BMI,hypertension and low bone mineral density in adult men and women

The aim of this work was to estimate the body mass index (BMI) at which risk of hypertension is lowest in men and women, while concurrently considering the protective role of adipose tissue in osteoporosis. Healthy, occupationally active inhabitants of the city of Wroc?aw, Poland, 1218 women and 434 men were studied. BMI, systolic and diastolic blood pressures, bone mineral density (BMD) of the trabecular compartment and distal radius of the non-dominant hand were recorded. Overweight in young women (≤45 years) was associated with increased risk of hypertension, whereas the risk of low bone mineral was decreased for the same BMI. In older women (>45 years), a BMI > 27 was the threshold for increased risk of hypertension. In this age group, extremely slim women (BMI < 21) had the highest risk of low bone mineral density. In younger males (≤45 years), risk of hypertension was lowest among the thinnest subjects (BMI < 21). Increase in BMI over 21 kg/m² increased the risk of hypertension. The probability of low bone mineral density was the same in all BMI categories of men. In older men (>45 years), the thinnest (BMI < 21) had higher risk of hypertension. To begin from BMI = 25 kg/m², there was a monotonous increase in risk of hypertension in men. Higher risk for low bone mineral density was observed in older men with the BMI < 23.Among younger adults, risk of hypertension and low bone mineral density increase at BMI ≥ 21 kg/m² in men and BMI ≥ 23 kg/m² in women. Among older men and women, the BMI threshold was 27 kg/m².     

Zoledronic Acid Treatment of Osteoporosis: Effects in Men

ObjectiveTo study changes in bone mineral density (BMD) and a bone resorption marker in elderly men who received off-label zoledronic acid for osteoporosis treatment.MethodsWe conducted a retrospective review of medical records of 50 male veterans who had received at least one 4-mg intravenous infusion of zoledronic acid and had BMD measurements at 2 of 3 skeletal sites both before the infusion and at a mean of 2.2 years after the infusion. Patients were classified into those who had never received bisphosphonate therapy versus those who had previously received such treatment.ResultsIn our study population, 66% of patients had been prescribed orally administered bisphosphonates or intravenously administered pamidronate before receiving zoledronic acid. Larger increases in spine BMD (6.7% versus 3.4% [P < .05]; per year: 2.8% versus 1.2% [P < .01]) and total hip BMD (3.2% versus 0.1% [P < .03]; per year: 1.3% versus 0.02% [P < .02]) occurred after infusion of zoledronic acid in bisphosphonate-naïve patients in comparison with those who had previous bisphosphonate exposure. In addition, 26 of 50 patients (52%) had suppressed urinary N-terminal telopeptide of cross-linked collagen type I (NTx) (a bone turnover marker) at 12 months, and 5 men had NTx suppression for 24 months after infusion.ConclusionOur data suggest that 4 mg of intravenously administered zoledronic acid is an effective treatment for increasing BMD in a “real-world” population of men with osteoporosis. The prolonged suppression of urinary NTx after zoledronic acid infusion raises the question of whether this treatment could be given less frequently than every year. The changes seen in BMD during a mean period of 2 years were similar to those reported in clinical studies with alendronate therapy in men and zoledronic acid treatment in women. (Endocr Pract. 2010;16:960-967)     

Size and density of East Greenland polar bear (Ursus maritimus) skulls: Valuable bio-indicators of environmental changes?

There is an increasing interest in assessing the relationship between climatic oscillations, environmental contaminants and the modelling of animal physiological and morphological responses. We therefore undertook a study of skull condylobasal length (CBL; reflecting body size) and bone mineral density (BMD) in 87 East Greenland male polar bears (Ursus maritimus) sampled in the time period of 1892–2010. The purpose of the study was to investigate if these measures are potential candidates as indicators for stress associated with climate change and long-range transported toxic industrial chemicals. The analyses showed that both BMD and CBL in polar bears sampled in period 4 (1999–2010, n = 57) were significantly lower when compared with period 2 (1920–1936, n = 19) (both p < 0.02). Groups of persistent organohalogen contaminants (PCBs [polychlorinated biphenyls], DDT [dichlordiphenyltrichlorethane], HCH [hexachlorocyclohexane], HCB [hexachlorobenzene], chlordanes, dieldrin, PBDEs [polybrominated diphenyl ethers]) were measured in period 4 and multiple regression analyses controlling for age showed that dieldrin had a significant negative effect on BMD (p = 0.03, n = 52) while significant positive correlations with CBL were found for DDT, dieldrin and PBDE (all p < 0.05, n = 52). When testing the correlation with the North Atlantic Oscillation climate index no significant relationship was found for BMD (p = 0.97, r = −0.01, n = 27) nor CBL (p = 0.31, r = −0.2, n = 27). We therefore suggest that BMD and body size have decreased in East Greenland polar bear males over the past 120 years and that exposure to organohalogen contaminants may explain the BMD reductions. It is, however, not entirely clear if and how climatic oscillations affected the reductions in body size and BMD mainly because of the limited sample size in period 2 and lower mean age in period 4. Therefore, precautions should be taken towards a final conclusion on BMD and CBL as bioindicators for climate oscillations and exposure to toxic environmental chemicals. It is recommended that the sampling and archiving of East Greenland polar bear skulls continue in order to further explore how CBL and BMD reflect individual and population response upon exposure to environmental stress.     

