The Impact of Diet on Bone and Fracture Risk in Diabetes.

PURPOSE OF REVIEW: The purpose of this review is to summarize the recently published scientific evidence on the effects of diet on diabetes and skeletal health. RECENT FINDINGS: The impact of diet on overall health has been a growing topic of interest among researchers. An inappropriate eating habit is a relatively modified risk factor for diabetes in adults. Parallel with the significant increase in the incidence of diabetes mellitus worldwide, many studies have shown the benefits of lifestyle modifications, including diet and exercise for people with, or at risk of developing, diabetes. In the last years, accumulating evidence suggests that diabetes is a risk factor for bone fragility. As lifestyle intervention represents an effective option for diabetes management and treatment, there is potential for an effect on bone health. Healthy lifestyle is critical to prevent bone fragility. However, more studies are needed to fully understand the impact of diet and weight loss on fracture risk in diabetics.

Increased fiber intake predicts the decrease in 2nd phase glucose-induced hyperinsulinemia following a hypocaloric diet in obese subjects.

BACKGROUND AND AIMS: Higher fiber intake is associated with increased insulin sensitivity (IS) and reduced glucose-induced insulin secretion (GIIS) during isocaloric-diets; however, its role in hypocaloric-diets is unclear. We examined whether increased fiber intake predicts the amelioration in IS and GIIS following a hypocaloric-diet. METHODS AND RESULTS: This is a post-hoc analysis of 55 adult subjects (BMI > 27 kg/m2) who completed a 6-month hypocaloric-diet (-500 kcal/day). Dietary intake was assessed using 3-day food records at baseline and post-intervention. We evaluated glucose-induced insulin and C-peptide secretions as AUC of plasma insulin and C-peptide during intravenous-glucose-tolerance tests (IVGTT) and IS via hyperinsulinemic-euglycemic clamps. Data analysis employed regression models and 2-way RM ANOVAs. Post-intervention % change in fiber intake was associated positively with ISclamp (r = 0.30) and negatively with % change in total (r = -0.37) and 2nd phase GIISIVGTT (r = -0.44) but not C-peptide secretion. It remained associated with lower 2nd phase GIISIVGTT after adjustment for sex and % changes in BMI and energy-intake, independently of other macronutrients. Subjects who increased fiber intake (to 28.7 ± 9.0 g/day) had a greater decrease in 2nd phase GIISIVGTT, not C-peptide secretion, independently of sex or changes in adiposity or energy-intake compared to subjects who decreased intake (to 20.0 ± 6.8 g/day). CONCLUSION: Higher fiber intake is an independent predictor of reduced 2nd phase glucose-induced hyperinsulinemia after a hypocaloric-diet. It was not associated with plasma C-peptide, suggesting a role in faster insulin clearance rather reduced insulin secretion. Promoting high-fiber intake may increase the effectiveness of hypocaloric-diets in preventing type 2 diabetes. REGISTRATION: ISRCTN14476404, BioMedCentral.com. CLINICAL TRIAL REGISTRATION: This trial was registered at BioMed Central as ISRCTN14476404, on July 28th, 2017.

Demographic, Clinical and Histopathological Features of Oral Neural Neoplasms: A Retrospective Study.

Intraoral neural neoplasms though unusual may be clinically significant. The aim of this study was to categorize and evaluate oral neural tumors in a large oral pathology biopsy service. With IRB approval, a retrospective search of all neural neoplasms of the oral cavity in the archives of the University of Florida Oral Pathology Biopsy Service spanning from 1994 to 2015 was performed. Extraoral cases as well as cases with insufficient patient information were excluded. A total of 340 out of 164,578 submitted specimens in a 22 year period (0.2%) were included with a mean age of 43.3 years (range: 6-89), and 44% male and 56% female. The most commonly affected locations were: tongue (37.5%), palate (22%), lip (19%), and gingiva (14%). The microscopic diagnoses rendered, in descending order of frequency were: neurofibromas (NFs): 123 (36%), granular cell tumor (GCT): 108 (32%), schwannomas: 61 (17%), palisaded encapsulated neuromas: 39 (11%), benign neural lesion not otherwise specified: 8 (2%), and mucosal neuroma c/w multiple endocrine neoplasia type 2B (MEN 2B): 1 (< 0.5%). Six cases of NF reported a history of neurofibromatosis Type 1 (NF 1). Four cases showed multifocal lesions. Immunohistochemical staining was performed on equivocal cases (25% of the lesions) and all were confirmed by their S-100 positivity. Intraoral neural neoplasms, though uncommon should be in the differential diagnosis of oral soft tissue entities and specific consideration to syndromal linkage is paramount as this may impact patient management.

