Spectrum of physiological and pathological cardiac and pericardial uptake of FDG in oncology PET-CT.

Cardiac uptake of 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) is frequently observed on FDG positron-emission tomography combined with computed tomography (PET-CT) performed for diagnosis, staging, and assessment of therapeutic response of lymphoma and solid cancers, despite careful patient preparation to limit myocardial glucose substrate utilisation. We illustrate the varied physiological patterns of cardiac FDG uptake, and show a spectrum of pathological conditions causing FDG uptake within myocardial and pericardial structures, due to clinically important benign and malignant diseases. Recognition and awareness of these various causes of FDG uptake in the heart, along with the appropriate use of correlative contrast-enhanced CT and magnetic resonance imaging (MRI) will facilitate correct interpretation.

Molecular imaging in the management of thyroid cancer.

Thyroid cancer is the most common endocrine malignancy in adults. The disease is classified into papillary, follicular, medullary and anaplastic types, each with characteristic histology and patterns of biological behavior. Diagnosis of thyroid cancer is usually made by needle aspiration of suspicious thyroid nodules. Disease management of well-differentiated thyroid cancer relies upon characteristic accumulation of radioisotopes of iodine that continues to play a central role in detection and treatment of disease. Recombinant human thyrotropin (rhTSH) is used as an alternative to thyroid hormone withdrawal to provide TSH stimulation necessary for diagnostic radioiodine scintigraphy and preparation for thyroid remnant ablation and cancer therapy. Hybrid SPECT/CT cameras combining functional scintigraphic information with CT anatomy are replacing stand-alone gamma cameras and these devices have been shown to outperform traditional planar and SPECT imaging techniques. Similarly, clinical application of novel radioisotopes like [124I]iodine with PET/CT for thyroid cancer imaging provides improved lesion resolution and direct tumor dosimetry. Alternative tracers such as [18F]fluorodeoxyglucose (FDG) can be used to evaluate well-differentiated thyroid cancers that no longer express the Na+/I- symporter, with a role in staging Hürthle cell, poorly differentiated, and anaplastic thyroid cancers. Medullary thyroid cancer recurrences are often difficult to detect using conventional imaging and traditional radionuclide studies, whereas [18F]FDG and [18F]fluorodihydroxyphenylalanine (DOPA) PET and PET/CT show promise for localizing the often elusive source (s) of elevated calcitonin in these patients.

A transiting giant planet with a temperature between 250 K and 430 K.

Of the over 400 known exoplanets, there are about 70 planets that transit their central star, a situation that permits the derivation of their basic parameters and facilitates investigations of their atmospheres. Some short-period planets, including the first terrestrial exoplanet (CoRoT-7b), have been discovered using a space mission designed to find smaller and more distant planets than can be seen from the ground. Here we report transit observations of CoRoT-9b, which orbits with a period of 95.274 days on a low eccentricity of 0.11 +/- 0.04 around a solar-like star. Its periastron distance of 0.36 astronomical units is by far the largest of all transiting planets, yielding a 'temperate' photospheric temperature estimated to be between 250 and 430 K. Unlike previously known transiting planets, the present size of CoRoT-9b should not have been affected by tidal heat dissipation processes. Indeed, the planet is found to be well described by standard evolution models with an inferred interior composition consistent with that of Jupiter and Saturn.

The influence of supplementation of different forms of zinc in goats on the zinc concentration in blood plasma and milk.

The aim of the experiment was to study zinc concentration in goat's milk during a short-term oral supplementation of three organic and one inorganic form of zinc and the influence of Zn supplementation on the concentration of Zn and Cu in blood plasma. The experiment involved 31 lactating goats. The group C was the control, group L received zinc lactate, group A received zinc chelate, group T received amino acid-polypeptidic complex with zinc, and group O received zinc oxide. Zinc preparations were administered orally in 500 mg Zn per animal for 28 days. In the course of the experiment, Zn concentration in plasma increased significantly in all experimental groups and in the control group was unchanged. The concentration of zinc in milk during the experiment fluctuated in individual groups, but there were no significant differences between groups. After 28 days of Zn supplementation, Zn concentration in milk of goats was similar as at the start of the experiment in all groups. According to our results, the supplementation of different forms of zinc did not influence the concentration of Zn in milk, but significantly influenced the Zn concentration in blood plasma. The efficiency of different organic and inorganic forms of zinc was similar.

