Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study.

BACKGROUND/AIMS: To compare short- and long-term outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) in obese (body mass index >30 kg/m2) patients. PATIENTS AND METHODS: Sixty-four consecutive obese patients who underwent laparoscopic (LPS) right colectomy with IA were matched with 64 patients who underwent LPS right colectomy with EA. Intraoperative variables, short-term outcomes, readmission rates, and morbidity and mortality rates were analyzed along with long-term outcomes. RESULTS: Conversion to open surgery occurred in 4 patients in the IA group and 11 patients in the EA group (p = 0.097). The overall 30-day morbidity rate was 29.6% in the IA and 32.8% in the EA (p = 0.70). No 30-day mortality occurred. Anastomotic leak occurred in 4.7% of patients in the IA group vs. 7.8% in the EA group (p = 0.71). In the IA group, an earlier recovery of bowel function was observed (p = 0.01). No differences were observed with respect to the length of stay and reoperation rate. No 30-day readmission occurred in the IA compared to 5 patients readmitted in the EA group (p = 0.058). A higher incidence of incisional hernia was observed in the EA group (p = 0.033). CONCLUSION: IA in obese patients is associated with similar short-term outcomes, lower incidence of incisional hernias, and might possibly reduce the risk of hospital readmission.

Duration of exclusive breastfeeding and wheezing in the first year of life: A longitudinal study.

INTRODUCTION: Wheezing is the most common symptom associated with asthma in young children. There is a lack of well-designed prospective studies on the relationship of exclusive breastfeeding with wheezing in infants. This prospective cohort study investigated whether a relationship exists of exclusive breastfeeding with wheezing at 12 months of age. MATERIALS AND METHODS: A series of 1632 mother-infant pairs were sequentially recruited. Mothers were trained at hospital on breastfeeding practices and how to recognise wheezing. At hospital discharge they received a calendar-diary to record the date at stopping breastfeeding and at onset of wheezing. Data were collected by telephone interviews through 12 months post-delivery. Breastfeeding was in accordance with the World Health Organisation and wheezing with the International Classification of Diseases (ICD-10-CM code R06.2). RESULTS: At 12 months 1522 mother-infant pairs were participating. Breastfeeding started in 95.9% of them and was exclusive in 86.1%. The incidence of wheezing ever and recurrent wheezing at 12 months of age was 33.7% and 10.0%, respectively. Duration of exclusive breastfeeding was shorter in wheezing than non-wheezing infants (median 2.6 months vs. 4.1 months, P<0.001). After adjustment for confounders each month of exclusive breastfeeding reduced the risk of wheezing ever by 11% and of recurrent wheezing by 15%, at 12 months of age. CONCLUSION: Longer duration of exclusive breastfeeding reduces the risk of wheezing throughout the first 12 months of life. These findings would be relevant to all healthcare operators and mothers, also to improve their awareness about the best feeding practices for the infant's health.

Serum salicylic acid and fruit and vegetable consumption in obese and normal-weight children: a pilot-study.

Salicylic acid (SA), a phenolic compound produced by plants, may play a beneficial role on health. This pilot study evaluated whether there might be an association between serum SA and fruit and vegetable (FV) consumption in obese and normal-weight children. Thirty-four obese children (17 boys and 17 girls) and 34 normal-weight children were recruited. Dietary intake was evaluated by the 7-day dietary record. Serum SA was measured using gas chromatography-mass spectrometry method. FV intake in obese and normal-weight children was not different between groups (175.00 (97.66) g versus 192.29 (90.54) g, p = .455). Obese children had lower serum SA than normal-weight children [mean difference, -0.025; 95% CI (-0.044; -0.006) µmol/L]. Serum SA was not associated with daily intake of FV in obese (p = .111) and normal-weight (p = .092) children. Further studies are needed to evaluate the role of FV on serum SA, taking into account also the quantity and the type.

Docosahexaenoic acid and non-alcoholic fatty liver disease in obese children: a novel approach?