Impedance Spectroscopy as a Novel Approach to Probe the Phase Transition and Microstructures Existing in CS:PEO Based Blend Electrolytes.

In this work the role of phase transition of PEO from crystalline to amorphous phases on DC conductivity enhancement in chitosan-based polymer electrolyte was discussed. Silver ion-conducting polymer electrolytes based on chitosan (CS) incorporated with silver nitrate (AgNt) is prepared via solution cast technique. Various amounts of polyethylene oxide (PEO) are added to the CS:AgNt system to prepare blend polymer electrolytes. Ultraviolet-visible (UV-vis) spectrophotometry is used to confirm that the blended samples containing AgNt salt exhibit a broad absorption peak. From optical micrograph images it is apparent that small white specs appear on the surface of the samples. The SEM results clearly show the aggregated silver nanoparticles. The enlargement of the crystalline area was observed from the morphological emergence and impedance plots. The phase separation in SEM images was observed at high PEO concentration. The XRD consequences support the morphological manifestation. In this study a new approach is offered to explore the microstructures existing in the blend electrolytes. The width of the semicircle linked to crystalline phase in impedance spectra was found to be increased with the increase of PEO concentration. A slow increase of DC conductivity was observed at low temperatures while above 333 K an immediate change in DC conductivity was obtained. The rapid rise of DC conductivity at high temperatures is correlated with the DSC results and impedance studies at high temperatures.

The effect of rubber dam on atmospheric bacterial aerosols during restorative dentistry.

Rotatory dental instruments generate atmospheric aerosols that settle on various surfaces, including the dentist's head. The aim of this study was to quantitatively assess bacterial contamination of the dentist's head and to evaluate whether it is affected by using a rubber dam. Senior dental students (n=52) were asked to wear autoclaved headscarves as collection media while performing restorative dental treatment with and without a rubber dam. Four points from each headscarf were swabbed for bacterial culture after 30min of operative work. Bacterial contamination was quantified by counting the colony-forming units. Regardless of the collection point, using a rubber dam was associated with more bacterial colony-forming units than not using a rubber dam (P=0.009). Despite its clinical value, the rubber dam seems to result in significantly higher aerosol levels on various areas of the dentist's head, requiring that dentists cover their heads with suitable protective wear.

Validity and reproducibility of a food frequency questionnaire focused on the Mediterranean diet for the Quebec population.

BACKGROUND AND AIMS: Validated dietary assessment methods specific to population and food habits are needed to conduct randomized clinical trials evaluating the efficacy of the Mediterranean diet in primary and secondary prevention of cardiovascular disease. Therefore, the aim of our study was to assess the reproducibility and the relative validity of a French language semi-quantitative food frequency questionnaire (FFQ) focused on the Mediterranean diet within the population of Quebec. METHODS AND RESULTS: Fifty-three participants aged 19-86 years with and without coronary heart disease were recruited, and randomized in 3 groups in a crossover design where the sequence of administration of two FFQs and a dietary record (DR) differed in each group. The FFQ includes 157 food items and was designed to measure food intake over one month. It was administered twice 3-5 weeks apart to assess reproducibility and was compared to a 12-day DR to assess validity. For reproducibility (n = 47), intraclass correlation coefficients (ICCs) for energy and 33 nutrients ranged from 0.38 to 0.91 (mean 0.63). For validity, the Pearson's correlation coefficients between the DR and the FFQ pre-DR ranged from 0.26 to 0.84 (mean 0.55) and ICCs ranged from 0.25 to 0.84 (mean 0.54). As for the DR and the FFQ post-DR, the Pearson's correlation coefficients ranged from 0.36 to 0.83 (mean 0.55) and the ICCs ranged from 0.36 to 0.83 (mean 0.53). CONCLUSION: This FFQ demonstrates good reproducibility and validity for most key nutrients of the Mediterranean diet for the Quebec population.