Influence of selenium on innate immune response in kids.

The effect is described of selenium supplemented in an inorganic and organic form on the innate immune response of goats. Though the phagocytic activity (as a marker of the immune function) was found to be lower in organic-Se-treated group than in control (54.5 +/- 4.32 vs. 60.2 +/- 9.15 %), it did not generally exhibit any significant differences; similarly, no differences were found in the phagocytic index. The production of reactive oxygen species (ROS) was determined using the luminol-enhanced chemiluminescence (CL) (estimated as peak CL, integral CL and a peak time after addition of calcium ionophore A23187, opsonised zymosan (OZP) and phorbol-12-myristate-13-acetate as effectors. A significant ROS increase reflected in integral CL and a peak time was found in the inorganic-Se-treated group when OZP was used as activator; other parameters did not exhibit significant changes. The supplementation of Se in inorganic form can thus be seen to influence positively the innate immune system of kids.

Initial experience of 3-tesla apparent diffusion coefficient values in characterizing squamous cell carcinomas of the head and neck.

BACKGROUND: With the increased clinical use of 3-Tesla (3T) magnets, it becomes important to identify the potential applications of advanced magnetic resonance (MR) imaging techniques such as diffusion-weighted imaging in head and neck pathologies. PURPOSE: To establish the 3T apparent diffusion coefficient (ADC) values for normal neck structures, and to examine the utility of ADC values in distinguishing head and neck squamous cell carcinomas (HNSCC) from normal neck anatomy. MATERIAL AND METHODS: 3T diffusion-weighted imaging was performed on 10 normal volunteers and 10 patients with known HNSCC. In the volunteers, mean ADC was calculated in the parotid gland, submandibular gland, base of the tongue, pterygoid muscle, masseter muscle, paraspinal muscles, true vocal cord, thyroid gland, thyroid cartilage, cricoid cartilage, and lymph nodes. The mean tumor ADC value was calculated from the 10 patients with HNSCC and compared with the normal ADC values from various neck structures. RESULTS: The mean ADC value measured in the HNSCC was 1.101 (+/-0.214) x 10(-3) mm(2)/s. This was significantly lower than ADC values of paraspinal muscles, pterygoid muscle, masseter muscle, thyroid gland, and base of the tongue (P=0.0006, 0.0002, 0.0001, 0.001, and 0.002, respectively). The tumor ADC values were not significantly different from ADC values of parotid and submandibular glands (P=0.057 and 0.14, respectively). CONCLUSION: 3T ADC values show potential for distinguishing HNSCC from normal extracranial head and neck structures.

Differentiation of benign and malignant pathology in the head and neck using 3T apparent diffusion coefficient values: early experience.

BACKGROUND AND PURPOSE: The purpose of this work was to study differences in apparent diffusion coefficient (ADC) values between benign and malignant head and neck lesions at 3T field strength imaging. MATERIALS AND METHODS: Our study population in this retrospective study was derived from the patient population who had undergone routine neck 3T MR imaging (for clinical indications) from December 2005 to December 2006. There were 33 patients identified: 17 with benign and 16 with malignant pathologies. In all of the subjects, conventional MR imaging sequences were performed apart from diffusion-weighted sequences. The mean ADC values in the benign and malignant groups were compared using an unpaired t test with unequal variance with a P < 0.05 considered statistically significant. RESULTS: There was a statistically significant difference (P = .004) between the mean ADC values (in 10(-3) mm(2)/s) in the benign and malignant lesions (1.505 +/- 0.487; 95% confidence interval, 1.305-1.706, and 1.071 +/- 0.293; 95% confidence interval, 0.864-1.277, respectively). There were 2 malignant lesions with ADC values higher than 1.3 x 10(-3) mm(2)/s and 5 benign lesions with ADC values less than 1.3 x 10(-3) mm(2)/s. The lack of overlap of ADC values within 95% confidence limits suggests that a 3T ADC value of 1.3 x 10(-3) mm(2)/s may be the threshold value for differentiation between benign and malignant head and neck lesions. CONCLUSION: ADC values of benign and malignant neck pathologies are significantly different at 3T imaging, though larger studies are required to establish threshold ADC values that can applied in daily clinical practice.