Non-alcoholic fatty liver disease represents the most common chronic liver disease in obese children of industrialized countries. Nowadays the first line of treatment of pediatric non-alcoholic fatty liver disease is based on dietary and lifestyle intervention; however compliance to these interventions is very difficult to maintain in long term period. This editorial discusses about docosahexaenoic acid treatment as possible novel approach for non-alcoholic fatty liver disease in obese children. Docosahexaenoic acid may modulate the inflammatory response, improve insulin sensitivity and could be effective in enhancing intestinal barrier integrity, essential to protect a healthy gut-liver axis. Indeed alteration of gut microbiota composition and increased intestinal permeability may rise the exposure of liver to gut-derived bacterial products, causing activation of signalling pathways implicated in liver inflammation and fibrogenesis. This mechanism has been observed in vitro and animal models of non-alcoholic fatty liver disease but also in a clinical study in adults. While evidence suggests that n-3 long-chain polyunsaturated fatty acids supplementation may decrease liver fat in adults, in pediatric population only a study examined this topic. In obese children with non-alcoholic fatty liver disease well designed randomized controlled trials are needed to better clarify the possible efficacy of docosahexaenoic acid treatment, and underlying mechanisms, to identify the optimal required dose and to evaluate if the docosahexaenoic acid effect is limited to the duration of the treatment or it may continue after the end of treatment.

Implementation of a Hospital-Based Home Palliative Care at regional level: a quantitative study of the Ospedalizzazione Domiciliare Cure Palliative Oncologiche program in Lombardy.

BACKGROUND: Home Palliative Care services can overcome trends of institutionalized dying and support higher rates of death at home. Home Palliative Care services rarely scale-up into regional health planning. This generates unwarranted variability in service provision and outcomes across patients. Lombardy Region sponsored a Hospital-Based Home Palliative Care program, which implemented a common service to oncological patients in the territory, with the purpose to align hospitals toward a target of 65% deaths at home. AIM: Our work assesses service characteristics and outcomes achieved by the regional program from 2009 to 2011. DESIGN AND SETTING: Descriptive analysis from an institutional database of service characteristics, regional expenditure, and outcomes (temporary hospitalization and patient discharge) representing 11,841 patients served by 24 providers in the period 2009-2011. RESULTS: Targets of 65% deaths at home were achieved across the Region, with temporary re-hospitalization below 4.4%. The average pathway length stood above 1 month; intensity of care stood above ministerial and regional standards, with most home visits performed by nurses and physicians. CONCLUSIONS: The implementation of the regional program revealed three strengths (prompt identification and enrollment of eligible patients, and quantity of home visits) and two weaknesses (limited enrollment from general practitioners and multi-disciplinarity). This highlights opportunities for policy-makers to invest on regional protocols of Hospital-Based Home Palliative Care to reduce trends of institutionalized dying and align providers to homogeneous results.

Empowering patients through eHealth: a case report of a pan-European project.

BACKGROUND: This paper crystallises the experience developed by the pan-European PALANTE Consortium in dealing with the generation of relevant evidence from heterogeneous eHealth services for patient empowerment in nine European Regions. The European Commission (EC) recently funded a number of pan-European eHealth projects aimed at empowering European patients/citizens thus transforming the traditional patient/citizen role in the management of their health (e.g., PALANTE, SUSTAIN, CARRE, HeartCycle, Empower). However, the heterogeneity of the healthcare systems, of the implemented services and of the target patients, the use of ad-hoc definitions of the salient concepts and the development of small-size experiences have prevented the dissemination of "global" results and the development of cumulative knowledge. The main challenge has been the generation of large-scale evidence from heterogeneous small-size experiences. DISCUSSION: Three lessons have been collectively learnt during the development of the PALANTE project, which involves 9 sites that have implemented different eHealth services for empowering different typologies of patients. These lessons have been refined progressively through project meetings, reviews with the EC Project Officer and Reviewers. The paper illustrates the ten steps followed to develop the three lessons. The first lesson learnt is about how EC-funded projects should develop cumulative knowledge by avoiding self-crafted measures of outcome and by adopting literature-grounded definitions and scales. The second lesson learnt is about how EC-funded projects should identify ambitious, cross-pilot policy and research questions that allow pooling of data from across heterogeneous experiences even if a multi-centre study design was not agreed before. The third lesson learnt is about how EC-funded projects should open their collections of data and make them freely-accessible to the scientific community shortly after the conclusion of the project in order to guarantee the replicability of results and conclusions. SUMMARY: The three lessons might provide original elements for fuelling the ongoing debate about the capability of the EC to develop evidence-based policies by pooling evidence from heterogeneous, local experiences.

Docosahexaenoic Acid Levels in Blood and Metabolic Syndrome in Obese Children: Is There a Link?