Plasma IL-1Ra: linking hyperapoB to risk factors for type 2 diabetes independent of obesity in humans.

BACKGROUND/OBJECTIVE: Plasma apoB predicts the incidence of type 2 diabetes (T2D); however, the link between apoB-linpoproteins and risks for T2D remain unclear. Insulin resistance (IR) and compensatory hyperinsulinemia characterize prediabetes, and the involvement of an activated interleukin-1 (IL-1) family, mainly IL-1ß and its receptor antagonist (IL-Ra), is well documented. ApoB-lipoproteins were reported to promote IL-1ß secretion in immune cells; however, in vivo evidence is lacking. We hypothesized that obese subjects with hyperapoB have an activated IL-1 system that explains hyperinsulinemia and IR in these subjects. SUBJECTS/METHODS: We examined 81 well-characterized normoglycemic men and postmenopausal women (⩾27 kg m(-2), 45-74 years, non-smokers, sedentary, free of chronic disease). Insulin secretion and sensitivity were measured by the gold-standard Botnia clamp, which is a combination of a 1-h intravenous glucose tolerance test (IVGTT) followed by 3-h hyperinsulinemic euglycemic clamp. RESULTS: Plasma IL-1ß was near detection limit (0.071-0.216 pg ml(-1)), while IL-1Ra accumulated at 1000-folds higher (77-1068 pg ml(-1)). Plasma apoB (0.34-1.80 g l(-1)) associated significantly with hypersinsulinemia (totalIVGTT: C-peptide r=0.27, insulin r=0.22), IR (M/I=-0.29) and plasma IL-1Ra (r=0.26) but not with IL-1ß. Plasma IL-1Ra associated with plasma IL-1ß (r=0.40), and more strongly with hyperinsulinemia and IR than apoB, while the association of plasma IL-1ß was limited to second phase and total insulin secretion (r=0.23). Adjusting the association of plasma apoB to hyperinsulinemia and IR for IL-1Ra eliminated these associations. Furthermore, despite equivalent body composition, subjects with hyperapoB (⩾80th percentile, 1.14 g l(-1)) had higher C-peptide secretion and lower insulin sensitivity than those with low plasma apoB (⩽20th percentile, 0.78 g l(-1)). Adjustment for plasma IL-1 Ra eliminated all group differences. CONCLUSION: Plasma apoB is associated with hyperinsulinemia and IR in normoglycemic obese subjects, which is eliminated upon adjustment for plasma IL-1Ra. This may implicate the IL-1 family in elevated risks for T2D in obese subjects with hyperapoB.

Viability of 'Candidatus Liberibacter asiaticus' prolonged by addition of citrus juice to culture medium.

Huanglongbing, or citrus greening disease, is associated with infection by the phloem-limited bacterium 'Candidatus Liberibacter asiaticus'. Infection with 'Ca. L. asiaticus' is incurable; therefore, knowledge regarding 'Ca. L. asiaticus' biology and pathogenesis is essential to develop a treatment. However, 'Ca. L. asiaticus' cannot currently be successfully cultured, limiting its study. To gain insight into the conditions conducive for growth of 'Ca. L. asiaticus' in vitro, 'Ca. L. asiaticus' inoculum obtained from seed of fruit from infected pomelo trees (Citrus maxima 'Mato Buntan') was added to different media, and cell viability was monitored for up to 2 months using quantitative polymerase chain reaction in conjunction with ethidium monoazide. Media tested included one-third King's B (K), K with 50% juice from the infected fruit, K with 50% commercially available grapefruit juice, and 100% commercially available grapefruit juice. Results show that juice-containing media dramatically prolong viability compared with K in experiments reproduced during 2 years using different juice sources. Furthermore, biofilm formed at the air-liquid interface of juice cultures contained 'Ca. L. asiaticus' cells, though next-generation sequencing indicated that other bacterial genera were predominant. Chemical characterization of the media was conducted to discuss possible factors sustaining 'Ca. L. asiaticus' viability in vitro, which will contribute to future development of a culture medium for 'Ca. L. asiaticus'.