Clinicoepidemiological features and course of 43 cases of bullous pemphigoid in Kuwait.

BACKGROUND: The clinicoepidemiological characteristics and course of bullous pemphigoid (BP) have not been described in populations from the Arabian Gulf. Hypothesis. Ethnic and regional variations can influence the clinical behaviour and course of autoimmune diseases. METHODS: In this study, 43 patients with BP, registered in our autoimmune bullous diseases (ABD) clinic over a span of 14 years, were studied to determine the clinicoepidemiological features and course of the disease in our region. RESULTS: BP was observed to be the second commonest ABD in our clinic (27%), with a minimum estimated incidence of 2.6 cases/million/year among the referral population. The largest proportion (93%) of the patients was of Arab ethnicity and the female to male ratio was 5.1 :1. Mean +/- SD age at diagnosis was 65.20 +/- 18.80 years. Most of the patients (96%) had moderate to severe disease, and mucosal involvement was seen in 37% of the patients. Systemic steroids (prednisolone 20-60 mg daily) alone or in combination with azathioprine, intravenous immunoglobulins, tetracyclines, mycophenolate mofetil or dapsone were used to treat theses cases. At the last follow-up, 32% of patients were in complete remission and off treatment. The first-year mortality was 30%. Old age and poor general medical condition were the significant risk factors (P < 0.05) contributing to the mortality. CONCLUSION: The study highlights the regional variations of BP and thus a need to uncover the ethnic, genetic and geographical influences, if any, responsible for these variations.

Effect of phosphorylated mannans and pharmacological additions of zinc oxide on growth and immunocompetence of weanling pigs.

Three experiments were conducted to evaluate the efficacy of phosphorylated mannans (MAN) and pharmacological levels of ZnO on performance and immunity when added to nursery pig diets. Pigs (216 in each experiment), averaging 19 d of age and 6.2, 4.6, and 5.6 kg of BW in Exp. 1, 2, and 3, respectively, were blocked by BW in each experiment, and penned in groups of six. A lymphocyte blastogenesis assay was performed in each experiment to measure in vitro lymphocyte proliferation response. In Exp. 1, diets were arranged as a 2 x 2 factorial with two levels of Zn (200 and 2,500 ppm) and two levels of MAN (0 and 0.3% from d 0 to 10, and 0 and 0.2% from d 10 to 38). Zinc oxide increased (P < 0.05) ADG, ADFI, and G:F from d 0 to 10, and ADG and ADFI from d 10 to 24. In Exp. 2, diets were arranged as a 2 x 3 factorial with two levels of Zn (200 and 2,500 ppm) and three levels of MAN (0, 0.2, and 0.3%). Pigs fed 2,500 ppm Zn from d 0 to 10 had greater (P < 0.05) ADG, ADFI, and G:F than pigs fed 200 ppm Zn. From d 10 to 24, ADG was similar when pigs were fed 200 ppm Zn, regardless of MAN supplementation; however, ADG increased (P < 0.05) when 0.2% MAN was added to dietscontaining 2,500 ppm Zn (MAN x Zn interaction, P < 0.05). In Exp. 3, diets were arranged as a 2 x 3 factorial with two levels of MAN (0 and 0.3%) and three levels of Zn (200, 500, and 2,500 ppm). Zinc was maintained at 200 ppm from d 21 to 35, so only two dietary treatments (0 and 0.3% MAN) were fed during this period. Average daily gain was greater (P < 0.05) from d 7 to 21 when pigs were fed 2,500 ppm Zn compared with pigs fed 200 or 500 ppm Zn. The addition of MAN improved (P < 0.05) G:F from d 7 to 21 and d 0 to 35. Lymphocyte proliferation of unstimulated cells and phytohemagglutinin-stimulated cells was decreased (P < 0.05) in cells isolated from pigs fed MAN compared with cells isolated from pigs fed diets without MAN. Lymphocyte proliferation of pokeweed mitogen-stimulated cells isolated from pigs fed MAN was less (P < 0.05) than for pigs fed diets devoid of MAN when diets contained 200 ppm Zn; however, MAN had no effect on lymphocyte proliferation when the diet contained 500 or 2,500 ppm Zn (MAN x Zn interaction, P < 0.05). Although the magnitude of response to MAN was not equivalent to that of pharmacological concentrations of Zn, MAN mayimprove growth response when pharmacological Zn levels are restricted.

