receptors located in cholinergic neurons, and that MEL can modulate these serotonergic actions through high-affinity membrane receptors.

Circadian clock genes of goldfish, Carassius auratus: cDNA cloning and rhythmic expression of period and cryptochrome transcripts in retina, liver, and gut.

Clock genes are known to be the molecular core of biological clocks of vertebrates. They are expressed not only in those tissues considered central pacemakers, but also in peripheral tissues. In the present study, partial cDNAs for 6 of the principal clock genes (Period 1-3 and Cryptochrome 1-3) were cloned from a teleost fish, the goldfish (Carassius auratus ). These genes showed high homology (approximately 90%) with the respective cDNAs of zebrafish (Danio rerio), the only other teleost from which clock genes have been cloned. The daily expression pattern of each gene in retina, gut, and liver of goldfish was investigated using quantitative RT-PCR and cosinor analysis. All clock genes analyzed in the retina showed circadian rhythmicity; however, only Per 2-3 and Cry 2-3 were rhythmic in goldfish liver and gut. The amplitude and phase of the expression in liver and gut were different from those found in goldfish retina. Such differences suggest that other cues, such as feeding time, may contribute to the entrainment of oscillators in goldfish liver and gut. Our results support the use of goldfish as a teleost model to investigate the location and functioning of the circadian oscillators.

Report and review of the fetal brain disruption sequence.

UNLABELLED: The fetal brain disruption sequence (FBDS), a rare cause of extreme microcephaly, is described in a patient and compared with 19 previously reported cases. Clinical findings present in almost all patients included: severe microcephaly (average occipitofrontal circumference -5.8 SD), overlapping sutures, prominent occipital bone, scalp rugae with normal hair patterning and marked neurological impairment. Early death occurred in 7/20 cases. The FBDS was sporadic in 17 out of 19 reported cases supporting a low recurrence risk for genetic counselling purposes. A group of related observations in cases were thromboembolic phenomenon following death of the co-twin, vascular and/or haematological involvement by prenatal cytomegalovirus infection, prenatal cocaine exposure, direct vascular fetal trauma (cordocentesis) and fetal vascular changes after a maternal car accident causing intracranial bleeding and brain damage. Normal scalp hair pattern in all cases and the second or third trimester location of the disruptive event in two cases suggest that in the FBDS, brain growth is normal throughout the first 18 weeks of gestation at least. CONCLUSION: Pathogenic factors suggest that different forms of vascular injury to the fetal brain (emboli, haemorrhage, vasoconstriction, disseminated intravascular coagulation) can produce partial brain destruction, diminished intracranial pression and skull collapse in the fetal brain disruption sequence.

[The nutritional status of the child entering the Nuevo Hospital Civil de Guadalajara]. / Estado de nutrición del niño que ingresa al Nuevo Hospital Civil de Guadalajara.

With the purpose to evaluate the nutritional status of children hospitalized in the Nuevo Hospital Civil de Guadalajara, they were included 278 subjects that entered in the infant, preschool, schoolchildren and infectious disease clinical ward of the Division of Pediatrics. There were chosen two subjects every day during one year. It was obtained information about family and sociodemographic background. In addition, there were undertaken anthropometric measurements; weight/age, weight/height and height/age indices were also calculated. It was obtained the parameters of median, percentiles and Z-score. Undernutrition was determined by the Gómez and Waterlow classifications. Is was also compared the reference pattern of Ramos-Galván and National Center for Health Statistics (NCHS). Blood was drawn for total protein and hemoglobin. Mean of height/age was 95.74% (NCHS), weight/age 84.04% and weight/height 89.7%. It was not difference on weight/age between Ramos-Galván and NCHS. Weight/height and height/age had little difference. The median system identified more cases with deficit than Z-score, which seems to be more specific and conservative. There is a high prevalence of acute and chronic malnutrition identified with the median system, and maybe reflects the poor quality of life and major morbidity in this population.

[Rheumatic features of Grave's disease in children]. / Aspectos reumáticos de la enfermedad de Graves en niños.

We report three cases from girls with Graves disease who developed serious rheumatic manifestations. One patient had systemic lupus erythematosus with articular, renal, neurological and cardiac afectation with fatal outcome. Other patient presented clinical features of scleroderma with skin thickness, myopathy, arthritis, Raynaud's phenomenon and findings of pulmonary fibrosis. A lupus-like syndrome associated to methimazole therapy (polyarthritis, rash and hemolytic anemia) with positive Cel-LE preparations but negative antinuclear-antibodies was observed in a third patient. A careful history and the recognition of these manifestations will help in the identification of these syndromes.

[Mortality in children under 5 years of age in families of marginal settlements in Guadalajara]. / Mortalidad en niños menores de cinco años en familias de colonias marginadas de Guadalajara.

The purpose was, to determine the frequency of infant mortality in the marginal areas of Guadalajara and, find its association with sociodemographic and economical factors, which are known as determinant of the nutritional status of children. There were included 898 families in a cross sectional design among children who applied to the food supplementation program of ONI of Guadalajara. Through an interview and home visit, it was obtained information about sociodemographic and economical characteristics and food habits. The data was recorded and analyzed by the Dbase III Plus and Epi-Info program. It was also used Chi square test and Odds Ratio for the statistical analysis. Education of the mother and income per capita for feeding (as a percentage of the minimum salary) had a significantly and inverse association with infant mortality (P less than 0.0001 and P less than 0.001 respectively). There was also major mortality among children with no social security (P less than 0.05). The Odds Ratio for infant mortality was of 3.02 for education of the father, 8.42 for education of the mother and 6.8 for income per capita for feeding. Meanwhile the level of education and the economical situation of the studied population remain so low, it seems improbable to decrease the rate of infant mortality.

Cryptosporidium sp in 300 children with and without diarrhea.

Cryptosporidium sp was searched prospectively by means of the Ziehl-Nielsen acid fast staining of stools in 403 samples obtained from patients with diarrhea (n =/152) or other non-gastrointestinal diseases (n =/152) in a six month period. Cryptosporidium was present in 11/304 samples (3.6%), 9 (81%) were taken from patients with diarrhea. Oocysts were detected in 5% of stools form malnourished (II or III) children with diarrhea; 10/11 (91%) with positive-cryptosporidium stools occurred in children less than one year of age. Cryptosporidium was present with increased frequency in malnourished children with diarrhea (p < 0.05).

11-Deoxy-11 alpha,12 alpha-methanoprostaglandin E2, a potent, short-acting bronchodilator.

11-Deoxy-11 alpha,12 alpha-methanoprostaglandin E2 (1b) and the corresponding methyl ester 7a were highly potent, but short acting, bronchodilators both by the intravenous (80 and 10 times PGE2, respectively) and aerosol (2 and approximately 1 times PGE2) routes, as measured by the Konzett-Rössler assay. The 11 beta,12 beta-methano compound 15a was two orders of magnitude less active than 7a. In rhesus monkeys anesthetized by aerosol administration, 1b was 10-50% as potent as, and had a duration of action similar to, PGE1 in the inhibition of methacholine-induced increases in airway resistance. At doses effective in preventing the methacholine response, 1b increased the heart rate (less than or equal to 30%) and precipitated mild upper airway irritation.

Synthesis of ring halogenated prostaglandins (1).

The synthesis of nine mono- and difluoro prostaglandins XIII, XV, XXIV, XXVII, XXXII, XXXVIII, XLV, LI and LIV, and two monochloro prostaglandins LVII and LXI, from appropriately protected derivatives of natural PGF2 is described.