An HPLC-MS characterization of the changes in sweet orange leaf metabolite profile following infection by the bacterial pathogen Candidatus Liberibacter asiaticus.

Huanglongbing (HLB) presumably caused by Candidatus Liberibacter asiaticus (CLas) threatens the commercial U.S. citrus crop of an annual value of $3 billion. The earliest shift in metabolite profiles of leaves from greenhouse-grown sweet orange trees infected with Clas, and of healthy leaves, was characterized by HPLC-MS concurrently with PCR testing for the presence of Clas bacteria and observation of disease symptoms. Twenty, 8-month-old 'Valencia' and 'Hamlin' trees were grafted with budwood from PCR-positive HLB source trees. Five graft-inoculated trees of each variety and three control trees were sampled biweekly and analyzed by HPLC-MS and PCR. Thirteen weeks after inoculation, Clas was detected in newly growing flushes in 33% and 55% of the inoculated 'Hamlin' and 'Valencia' trees, respectively. Inoculated trees remained asymptomatic in the first 20 weeks, but developed symptoms 30 weeks after grafting. No significant differences in the leaf metabolite profiles were detected in Clas-infected trees 23 weeks after inoculation. However, 27 weeks after inoculation, differences in metabolite profiles between control leaves and those of Clas-infected trees were evident. Affected compounds were identified with authentic standards or structurally classified by their UV and mass spectra. Included among these compounds are flavonoid glycosides, polymethoxylated flavones, and hydroxycinnamates. Four structurally related hydroxycinnamate compounds increased more than 10-fold in leaves from 'Hamlin' and 'Valencia' sweet orange trees in response to Clas infection. Possible roles of these hydroxycinnamates as plant defense compounds against the Clas infection are discussed.

Association between physical activity energy expenditure and inflammatory markers in sedentary overweight and obese women.

OBJECTIVE: Chronic subclinical inflammation and regular physical activity have opposing relationships to obesity-related metabolic diseases. Yet, the association between chronic inflammation and physical activity has rarely been examined in obese subjects. We examined the association between physical activity energy expenditure (PAEE), total (TEE) and resting energy expenditure (REE) and cardiorespiratory fitness (VO(2)peak) with inflammatory markers in overweight/obese women. DESIGN: Cross-sectional study. METHODS: The study included 152 overweight/obese postmenopausal women who were sedentary and free of chronic/inflammatory diseases (mean age: 57.5 (95% confidence interval (CI) 56.7-58.3) years, body mass index (BMI): 32.5 (95% CI 31.8-33.2) kg m(-2)). The following parameters were measured: TEE (doubly labeled water), REE (indirect calorimetry), PAEE (as (TEE x 0.90)-REE), VO(2)peak (ergocycle) and serum high-sensitive C-reactive protein (hsCRP), haptoglobin, soluble tumor necrosis factor-α receptor 1 (sTNFR1), interleukin-6, orosomucoid and white blood cells. RESULTS: Sedentary women with the highest tertile of PAEE (1276 (1233-1319) kcal day(-1)) had lower concentrations of hsCRP and haptoglobin than those in the lowest tertile (587 (553-621) kcal day(-1)) after adjustment for fat mass (P<0.05). Soluble TNFR1 was positively correlated with VO(2)peak, TEE and REE (P<0.05), and hsCRP and orosomucoid were positively associated with REE (P<0.01), whereas haptoglobin was negatively associated with PAEE (P<0.05). In stepwise regression analyses that examined the concomitant associations of components of energy expenditure with inflammatory markers, PAEE remained the only predictor of hsCRP and haptoglobin (P<0.05), explaining 14 and 5%, respectively, of their variation,whereas REE was the only predictor of orosomucoid (r (2) = 0.05, P = 0.02) after adjustment for fat mass. Adding leptin to the regression models results in similar relationships between inflammatory markers and components of energy expenditure. CONCLUSION: PAEE is an independent predictor of hsCRP and haptoglobin in sedentary overweight/obese postmenopausal women free of chronic disease. Our data support the role of physical activity in reducing subclinical inflammation and risk of metabolic and cardiovascular diseases.