Clinicopathological features and HLA tissue typing in pemphigoid gestationis patients in Kuwait.

Pemphigoid gestationis (PG) is a rare autoimmune disease of pregnancy. We report a series of 22 cases of PG in Kuwait. They constituted 18% of all the autoimmune bullous diseases registered in our centre over a span of 11 years. PG was observed to be the third most common bullous disease in our region. Ninety-five per cent of the patients were of Arab ethnicity. The clinical features observed in our patients were comparable to those reported elsewhere. Systemic steroids (prednisolone 20-60 mg daily) remained the mainstay of treatment to control the active disease and an optimal dose of 20 mg of prednisolone was maintained throughout the pregnancy and immediate postpartum period. We observed a favourable outcome of pregnancies complicated by PG without any associated maternal or foetal morbidity. Kuwaiti patients with PG were observed to have a predominance of HLA-DR3 and DQ2 antigens. No predominance of HLA-DR4 antigen was observed.

Effect of dietary mannan oligosaccharides and(or) pharmacological additions of copper sulfate on growth performance and immunocompetence of weanling and growing/finishing pigs.

Two experiments were conducted to determine the efficacy of mannan oligosaccharides (MOS) fed at two levels of Cu on growth and feed efficiency of weanling and growing-finishing pigs, as well as the effect on the immunocompetence of weanling pigs. In Exp. 1, 216 barrows (6 kg of BW and 18 d of age) were penned in groups of six (9 pens/treatment). Dietary treatments were arranged as a 2 x 2 factorial consisting of two levels of Cu (basal level or 175 ppm supplemental Cu) with and without MOS (0.2%). Diets were fed from d 0 to 38 after weaning. Blood samples were obtained to determine lymphocyte proliferation in vitro. From d 0 to 10, ADG, ADFI, and gain:feed (G:F) increased when MOS was added to diets containing the basal level of Cu, but decreased when MOS was added to diets containing 175 ppm supplemental Cu (interaction, P < 0.01, P < 0.10, and P < 0.05, respectively). Pigs fed diets containing 175 ppm Cu from d 10 to 24 and d 24 to 38 had greater (P < 0.05) ADG and ADFI than those fed the basal level of Cu regardless of MOS addition. Pigs fed diets containing MOS from d 24 to 38 had greater ADG (P < 0.05) and G:F (P < 0.10) than those fed diets devoid of MOS. Lymphocyte proliferation was not altered by dietary treatment. In Exp. 2, 144 pigs were divided into six pigs/pen (six pens/treatment). Dietary treatments were fed throughout the starter (20 to 32 kg BW), grower (32 to 68 kg BW), and finisher (68 to 106 kg BW) phases. Diets consisted of two levels of Cu (basal level or basal diet + 175 ppm in starter and grower diets and 125 ppm in finisher diets) with and without MOS (0.2% in starter, 0.1% in grower, and 0.05% in finisher). Pigs fed supplemental Cu had greater (P < 0.05) ADG and G:F during the starter and grower phases compared to pigs fed the basal level of Cu. During the finisher phase, ADG increased when pigs were fed MOS in diets containing the basal level of Cu, but decreased when MOS was added to diets supplemented with 125 ppm Cu (interaction, P < 0.05). Results from this study indicate the response of weanling pigs fed MOS in phase 1 varied with level of dietary Cu. However, in phase 2 and phase 3, diets containing either MOS or 175 ppm Cu resulted in improved performance. Pharmacological Cu addition improved gain and efficiency during the starter and grower phases in growing-finishing pigs, while ADG response to the addition of MOS during the finisher phase seems to be dependent upon the level of Cu supplementation.

Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a controlled randomized trial.

