Circulating adipocytokines in non-diabetic and Type 1 diabetic children: relationship to insulin therapy, glycaemic control and pubertal development.

AIM: To determine the influence of Type 1 diabetes mellitus on circulating adipocytokines in children. METHODS: The circulating concentrations of leptin, adiponectin, resistin and tumour necrosis factor (TNF)-alpha were measured in 91 children, aged 11.1 +/- 2.7 years, with Type 1 diabetes mellitus (T1DM). Ninety-one healthy children were selected as control subjects. RESULTS: Body mass index-adjusted leptin concentrations were higher in the pubertal diabetic children compared with the control children. There was a significant positive correlation between leptin and daily insulin dose in the diabetic group. Circulating adiponectin concentrations were higher in the prepubertal diabetic children and were positively associated with HbA(1c). Resistin concentrations were lower in the prepubertal non-diabetic subjects compared with the pubertal non-diabetic children, whose values were higher than those of the diabetic children. TNF-alpha concentrations were similar in non-diabetic and diabetic children. CONCLUSIONS: Circulating concentrations of adipocytokines are abnormal in Type 1 diabetic children, although the direction of change differs by cytokine. Pubertal development, in addition to insulin treatment and glycaemic control, also influences the concentrations.

Circulating acylated and total ghrelin and galanin in children with insulin-treated type 1 diabetes: relationship to insulin therapy, metabolic control and pubertal development.

OBJECTIVE: To study the circulating levels of two gut-derived peptides in children with type 1 (insulin-dependent) diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS: Plasma levels of ghrelin, both total ghrelin (TG) and the acylated form (AG), and galanin and their relationships with insulin dosage, metabolic control, IGFBP-1, body mass and pubertal development were evaluated in 91 children, aged 11.1 +/- 2.7 years, affected by IDDM and treated with insulin. Ninety-one healthy children were selected as controls. RESULTS: Body mass index (BMI)-adjusted levels of both forms of ghrelin were reduced in IDDM compared with healthy subjects, with greater values in prepubertal than pubertal IDDM subjects. A negative association was found between AG and fasting insulin serum levels and insulin resistance [measured by using the homeostasis model assessment of insulin resistance (HOMA IR)] among the healthy children. IDDM children showed a negative association of their plasma ghrelin (both acylated and total) with daily insulin dosage, and the three adiposity indices (BMI, skinfold thickness and percentage fat mass). IGFBP-1 levels were higher among the IDDM children without any association with ghrelin serum values. BMI-adjusted plasma levels of galanin were higher among IDDM compared to healthy subjects, irrespective of sex or pubertal development. Greater values for galanin were found among pubertal than prepubertal subjects in both groups without any significant differences between the genders. A positive association was found between galanin and BMI in both groups and between galanin and haemoglobin A1c (HbA1c) among the IDDM children. No relationship existed between either galanin and fasting serum insulin among the healthy subjects or galanin and both insulin dosage or duration of treatment among the IDDM subjects. CONCLUSIONS: The associations found between both ghrelin and galanin with adiposity indices could be considered as an indirect signal of involvement of the two peptides in the development of the nutritional status of the IDDM adolescents. The reduction in both forms of ghrelin could be involved in the development of the body mass increase of IDDM subjects with opposite effects, either influencing insulin sensitivity or exerting a compensatory restraint of feeding.

Unusually long inflation times during percutaneous transluminal coronary angioplasty.

Unusually prolonged balloon inflations (PBI) during percutaneous transluminal coronary angioplasty (PTCA) have been utilized in 26 consecutive patients to establish adequate coronary perfusion after shorter inflation times resulted in severe residual stenosis (N = 15), early arterial closure (N = 5), or extensive dissection (N = 6). Inflations lasted 1.5 to 15 min and 23/27 stenoses were successfully dilated. The average reduction in stenosis was 67% (90%-33%). Chest pain occurred in 34% vs. 7% (P less than 0.01), and ST changes occurred during 66% vs. 57% (NS) of PBI vs. short inflations. Four patients required coronary artery bypass surgery in spite of PBI, but none suffered an infarction. Electrocardiograms were unchanged in 22 patients and showed nonspecific ST-T wave changes in four. Cardiac enzymes obtained in nine patients failed to reveal a significant increase in serum concentration. We conclude that PBI is well tolerated and can successfully dilate lesions not responding to short inflations.