Levels of 2-dodecylcyclobutanone in ground beef patties irradiated by low-energy X-ray and gamma rays.

Food irradiation improves food safety and maintains food quality by controlling microorganisms and extending shelf life. However, acceptance and commercial adoption of food irradiation is still low. Consumer groups such as Public Citizen and the Food and Water Watch have opposed irradiation because of the formation of 2-alkylcyclobutanones (2-ACBs) in irradiated, lipid-containing foods. The objectives of this study were to measure and to compare the level of 2-dodecylcyclobutanone (2-DCB) in ground beef irradiated by low-energy X-rays and gamma rays. Beef patties were irradiated by low-energy X-rays and gamma rays (Cs-137) at 3 targeted absorbed doses of 1.5, 3.0, and 5.0 kGy. The samples were extracted with n-hexane using a Soxhlet apparatus, and the 2-DCB concentration was determined with gas chromatography-mass spectrometry. The 2-DCB concentration increased linearly (P < 0.05) with irradiation dose for gamma-ray and low-energy X-ray irradiated patties. There was no significant difference in 2-DCB concentration between gamma-ray and low-energy X-ray irradiated patties (P > 0.05) at all targeted doses.

Body fat distribution modulates insulin sensitivity in post-menopausal overweight and obese women: a MONET study.

OBJECTIVE: Central fat mass (CFM) correlates with insulin resistance and increases the risk of type 2 diabetes and cardiovascular complications. On the other hand, increased peripheral fat mass (PFM) is associated with higher insulin sensitivity. Thus, we examined the contribution of adipose tissue distribution, as assessed by the PFM/CFM ratio, to insulin sensitivity in overweight and obese postmenopausal women. DESIGN AND METHODS: A total of 124 nondiabetic overweight and obese postmenopausal women underwent an oral glucose tolerance test (OGTT) and a hyperinsulinemic/euglycemic (HI) clamp. Body composition was determined using computed tomography for visceral adipose tissue (VAT) and dual X-ray absorptiometry for fat mass, lean body mass and their respective proportions. Participants were divided by tertiles of the PFM/CFM ratio. RESULTS: Participants with preferential CFM (group 1) had higher fasting insulin levels and insulin area under the curve (AUC) during OGTT, as well as lower glucose infusion rates during the HI clamp, whether it was expressed per kg of body weight (M) or per kg of fat-free mass (Mm), compared with the other two groups. The PFM/CFM ratio also correlated significantly with fasting insulin (r=-0.32, P<0.001), the insulin AUC (r=-0.42 P<0.001), M (r=0.39 P<0.001) and Mm (r=0.37 P<0.001). Using hierarchical regression, we demonstrated that the PFM/CFM ratio was an independent predictor of insulin AUC, M and Mm and that its sequential addition to CFM and VAT improved significantly the predictive value of the model for insulin sensitivity for all variables except fasting insulin. CONCLUSION: The PFM/CFM ratio, which integrates the antagonistic effects of both central and peripheral depots on insulin sensitivity, added substantially to the prediction of insulin sensitivity over VAT and CFM alone.

Regulation of leptin, adiponectin and acylation-stimulating protein by hyperinsulinaemia and hyperglycaemia in vivo in healthy lean young men.