We examined the effects of a 6-month randomized program of endurance training (n = 14), resistance training (n = 17), or control conditions (n = 20) on insulin sensitivity in nonobese, younger women (18-35 yr). To examine the possible mechanism(s) related to alterations in insulin sensitivity, we measured body composition, regional adiposity, and skeletal muscle characteristics with computed tomography. We observed no changes in total body fat, sc abdominal adipose tissue, or visceral adipose tissue with endurance or resistance training. Insulin sensitivity, however, increased with endurance training (pre, 421 +/- 107; post, 490 +/- 133 mg/min; P < 0.05) and resistance training (pre, 382 +/- 87; post, 417 +/- 89 mg/min; P = 0.06). When the glucose disposal rate was expressed per kg fat-free mass (FFM), the improved insulin sensitivity persisted in endurance-trained (pre, 10.5 +/- 2.7; post, 12.1 +/- 3.3 mg/min x kg FFM; P < 0.05), but not in resistance-trained (pre, 9.7 +/- 1.9; post, 10.2 +/- 1.8 mg/min x kg FFM; P = NS) women. Muscle attenuation ratios increased (P < 0.05) in both endurance- and resistance-trained individuals, but this was not related to changes in insulin sensitivity. Moreover, the change in insulin sensitivity was not related to the increased maximum aerobic capacity in endurance-trained women (r = 0.24; P = NS). We suggest that both endurance and resistance training improve glucose disposal, although by different mechanisms, in young women. An increase in the amount of FFM from resistance training contributes to increased glucose disposal probably from a mass effect, without altering the intrinsic capacity of the muscle to respond to insulin. On the other hand, endurance training enhances glucose disposal independent of changes in FFM or maximum aerobic capacity, suggestive of an intrinsic change in the muscle to metabolize glucose. We conclude that enhanced glucose uptake after physical training in young women occurs with and without changes in FFM and body composition.

Respiratory fitness, free living physical activity, and cardiovascular disease risk in older individuals: a doubly labeled water study.

The objective of this study was to examine the importance of cardiorespiratory fitness vs. physical activity energy expenditure on selected cardiovascular disease risk factors in older individuals. One hundred and seventeen older individuals, 53 men (68 +/- 9 yr) and 63 women (67 +/- 7 yr), participated in the study. This cohort was divided into 4 groups: 1) high cardiorespiratory fitness and high physical activity, 2) high cardiorespiratory fitness and low physical activity, 3) low cardiorespiratory fitness and high physical activity, and 4) low cardiorespiratory fitness and low physical activity. Cardiorespiratory fitness (VO2max) was determined from a graded exercise test, physical activity energy expenditure was measured by doubly labeled water and indirect calorimetry, body composition was determined by dual energy x-ray absorptiometry, and dietary practices were determined by a 3-day recall. Cardiorespiratory fitness exerted greater effects on the cardiovascular disease risk profile than physical activity. That is, older individuals with higher levels of cardiorespiratory fitness, regardless of their physical activity levels, showed lower levels of fasting insulin (P < 0.01), triglycerides (P < 0.05), total cholesterol (P < 0.05), total to high density lipoprotein cholesterol ratio (P < 0.05), low density lipoprotein (P < 0.05), and lower waist circumference (P < 0.01). Moreover, individuals with a high cardiorespiratory fitness but low physical activity energy expenditure displayed a more favorable cardiovascular disease risk profile than individuals with low cardiorespiratory fitness and high physical activity energy expenditure. The results suggest that higher levels of cardiorespiratory fitness have greater cardioprotective effects than higher levels of free living physical activity in older individuals. Although these findings do not discount the health benefits of being physically active, it is possible that greater emphasis should be placed on aerobic exercise to increase cardiorespiratory fitness in the elderly.

Energy expenditure, energy intake, and weight loss in Alzheimer disease.

Alzheimer disease is one of the leading causes of death among older individuals. Unexplained weight loss and cachexia are frequent clinical findings in patients with Alzheimer disease. Thus, it has been postulated that Alzheimer disease may be associated with dysfunction in body weight regulation. This brief review examines the interrelations among energy intake, energy expenditure, and body composition in Alzheimer disease. We explored whether abnormally high daily energy expenditures, low energy intakes, or both contribute to unexplained weight loss and a decline in nutritional status. Specifically, we considered studies that examined energy intake, body composition, and daily energy expenditure and its components. The application of doubly labeled water and indirect calorimetry to understand the etiology of wasting has increased our knowledge regarding the relation among energy expenditure, physical activity levels, and body composition in Alzheimer disease patients. Although the number of studies are limited, results do not support the notion that a hypermetabolic state contributes to unexplained weight loss in Alzheimer disease, even in cachectic patients. Recent findings are presented suggesting an association between abnormally elevated levels of physical activity energy expenditure and elevated appendicular skeletal muscle mass and energy intake in Alzheimer disease patients. Clinical strategies aimed at developing lifestyle and dietary interventions to maintain adequate energy intake, restore energy balance, and maintain skeletal muscle mass should be a future area of investigation in Alzheimer disease research.