Prevalence of metabolic syndrome is increasing in the pediatric population. Considering the different existing criteria to define metabolic syndrome, the use of the International Diabetes Federation (IDF) criteria has been suggested in children. Docosahexaenoic acid (DHA) has been associated with beneficial effects on health. The evidence about the relationship of DHA status in blood and components of the metabolic syndrome is unclear. This review discusses the possible association between DHA content in plasma and erythrocytes and components of the metabolic syndrome included in the IDF criteria (obesity, alteration of glucose metabolism, blood lipid profile, and blood pressure) and non-alcoholic fatty liver disease in obese children. The current evidence is inconsistent and no definitive conclusion can be drawn in the pediatric population. Well-designed longitudinal and powered trials need to clarify the possible association between blood DHA status and metabolic syndrome.

Randomized controlled trial of a protein substitute with prolonged release on the protein status of children with phenylketonuria.

OBJECTIVE: To examine whether a phenylalanine-free protein substitute with prolonged release may be beneficial to the protein status of children with phenylketonuria (PKU) compared to conventional substitutes. METHODS: Sixty children with PKU, 7 to 16 years of age, were randomly allocated to receive either a prolonged-release (test) or the current conventional protein substitute for 30 days. Subjects were additionally sex and age matched with 60 subjects with mild hyperphenylalaninemia and 60 unaffected subjects. The protein status in children with PKU was assessed by albumin, transthyretin, and retinol-binding protein (RBP), and changes throughout the trial period were the primary outcome measures. RESULTS: Children with PKU did not differ in anthropometry from children with mild hyperphenylalaninemia or unaffected children but they ingested lower amounts of proteins (p < 0.01). No differences occurred throughout the trial between or within children with PKU who received the test or conventional substitute for macronutrient intake. Albumin and RBP concentrations were within the age-specific reference range for all children. The rate of protein insufficiency (transthyretin concentration less than 20 mg/dL) did not differ statistically between children receiving test or conventional substitute (recruitment 51.8% vs 53.6%; end of the trial 44.4% vs 50.0%) but mean transthyretin recovered over 20 mg/dL in children who received the test substitute, increasing from 19.1 to 20.7 mg/dL (mean change, 1.6 mg/dL; 95% confidence interval 0.4 to 2.8 mg/dL). In children receiving conventional substitute mean transthyretin changed from 19.0 to 19.2 mg/dL (0.2; -0.2 to 0.6) mg/dL. CONCLUSIONS: Protein substitutes with prolonged release might be beneficial to protein status in children with phenylketonuria.

Implementation of EUnetHTA core Model® in Lombardia: the VTS framework.

OBJECTIVES: This study describes the health technology assessment (HTA) framework introduced by Regione Lombardia to regulate the introduction of new technologies. The study outlines the process and dimensions adopted to prioritize, assess and appraise the requests of new technologies. METHODS: The HTA framework incorporates and adapts elements from the EUnetHTA Core Model and the EVIDEM framework. It includes dimensions, topics, and issues provided by EUnetHTA Core Model to collect data and process the assessment. Decision making is instead supported by the criteria and Multi-Criteria Decision Analysis technique from the EVIDEM consortium. RESULTS: The HTA framework moves along three process stages: (i) prioritization of requests, (ii) assessment of prioritized technology, (iii) appraisal of technology in support of decision making. Requests received by Regione Lombardia are first prioritized according to their relevance along eight dimensions (e.g., costs, efficiency and efficacy, organizational impact, safety). Evidence about the impacts of the prioritized technologies is then collected following the issues and topics provided by EUnetHTA Core Model. Finally, the Multi-Criteria Decision Analysis technique is used to appraise the novel technology and support Regione Lombardia decision making. CONCLUSIONS: The VTS (Valutazione delle Tecnologie Sanitarie) framework has been successfully implemented at the end of 2011. From its inception, twenty-six technologies have been processed.

Blood lipids profile in hyperlipidemic children undergoing different dietary long chain polyunsaturated supplementations: a preliminary clinical trial.