Identification of HCV genotypes in the Calabria region.

The present work describes the distribution of HCV genotypes in Calabria. The data presented suggest that, in the sample of population investigated, genotype 1b is the most prevalent followed by the 2b and the 2a.. In addition it is important to note that in Calabria the prevalence of genotype 1b is strikingly high in respect to the other Italian pullulation. An Association between HCV type 1b and the more severe clinical course of the liver disease has been reported. Although the data presented indicate that in Calabria most of the subjects enrolled in the study are infected by a virulent HCV strain, no association has been found with more severe clinical manifestations.

Leptin serum levels are involved in the relapse after weight excess reduction in obese children and adolescents.

BACKGROUND: Leptin concentrations as a predictor of weight excess (WE) variations in obese children continue to be controversial. AIM AND DESIGN: To evaluate the relationship between fasting leptin serum concentrations and the ability to maintain loss of WE during obesity treatment, 172 (82 males and 90 females) overweight children and adolescents (OW), 6-16 yr old, were recruited. The subjects were retrospectively selected among those who had demonstrated a reduction of their WE during an initial phase of 12 months of a WE reduction programme (WERP). Fasting serum levels of leptin were assayed, together with insulin, triacylglycerol and cholesterol, before (time 0) and at the end of the first phase of WERP (time 1), and BMI (Z-score) was determined at time 0, time 1 and at the end (time 2) of a subsequent second phase of 12 months. OW were subdivided according to wether their Z-BMI showed a persistent reduction also during the second phase (maintaining WE reduction subjects or MS) or showed a subsequent increase after the reduction observed during the first phase (relapsing WE subjects or RS). RESULTS: A significant reduction in serum levels of leptin, insulin and lipids, paralleling Z-BMI reduction, was observed at the end of the first phase of WERP, during which we found a correlation between the decrease in serum leptin concentrations and the decrease in Z-BMI. The decrease in RS during the first phase ((deltalgL(0-1) was significantly greater when compared to that observed in MS (p < 0.05). In two different multiple logistic regression analyses, where RS = 0 and MS = 1, serum leptin at time 1 [odds ratio (OR) = 1.08; 95% confidence interval (CI) = 1.04-1.13] and deltalgL(0-1) (OR = 0.48; 95% CI = 0.25-0.92), together with final pubertal stage (OR = 0.78; 95% CI = 0.63-0.96), were significantly associated with final subject status. CONCLUSIONS: Leptin serum levels after a previous WE reduction and its parallel decline are related to subsequent adiposity outcome. The lower the leptin serum concentration after previous WE reduction and/or the greater its decrease, the greater was the probability of WE relapse.

Aortocoronary bypass surgery: a 7-year follow-up.

Follow-up of 748 consecutive patients who underwent aortocoronary artery bypass grafts was obtained for 5 to 94 months (average, 59 months). Operative mortality of 2.5% did not vary with number of vessels bypassed. There was a linear 3.5% annual recurrence rate of angina, and average annual late infarction rate of 1.4%. The cumulative survival rates did not differ for the number of grafts performed or for men and women, but did differ for left main coronary stenosis and impaired ejection fractions. The late cumulative survival rates for the entire group approached those of the general U.S. population.

Spectrum of beta-thalassemia mutations in Calabria: implications for prenatal diagnosis.

Using a combination of oligonucleotide probes and restriction endonuclease enzymes, we characterize beta-thalassemic mutations in 91 homozygous patients and 86 unrelated carriers. Overall, 268 beta-thalassemic genes were obtained. Eleven beta-globin mutations were identified, confirming the wide molecular heterogeneity of beta-thalassemia in Calabria. Information from the present study represents the mainstay for the development of a program of early prenatal diagnosis by direct detection of mutations in Calabria.