AIM: Both type 1 and 2 diabetes are associated with differential regulation of leptin, adiponectin and ASP. Our aim was to examine whether or not acute hyperinsulinaemia and/or hyperglycaemia per se have differential regulation of these hormones in healthy subjects. METHODS: We examined changes in leptin, adiponectin and ASP concentrations and subcutaneous white adipose tissue mRNA expression with 3-hour hyperinsulinaemic (HI, n=10), hyperglycaemic (HG, n=7) and hyperinsulinaemic-hyperglycaemic (HGHI, n=8) clamps in healthy lean young men. As somatostatin was used for the HG and HGHI clamps, a control somatostatin clamp was carried out (n=4). Changes in the expression of HKII and p85alpha Pi3K were examined as positive controls for the induction of gene expression by the insulin pathway. RESULTS: HI, HG and HGHI clamps increased expression of HKII and p85alpha Pi3K while somatostatin did not. The HI clamp decreased serum adiponectin (-15%, P<0.001) and increased serum leptin (+11%, P=0.031), while the HG clamp reduced serum leptin (-20%, P=0.003). The HGHI clamp increased serum ASP (+21%, P=0.047) and expression of C3 (+26%, P=0.018) and leptin (+50%, P=0.024). Interestingly, the control somatostatin clamp suppressed both serum leptin (-17%, P=0.043) and adiponectin (-7%, P=0.020). CONCLUSION: HG and/or HI per se regulated the concentrations and expression of leptin, adiponectin and ASP in healthy lean young men, suggesting a contribution to dysregulation of these hormones in diabetes.

HOMA or QUICKI: is it useful to test the reproducibility of formulas?

AIM: HOMA and QUICKI are the most widely used indices for assessing insulin sensitivity. Both are based on fasting glucose and insulin measures, and mainly differ by the log transformation of these variables in QUICKI. However, HOMA is less reproducible than QUICKI, and log HOMA does not improve its reproducibility. The aim of this study was to investigate the various mathematical transformations of HOMA and to assess its reproducibility. METHOD: We used data from a clamp study involving 123 non-diabetic overweight and obese postmenopausal women. Fasting insulin and glucose were measured in two visits 15 and 30 days apart. This allowed us to calculate HOMA as (fasting glucose [mmol/L] x fasting insulin [microU/mL])/22.5 and QUICKI as 1/(log fasting glucose [mg/dL]+log fasting insulin [microU/mL]) twice for subjects who were weight-stable between visits. RESULTS: QUICKI had better reproducibility (CV=3.9%) than either HOMA (CV=26.7%) or log HOMA (CV=22.0%). However, log-transforming HOMA using log (glucose x insulin)/log (22.5) and log-transforming HOMA without transforming the constant denominator improved its CV to 6.5% and 5.7%, respectively. CONCLUSION: By modifying the mathematical expression of HOMA, we were able to achieve comparable CVs for QUICKI and HOMA. However, the CV should be used to assess the reproducibility of techniques to measure glucose and insulin, not of mathematical formulas. When evaluating indices for the assessment of insulin sensitivity, the key point is how well they correlate with the 'gold-standard' glucose clamp.

Relationship between the hyperinsulinemic-euglycaemic clamp and a new simple index assessing insulin sensitivity in overweight and obese postmenopausal women.

OBJECTIVE: The purpose of this study was to compare assessment of insulin sensitivity from hyperinsulinemic euglycaemic (HIEG) clamp with indexes derived from fasting and oral glucose tolerance test (OGTT). SUBJECTS AND METHODS: Cross-sectional study with 107 sedentary non-diabetic overweight and obese postmenopausal (BMI=32.4+/-0.4 kg/m(2)) women undergoing both HIEG clamp and OGTT. Pairs of data were analyzed using Pearson correlation and Bland-Altman graphs analysis. Comparison between correlations was made using the method reported by Zar. RESULTS: All the indexes derived from either the OGTT or surrogate indexes were highly correlated with all the clamp-derived formulas (P<0.0001). However, HOMA and QUICKI were generally less correlated than OGTT-derived indexes. Analogically to QUICKI, we calculated a new formula derived from the OGTT measurements of glucose and insulin named simple index assessing insulin sensitivity (SI(is)OGTT)=1/[log(sum glucose t(0-30-90-120)) (mmol/l)+log(sum insulin t(0-30-90-120)) (microUI/ml)]. By using this formula, we found high significant correlations (r's=0.61-0.65; P<0.0001) with the clamp results. Moreover, the correlations of SI(is)OGTT with the clamp data were higher than for other previously published indexes. CONCLUSION: In that large group of non-diabetic overweight and obese postmenopausal women insulin sensitivity index derived from OGTT provided more accurate information than fasting based formula. We propose a new simple index for the assessment of insulin sensitivity from the OGTT data (SI(is)OGTT). The advantage of this new formula over all previously published OGTT-derived indexes of insulin sensitivity is that it is 1) easy to calculate 2) better correlated than other indexes of insulin sensitivity and 3) not affected by the way clamp results are expressed. Further studies are needed to validate SI(is)OGTT index in other populations.