The aim of this preliminary study was to explore the effect size of different dietary long chain polyunsaturated supplementations on blood lipid profile in children with primary hyperlipidemia. Thirty-six children (8-13 years) were recruited. After an 8-week stabilization period on the Step I diet, they were randomized to additionally receive for a 16-week period one capsule (500 mg) daily of docosahexaenoic acid (DHA) alone or a DHA plus eicosapentaenoic acid (EPA) mixture (45.6% DHA; 41.6% EPA) or wheat germ oil (control). An effect size (as percentage change from baseline) of +8%, -12% and -16% for high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C ratio and triglycerides was observed in children supplemented with DHA, compared to +2%, -8% and -12%, respectively, in children supplemented with DHA plus EPA. This preliminary study suggests powered trials appear feasible and are warranted to evaluate efficacy of n-3 long-chain polyunsaturated fatty acid dietary supplementations on the blood lipid profile of children with primary hyperlipidemia.

Odonate diversity of a highly urbanised region: An annotated checklist of the damselflies and dragonflies (Insecta, Odonata) of Lario and Brianza (Lombardy, N Italy).

Background: Given their sensitivity to environmental alterations, odonates act as reliable bioindicators to assess the effects of changes in freshwater ecosystems and associated terrestrial habitats. The region comprised between Lario and Brianza (Provinces of Como, Lecco and Monza and Brianza - Lombardy, N Italy) is one of the most urbanised of the Italian peninsula and large parts of its territory have been heavily altered, especially at low elevation. Despite this pervasive anthropogenisation, the area is still characterised by a considerable variety of freshwater habitats, possibly harbouring rich odonate communities, which, however, have been never thoroughly investigated. This study aimed to produce the first commented checklist of the Odonata of this region, accompanied by distribution maps. New information: The work is based on 12,093 records spanning from 1981 and 2022, derived from literature (289), revision of collections (42), citizen-science projects (1249) and unpublished data from the authors and their collaborators (10,513). Overall, fifty-five species occur - or occurred in the past - in the study area (20 Zygoptera and 35 Anisoptera). One species, Erythrommanajas, was confirmed exclusively before 1978, while seven species (Lestesbarbarus, Coenagrionscitulum, Aeshnaaffinis, Anaxephippiger, Somatochloraarctica, Sympetrummeridionale and Trithemisannulata) have been recorded only after 2000. Records referring to Chalcolestesparvidens and Sympetrumflaveolum were considered questionable and excluded from the checklist. A list of species for each protected site is additionally provided. This work highlighted the importance for odonates of Lario and Brianza Regions from a national perspective, in particular for species of conservation priority/interest, such as Sympecmapaedisca, Oxygastracurtisii and Sympetrumdepressiusculum.

The status of invasive pneumococcal disease among children younger than 5 years of age in north-west Lombardy, Italy.

BACKGROUND: Streptococcus pneumoniae is a leading cause of invasive infection in young children causing morbidity and mortality. Active surveillance systems of invasive pneumococcal disease (IPD) are recommended worldwide. The aim of this study was to estimate the current incidence of IPD and to describe the serotype distribution and the antimocrobial susceptibility of S. pneumoniae isolates in children aged less than 5 years residing in North-West Lombardy, Italy. METHODS: A twelve-month prospective active surveillance system recruited all children aged less than 5 years admitted for suspicion of IPD at emergency room of ten hospitals located in the monitored area. Blood samples were taken in all participants for confirmation of IPD based on isolation of S. pneumoniae from blood. Pneumococcal meningitis and sepsis were additionally confirmed by cerebrospinal fluid analysis. Serotyping and antimicrobial susceptibility testing were performed on isolates from blood. RESULTS: A total of 15 confirmed cases of IPD were detected among 135 recruited children, including pneumonia (n = 8), bacteremia (n = 4), sepsis (n = 2) and meningitis (n = 1). The annual IPD incidence rate was 50.0/100,000 (95%CI, 30.5-82.5/100,000). Incidence was 58.3/100,000 (28.8-120.1/100,000) among children aged less than 2 years and 44.4/100,000 (22.9-87.5/100,000) among children aged 2-4 years. Thirteen isolates were typified. The most common serotype was 19A (23.1%) that together with serotypes 1, 7F and 19F accounted for 69.2% of typified isolates. Serotypes 14, 23F, 12B and 15C were also identified. The 7- and 13-valent pneumococcal conjugate vaccines covered respectively 30.8% and 84.6% of typified IPD cases. One isolate (serotype 15C) was penicillin-resistant and caused meningitis. CONCLUSIONS: The inclusion of the 13-valent pneumococcal conjugate vaccine in immunization programs of young children might be considered to reduce incidence and morbidity of invasive pneumococcal disease in this surveilled population.