Expression of beta-catenins and cadherins by follicular dendritic cells in human lymph nodes.

In lymph nodes, dendritic cells form a complex meshwork and are linked by intercellular junctions. Intercellular junctions contribute to the integrity of lymphatic follicles and can potentially be affected by malignant processes in neighbouring B cells. We examined whether transmembrane molecules that constitute "adherens junctions" are present in follicular dendritic cells of normal human lymph nodes. We found that follicular dendritic cells but not interdigitating dendritic cells or sinus lining cells expressed cadherin molecules. Follicular dendritic cells also expressed beta-catenin but not vinculin. The cadherin molecules, which were identified in situ with the use of a monoclonal pan-cadherin antibody, were not recognized by antibodies to E-cadherin, N-cadherin or P-cadherin. Intrafollicularly, cadherins were clearly colocalized with beta-catenins, in a dot-like fashion. We also detected intrafollicular expression of desmogleins and desmosomal plaque proteins. These findings indicate the presence of desmosomes within the dendritic meshwork. However, pan-cadherin reactivity was not only colocalized with desmoglein immunoreactivity that was abundantly present. Immunoprecipitation showed that pan-cadherin reactivity was absent in fractions of desmosomal plaque proteins or pan-desmogleins. We speculate that complexes of cadherins of an unknown subclass and beta-catenins form non-desmosomal intercellular junctions in the intrafollicular dendritic meshwork.

[Electric programmed ventricular stimulation using a permanent cardiac pacing system--a noninvasive method in arrhythmia]. / Elektrická programovaná stimulace komor provádená prostrednictvím trvalého kardiostimulacního systému--neinvazivní metoda v arytmologii.

BACKGROUND: Complex forms of ventricular arrhythmias often occur in patients with an implanted permanent cardiac pacing system. Some of the pacemakers are provided with software which allows electrophysiological testing of the cardiac conduction system by coupling with an external diagnostic pacemaker via their programmer. This method is non-invasive. METHODS AND RESULTS: In a group of 26 patients (19 males, 7 females) with an implanted pacemaker (Paragon III, Synchrony III, Sensorithm--all Pacesetter) complex ventricular arrhythmias were observed (class Lown IVa and higher). In these patients the electrical stability of the myocardium was tested by the described method (protocol: incremental pacing 90-220 bpm, pacing drives 110 bpm and 140 bpm with 1-3 extrastimuli). Complex ventricular arrhythmias were induced in 42% patients (n = 11), in this subgroup 55% (n = 6) was non-sustained ventricular tachycardia, 36% (n = 4) sustained ventricular flutter, 9% (n = 1) sustained ventricular tachycardia. Patients with non-sustained ventricular tachycardia were treated with beta-blockers, in the others the effective therapy was selected according to electrophysiological testing (amiodarone in 4 patients, ICD in 1 patient). During a 24-month follow-up the overall mortality was 7.7% (n = 2), sudden death mortality was 3.8% (n = 1). CONCLUSIONS: Programmed ventricular stimulation performed by a permanent cardiac pacing system is a simple and above all non-invasive method with no need for fluoroscopy. It can be repeated several times. It is not possible to pace from the right ventricle outflow tract. This is the main disadvantage. Nevertheless, by using non-invasive risk stratification methods (echocardiography, signal averaged ECG, heart rate variability, baroreflex sensitivity, dispersion of QT interval) the patients in need of an invasive study can be identified. This method can be considered an alternative screening method and a standard part of the investigation of the algorithm in patients with a previously implanted pacemaker.

Phenotypic characteristics associated with insulin resistance in metabolically obese but normal-weight young women.