Lifestyle behaviours and components of energy balance as independent predictors of ghrelin and adiponectin in young non-obese women.

AIM: Dysregulation of the normal levels of ghrelin, leptin and adiponectin in young non-obese subjects could promote food intake, diabetes and cardiovascular disease in later stages of life. Little information is available on how plasmatic concentrations of these hormones may be influenced by eating habits and/or components of energy balance in a young population, which if known, could facilitate their voluntary regulation. METHODS: In this cross-sectional study we examined the predictors of fasting plasma ghrelin, adiponectin and leptin in a population of well-characterized young non-obese women (N = 63). Energy intake was assessed by 24-hour dietary recall, resting metabolic rate (RMR) by indirect calorimetry, physical activity energy expenditure (PAEE) by tri-axial accelerometer, physical fitness by VO(2 peak), and eating behaviors by self administrated questionnaire. RESULTS: Lower RMR and higher HDL-cholesterol were independent predictors of higher plasma ghrelin explaining 17.6% of its variation even after correcting for BMI. Higher total or central fat mass was the only predictor of higher plasma leptin, and no other variable added any power to the prediction equation. Finally, higher energy intake and waist circumference and lower PAEE predicted lower plasma adiponectin in young non-obese women, explaining 43% of the variation in its concentrations even after correcting for total or central fat mass. CONCLUSION: Components of the energy balance (ie: energy intake and/or expenditure) influence adiponectin and ghrelin circulating levels. That is, higher energy intake and lower physical activity independently predict lower adiponectin concentrations, whereas lower resting metabolic rate independently predicts higher ghrelin levels in young non-obese women. Prospective studies are needed to examine whether circulating concentrations of ghrelin and adiponectin can be voluntarily regulated by lifestyle interventions.

Apolipoprotein B: a predictor of inflammatory status in postmenopausal overweight and obese women.

AIMS/HYPOTHESIS: Inflammation is implicated in the development of type 2 diabetes and CHD, but the trigger of inflammation is unclear. Although in vitro and animal studies support a role of elevated levels of atherosclerotic lipoproteins in the activation of inflammation, plasma cholesterol cannot predict inflammatory markers in humans. Moreover, the association between inflammatory markers and other traditional risk factors of diabetes and CHD is unclear. To increase our knowledge of in vivo regulation of inflammation, we examined the association between several traditional risk factors and inflammatory markers. We hypothesised that because apolipoprotein B (ApoB) reflects atherogenic particle number, it is the primary predictor of inflammatory status. SUBJECTS, MATERIALS AND METHODS: We examined the association between several traditional risk factors and plasma high-sensitivity (hs) C-reactive protein (CRP), hsTNF-alpha, soluble TNF receptor 1, IL-6, orosomucoid, haptoglobin and alpha(1)-antitrypsin in 77 non-diabetic overweight and obese postmenopausal women. RESULTS: The inflammatory markers correlated positively with total and abdominal adiposity, blood pressure, 2-h OGTT glucose, insulin resistance, triglyceride, total/HDL cholesterol, ApoB, ApoB:apolipoprotein A1 (ApoA1) ratio and Framingham CHD risk points. They correlated negatively with ApoA1, and total, LDL and HDL cholesterol. ApoB was an independent predictor of the interindividual variation in IL-6, hsCRP, orosomucoid, haptoglobin and alpha(1)-antitrypsin (R (2) range 8-40%); other risk factors were less predictive. Compared with BMI-matched control subjects, women with hyperapobetalipoproteinaemia (hyperapoB) had higher hsTNF-alpha, IL-6, hsCRP and orosomucoid (increase 17-104%). CONCLUSIONS/INTERPRETATION: ApoB is the primary predictor of inflammatory markers in postmenopausal overweight and obese women. Given elevated levels of inflammatory markers in hyperapoB women, we hypothesise that hyperapoB women may have an increased risk of developing both CHD and diabetes.