Attitudes and practices of family paediatricians in Italy regarding infant feeding.

AIM: The aim of this study was to examine attitudes and practices of family paediatricians in Italy towards infant feeding. METHODS: A questionnaire was sent to 850 paediatricians across Italy, asking about attitudes and practices towards infant feeding with focus on the World Health Organization's criteria. RESULTS: The response rate was 91.2%. Breastfeeding is recommended for 6-11 months (70.6%) or longer (29.4%). A 95% of paediatricians recommend introducing complementary foods throughout 4-5.9 months. Among paediatricians who give indications about the minimum acceptable diet (61.7%), recommendations agree with WHO in 71.3% and 83.3% of cases for infants aged 6-8 or 9-11 months, respectively. A 95.6% of paediatricians recommend consumption of meat for infants aged 6 months or more, and 98.4% use of formula milk for infants having breastfeeding stopped in the first year of life. Paediatricians reported own experience (73.4%) and reading (54.2%) as main sources of information. A 70% of paediatricians know the WHO/Infant and Young Child Feeding Practices criteria regarding breastfeeding but <5% the complementary feeding indicators. CONCLUSION: Family paediatricians in Italy have positive disposition towards infant feeding but their knowledge and practices are suboptimal with respect to the WHO criteria, especially regarding complementary feeding.

Plasma long-chain fatty acids profile and metabolic outcomes in normolipidaemic obese children after one-year nutritional intervention.

AIM: To assess the association between changes in plasma long-chain polyunsaturated fatty acids (LCPUFAs) profile and metabolic outcomes after 1-year nutritional intervention in normolipidaemic obese children. METHODS: Fifty-seven normolipidaemic obese children, aged 8-13 years, were recruited in the study. Body mass index (BMI) z-scores were calculated. Fasting blood samples were analysed for insulin, glucose, lipid profile and fatty acid (FA) levels at baseline and after an 1-year nutritional-behaviour intervention. Insulin resistance was estimated by homeostatic model assessment (HOMA). RESULTS: Fifty-one obese children completed the study. At the end of the intervention, the children showed decreased BMI z-score (mean reduction 0.25; 95% confidence interval [CI], 0.18-0.31), HOMA index (1.6; 0.6-2.5), plasma-saturated FA (1.49; 0.67-2.31 mg/dL), C20:3n-9 (0.05; 0.02-0.07 mg/dL) and increased plasma levels of monounsaturated FA (mean increase 1.35; 0.63-2.07 mg/dL), n-6 PUFA (1.02; 0.08-1.97 mg/dL), n-3 PUFA (0.24; 0.07-0.40 mg/dL), C20:4n-6 (0.37; 0.11-0.63 mg/dL), C18:3n-3 (0.04; 0.01-0.07 mg/dL), C22:6n-3 (0.30; 0.17-0.42 mg/dL) and the C22:6n-3/C20:4n-6 ratio (0.02; 0.01-0.03 mg/dL) ratio. CONCLUSIONS: Nutritional interventions may improve plasma LCPUFA profile and metabolic outcomes of normolipidaemic obese children.

Effect of individual- versus collective-based nutritional-lifestyle intervention on the atherogenic index of plasma in children with obesity: a randomized trial.

BACKGROUND: The Atherogenic Index of Plasma is a predictive biomarker of atherosclerosis in adults but there is a lack of studies in paediatric population aimed at evaluating the longitudinal changes of the AIP and of the cardiometabolic blood profile related to nutritional interventions. The aim of this study was to compare the effect of individual- versus collective-based nutritional-lifestyle intervention on the Atherogenic Index of Plasma in schoolchildren with obesity. METHODS: One-hundred sixty-four children aged 6-12 years with Body Mass Index z-score > 2 referred to the Paediatric Obesity Clinic, San Paolo Hospital, Milan, Italy, were consecutively enrolled and randomized to undergo to either an individual- (n = 82) or a collective- (n = 82) based intervention promoting a balanced normo-caloric diet and physical activity. In addition, the individual intervention included a tailored personalized nutritional advice and education based on the revised Coventry, Aberdeen, and London-Refined taxonomy. Both at baseline and after 12 months of intervention, dietary habits and anthropometric measures were assessed, a fasting blood sample were taken for biochemistry analysis. RESULTS: The participation rate at 12 months was 93.3% (n = 153 patients), 76 children in the individual-intervention and 77 children in the collective intervention. At univariate analysis, mean longitudinal change in Atherogenic Index of Plasma was greater in the individual than collective intervention (- 0.12 vs. - 0.05), as well as change in triglyceride-glucose index (- 0.22 vs. - 0.08) and Body Mass Index z-score (- 0.59 vs. - 0.37). At multiple analysis, only change in Body Mass Index z-score remained independently associated with intervention (odds ratio 3.37). CONCLUSION: In children with obesity, an individual-based nutritional and lifestyle intervention, including techniques from the CALO-RE taxonomy, could have an additional beneficial effect over a collective-based intervention, although the actual size of the effect remains to be clarified. Trial Registration Clinical Trials NCT03728621.