Metabolically obese, normal-weight (MONW) individuals are a hypothesized subgroup of the general population. These normal-weight individuals potentially display a cluster of obesity-related features, although this has not been systematically tested in young women. We hypothesized that MONW young women would display higher levels of total and visceral fat and lower levels of physical activity than normal women. In a cohort of 71 healthy nonobese women (21-35 years old), we identified MONW women based on cut points for insulin sensitivity (normal = glucose disposal >8 mg x min(-1) x kg(-1) of fat-free mass [FFM], n = 58; impaired = glucose disposal <8 ml x min(-1) x kg(-1) of FFM, n = 13). Thereafter, we measured body composition (dual energy X-ray absorptiometry) and body fat distribution (computed tomography), cardiorespiratory fitness (VO2max on a treadmill), physical activity energy expenditure (doubly labeled water and indirect calorimetry), glucose tolerance (oral glucose tolerance test), serum lipid profile, and dietary intake. We found a higher body fat percentage (32 +/- 6 vs. 27 +/- 6%, P = 0.01) and higher subcutaneous (213 +/- 61 vs. 160 +/- 78 cm2, P = 0.03) and visceral (44 +/- 16 vs. 35 +/- 14 cm2, P < 0.05) abdominal adiposity in the MONW group versus the normal group. The MONW group showed a lower physical activity energy expenditure (2.66 +/- 0.92 vs. 4.39 +/- 1.50 MJ/day, P = 0.01), but no difference in cardiorespiratory fitness was noted between groups. In conclusion, despite a normal body weight, a subset of young, apparently healthy women displayed a cluster of risky phenotypic characteristics that, if left untreated, may eventually predispose them to type 2 diabetes and cardiovascular disease.

Obesity-related phenotypes and the beta3-adrenoceptor gene variant in postmenopausal women.

We examined the hypothesis that postmenopausal women with the beta3-adrenoceptor gene variant (Trp64Arg) have reduced total daily energy expenditure (TEE), altered free fatty acid kinetics, and increased intra-abdominal fat. A secondary objective was to examine whether the obese state masks the effect of the variant on resting metabolic rate (RMR). There were 23 obese heterozygous women with the genetic variant (age 58 +/- 6 years; BMI 36 +/- 7 kg/m2) who were compared with 19 homozygous obese women with the normal allele (age 56 +/- 4 years; BMI 36 +/- 3 kg/m2). Daily energy expenditure was determined from doubly labeled water and indirect calorimetry, lipolysis from infusion of [1-13C]palmitate, and body fat distribution from computed tomography. No significant differences were found in TEE, RMR, energy expenditure of physical activity, the thermic effect of a meal, fat oxidation as estimated by fasting and postprandial respiratory quotients (RQs), or rate of lipolysis. Similarly, no difference was found in visceral adipose tissue and abdominal subcutaneous fat areas. When RMR was compared between obese (n = 23) and never-obese women with the Trp64Arg variant (n = 16), we found a 317 kcal/day lower RMR in never-obese women after controlling for fat mass, fat-free mass, and age (P < 0.0017). These results do not support the hypothesis that already obese women with the Trp64Arg polymorphism of the beta3-adrenergic receptor gene have lower daily energy expenditure, altered lipolysis, and increased abdominal obesity. On the other hand, the lower RMR in never-obese women suggests that the obese state may mask a moderate effect of the Trp64Arg variant on energy expenditure. Although these results need to be confirmed in other populations, the obese state may have been a confounding factor in previous studies of the beta3-adrenoceptor Trp64Arg variant and energy expenditure.

Pemphigus in Kuwait.

BACKGROUND: Although pemphigus is a well-characterized entity, detailed epidemiologic studies from the Arabian Peninsula are not available. The purpose of this study was to elucidate the clinical features, course, and prognosis of pemphigus patients followed at a national dermatology center in Kuwait. METHODS: Fifty-four patients with pemphigus in this report were treated between 1981 and 1996, and were studied for several clinical features, treatment, course and prognosis. RESULTS: Around 80% of pemphigus patients were Arabs, and Kuwaitis constituted the largest number (46.3%) with a female predominance (F: M = 2:1). Pemphigus vulgaris (PV) was the commonest clinical type. The mean age of onset was 36 years. The follow-up period ranged from 2 months to 12 years (mean, 4.5 years). The majority of the patients could be managed with low-dose steroids (30-60 mg/day). Twenty per cent of the patients were in complete clinical remission and were off systemic therapy for an average of 3 years. No death secondary to the disease or its treatment was observed. CONCLUSIONS: Kuwaiti patients with pemphigus were observed to have a relatively young age of onset and a female predominance. Low doses of steroids were enough to control the disease in the majority, and at least 20% of patients were off therapy and in complete remission on follow-up.