Diagnostic value of gadolinium-enhanced 3D magnetic resonance angiography in patients with suspected hepatic arterial complications after liver transplantation.

PURPOSE: To evaluate the accuracy and clinical role of gadolinium-enhanced 3D magnetic resonance angiography (MRA) in patients with suspected hepatic arterial complications after liver transplantation. MATERIALS AND METHODS: Thirty-six consecutive MRA studies were performed in 33 liver transplant recipients after transplantation. MRA image quality was assessed subjectively. Thirty-two MRA studies were retrospectively reviewed and correlated with surgery (n = 2), conventional angiography (n = 18), or clinical follow-up (n = 12). MRA findings were also correlated with those of Doppler sonography in 30 of the cases. In 20 cases, concordance between MRA and surgery or conventional angiography was evaluated for each grade of hepatic artery stenosis (normal, mild [<50%], moderate [50-75%], severe [>75%], or occluded). RESULTS: MRA image quality was degraded 13 of 36 cases (36.1%) studies. The sensitivity, specificity, and accuracy of MRA by consensus reading for more than 50% of hepatic artery stenosis or occlusion were 67%, 90%, and 81.3%, respectively. Of the 19 cases in which Doppler sonography was abnormal, MRA correctly characterized hepatic artery stenosis in 16 (84.2%). MRA also correctly identified all 5 occurrences of celiac artery stenosis. However, MRA overestimated the severity of hepatic arterial stenosis in 3 (15%) of 20 cases and underestimated 5 (25%) of 20 cases. CONCLUSION: MRA complements Doppler ultrasound to exclude significant hepatic artery stenosis. However, a substantial number of MRA studies were technically inadequate, and MRA demonstrated limited efficacy for correctly grading the severity of hepatic artery stenosis.

A comparison of sevoflurane-propofol versus sevoflurane or propofol for laryngeal mask airway insertion in adults.

In a prospective, randomized study, we investigated the incidence of successful insertion of laryngeal mask airway (LMA) at the first attempt and the incidence of side effects after LMA insertion using the combination of sevoflurane and propofol as compared with either sevoflurane or propofol alone for induction of anesthesia. Eighty-three unpremedicated ASA physical status I-II patients were anesthetized with a single vital capacity breath (VCB) of sevoflurane 8% supplemented with IV propofol 1.5 mg/kg, a single VCB of sevoflurane 8%, or IV propofol 3 mg/kg. The coinduction technique was associated with the most frequent incidence of successful LMA insertion at the first attempt (93.5%) than either sevoflurane alone (46%) or propofol alone (61.5%) (P < 0.001). Propofol-induced induction of anesthesia allowed the fastest insertion of LMA and was associated with the least frequent incidence of postoperative nausea and vomiting. However, this advantage of propofol was offset by a frequent incidence of pain on injection (69%) and the occurrence of movements during insertion of the LMA (50% in the propofol group versus 19% and 26% in the sevoflurane and sevoflurane-propofol groups, respectively; P < 0.05), as well as a more frequent incidence of apnea (84% in the propofol group versus 7% and 16% in the sevoflurane and sevoflurane-propofol groups, respectively; P < 0.001). The report shows that induction of anesthesia with sevoflurane-propofol combined provides a frequent incidence of successful LMA insertion at the first attempt that is associated with an infrequent incidence of apnea.