Epidemiological and clinical features of rotavirus among children younger than 5 years of age hospitalized with acute gastroenteritis in Northern Italy.

BACKGROUND: Rotavirus is the major cause of acute gastroenteritis and severe dehydrating diarrhea in young children. METHODS: To estimate the proportion of hospital admissions for rotavirus acute gastroenteritis and identify the circulating G and P genotypes among children under five years of age, we conducted a prospective observational study from January to December 2008, recruiting children consecutively admitted to six hospitals in Milan and nearby towns in northern Italy. Typing was done on stool samples by reverse transcriptase polymerase chain reaction amplification. RESULTS: Of the 521 stool samples from children with acute gastroenteritis, 34.9% (95%CI, 30.8 to 39.2%) were rotavirus-positive. Two thirds (67.6%) were under two years of age, and 13.2% were under six months. The predominant G type was G1 (40.7%), followed by G9 (22.5%), G2 (13.2%), G3 (5.5%), G4 (3.8%) and G10 (1.6%). Twenty-one (11.7%) mixed-G infections were identified: G1+G10 (8.8%); G1+G9 (1.6%); and G2+G10 (1.2%). Only P[8] (67.6%) and P[4] (12.6%) types were P genotyped. The predominant single G/P combination was G1P[8] (39.7%), followed by G9P[8] (25.3%), G2P[4] (14.3%), and G3P[8] (4.1%). All G-mixed types combined with P[8]. CONCLUSIONS: These findings show an high prevalence of rotavirus infections among children admitted to hospital for acute gastroenteritis caused by different rotavirus strains circulating in the area studied.

Liver fat change in obese children after a 1-year nutrition-behavior intervention.

OBJECTIVES: To evaluate whether a 1-year nutrition-behavior intervention based on normocaloric balanced diet and physical exercise may reduce liver fat in obese children. PATIENTS AND METHODS: Twenty-six obese children (11 boys and 15 girls), aged 6 to 14 years, underwent anthropometric, nutritional, metabolic, and liver magnetic resonance imaging (MRI) examinations at baseline and after a 1-year nutrition-behavior intervention. Anthropometry included weight, height, waist and hip circumference, and total upper arm area. Body mass index z scores were calculated. Biochemistry included serum aminotransferases, lipid profile, glucose, and insulin. Liver steatosis was judged as hepatic fat fraction (FF) by MRI and was > or =9%. RESULTS: Prevalence of steatosis was 34.6% at baseline and declined to 7.7% after intervention (P < 0.0001). Mean (95% CI) reduction of liver FF was 8.0% (4.0%-12.0%). In 77.8% of children with liver steatosis at baseline, the FF declined lower than 9% at the end of intervention, going from a mean (SD) of 18.7% (9.1) to 1.3% (4.1), (P < 0.0001). At the end of the intervention, children showed a mean reduction in body mass index z score of 0.26 (0.11-0.41) and waist circumference of 1.46 (0.34-2.60) cm. Triglycerides, total cholesterol, apolipoprotein A1, apolipoprotein B, ApoA1/ApoB ratio, and gamma-glutamyltransferase plasma values in plasma decreased at the end of intervention (P < 0.05). CONCLUSIONS: The results suggest that in obese children nutritional-behavior interventions may reduce the liver fat.

The relationship of insulin resistance with SNP 276G>T at adiponectin gene and plasma long-chain polyunsaturated fatty acids in obese children.

This study examined the association of insulin resistance with single-nucleotide polymorphism (SNP) 276G>T at adiponectin gene and the plasma long-chain polyunsaturated fatty acids (LCPUFAs) profile in obese children. One hundred thirty-one normolipidaemic obese children aged 8-13 y (53 girls and 68 boys) entered the study. The prevalence of T allele carriers at SNP276 was 48.8%. Mean [SD] values of fasting insulin and homeostasis model assessment-insulin resistance (HOMA-IR) index in noncarriers versus carriers of T allele were 12.4 [6.4] versus 20.6 [6.3] muU/mL (p = 0.039) and 2.6 [1.4] versus 4.5 [1.7] (p = 0.032). Mean [SD] values of plasma C18:3n - 3, C20:5n - 3/C20:4n - 6, and n - 6/n - 3 LCPUFA in phospholipids in noncarriers versus carriers of T allele were 0.10 [0.04] versus 0.08 [0.03] % (p = 0.013), 0.04 [0.01] versus 0.03 [0.01] % (p = 0.045), and 4.4 [0.7] versus 4.9 [0.9] % (p = 0.005), respectively. Insulin resistance was independently associated with SNP 276G>T (p = 0.002) and n - 6/n - 3 LCPUFA (p = 0.042) in plasma phospholipids, and interaction was found between SNP 276G>T and n - 6/n - 3 LCPUFA (p = 0.046). These findings suggest that obese children carriers of the SNP 276G>T may be at increased risk of metabolic complications compared with noncarriers, possibly due in part to a different plasma phospholipids profile.

Effect of prednisolone on local and systemic response in laparoscopic vs. open colon surgery: a randomized, double-blind, placebo-controlled trial.

PURPOSE: This study was designed to assess whether preoperative, short-term, intravenously administered high doses of methylprednisolone (30 mg/kg 90 minutes before surgery) influence local and systemic biohumoral responses in patients undergoing laparoscopic or open resection of colon cancer. METHODS: Fifty-two patients who were candidates for curative colon resection were randomly assigned to laparoscopic or open surgery and, in a double-blind design, assigned to receive methylprednisolone (n = 26) or placebo (n = 26). Pulmonary function, postoperative pain, C-reactive protein, interleukins 6 and 8, and tumor necrosis factor alpha were analyzed, as was patient outcome. RESULTS: The steroid and placebo groups were well balanced for preoperative variables, as were the subgroups of patients who underwent laparoscopic (methylprednisolone, n = 13; placebo, n = 13) and open surgery (methylprednisolone, n = 13; placebo, n = 13). No adverse events related to steroid administration occurred. In the methylprednisolone groups, significant improvement in pulmonary performance (P = 0.01), pain control (P = 0.001), and length of stay (P = 0.03) were observed independent of the surgical technique. No differences in morbidity or anastomotic leak rate were observed among groups. CONCLUSION: Preoperative administration of methylprednisolone in colon cancer patients may improve pulmonary performance and postoperative pain, and shorten length of stay regardless of the surgical technique used (laparoscopy, open colon resection).

Anatomic location and histopathologic subtype of basal cell carcinomas in adults younger than 40 or 90 and older: any difference?

BACKGROUND: Differences in age, site, and histopathologic subtype exist in basal cell carcinoma (BCC). OBJECTIVE: To compare the distribution of BCCs in patients younger than 40 with that of those aged 90 and older according to sex, site, and subtype. METHODS & MATERIALS: One hundred seventy-five BCCs were examined. The site was classified as head and neck, trunk, or limbs and the subtype as nodular, superficial, or morpheic-infiltrative. RESULTS: Younger exhibited a lower prevalence of BCCs on the head and neck (36.0% vs 57.3%, p<.01) and a higher prevalence on the trunk (59.3% vs 31.5%, p<.01) and of superficial BCCs (43.0% vs 31.5%, p<.05) than older patients. Site was associated with subtype in younger (p<.001) and older (p=.004) patients. Superficial BCCs were mostly on the trunk (p<.001), with a higher prevalence in younger patients (86.5% vs 62.5%, p<.05). Morpheic BCCs were mostly on the head and neck (p<.001), and prevalence did not differ between age groups. Nodular BCCs were mostly on the head and neck in older patients (p=.011). Subtype was independently associated with site (p=.005) but not with age or sex. CONCLUSION: A different distribution of site and subtype occurs in younger and older patients. Subtype is associated with site independent of age and sex. These findings suggest that, at least in some patients, the anatomic location of BCC may favor the development of a particular subtype.