Gene–gene interactions in RANK/RANKL/OPG system influence bone mineral density in postmenopausal women

Receptor activator of nuclear factor κB (RANK) is one of the proteins in regulation of osteoclastogenesis via RANK/RANKL/OPG. Gene that codes for RANK protein (TNFRSF11A) was associated with osteoporotic fractures in a recent genome-wide association study. As variations in the RANK gene could alter its expression and activity, the aim of our study was to evaluate the influence of four RANK gene polymorphisms on bone mineral density (BMD) and biochemical markers.We evaluated 467 postmenopausal women and 117 elderly men. All subjects were genotyped for the presence of RANK polymorphisms ?670G>C, +34694C>T, +34901G>A and +35966insdelC. BMD and biochemical markers were measured.Significant associations of +35966insdelC with BMD at lumbar spine (BMD-ls), total hip (BMD-th) and femoral neck (BMD-fn) were found in postmenopausal women (p = 0.020, 0.024 and 0.034), but not in men. Significant gene–gene interaction was proved for two RANK polymorphisms in combination with OPG and RANKL polymorphisms studied previously in postmenopausal women. Firstly, RANK/RANKL (+34901G>A/?290C>T) combination was associated with BMD-fn, BMD-th and BMD-ls (p = 0.034, 0.016 and 0.050), and secondly, RANK/OPG combination (+35966insdelC/K3N) showed influence on BMD-fn and BMD-ls (p = 0.043 and 0.039).Our results suggest that gene–gene interactions between RANK and OPG, and RANK and RANKL influence BMD in postmenopausal women.     

Parietin in the tolerant lichen Xanthoria parietina (L.) Th. Fr. increases protection of Trebouxia photobionts from cadmium excess

Secondary metabolites of lichens can be involved in production of chelates with heavy metals. We hypothesized that parietin plays important role in protection of photobiont cells in Xanthoria parietina from an excess of cadmium ions. Two types of X. parietina lichen thalli, natural with presence of secondary metabolite parietin (p+) as well as without parietin (p−) were exposed to different doses of cadmium (up to 300 μmol g⁻¹ dw). Based on determination of the total and intracellular Cd-accumulation, ergosterol and thiobarbituric acid reactive substances (TBARS) content did not show statistically significant differences in the response of both types of thalli (p+ and p−). However, a stronger toxic effect of the highest Cd-dose on photosynthetic pigment content and chlorophyll a fluorescence was observed in the parietin-depleted thalli. The protective role of parietin against Cd excess was better supported and concluded from the differences observed in the production of non-protein thiol compounds (cysteine, glutathione and phytochelatins) involved in Cd detoxification. In the p+ thalli Cys content was stable but GSH content slightly decreased in the studied Cd range, while in the p− thalli these compounds were completely absent at high Cd doses. At Cd doses higher than 37.5 μmol Cd g⁻¹ dw, toxic to both types of X. parietina thalli, Cys and GSH contents were significantly higher in p+ than in p− thalli. Also, the photobiont partner in the p+ thalli was better protected of the metal exposition, and able to produce phytochelatins (PCs) over the whole range of metal, while in the p− thalli the production was completely inhibited at 75 μmol Cd g⁻¹ dw and higher concentrations, together with the inhibition of cysteine (Cys) and reduced glutathione (GSH) production. The obtained results indicate that the parietin layer is a natural barrier decreasing Cd access to algal cells in X. parietina. Comparison of PCs production appeared to be the most sensitive marker for estimation of Cd availability to photobiont in the symbiotic system.     

Does Baseline PTH Influence Recovery of Bone Mineral Density,Trabecular Bone Score and Bone Turnover Markers? A Prospective Study Following Curative PArathyroidectomy in Primary Hyperparathyroidism

Objective: This prospective study was carried out to assess trabecular bone score, bone mineral density (BMD), and bone biochemistry in Indian subjects with symptomatic primary hyperparathyroidism (PHPT), and to study the influence of baseline parathyroid hormone (PTH) on recovery of these parameters following curative surgery.Methods: This was a 2-year prospective study conducted at a tertiary care centre in southern India. Baseline assessment included demographic details, mode of presentation, bone mineral biochemistry, BMD, trabecular bone score (TBS), and bone turnover markers (BTMs). These parameters were reassessed at the end of the first and second years following curative parathyroid surgery.Results: Fifty-one subjects (32 men and 19 women) with PHPT who had undergone curative parathyroidectomy were included in this study. The mean (SD) age was 44.6 (13.7) years. The TBS, BTMs, and BMD at lumbar spine and forearm were significantly worse at baseline in subjects with higher baseline PTH (≥250 pg/mL) when compared to the group with lower baseline PTH (<250 pg/mL). At the end of 2 years, the difference between high versus low PTH groups (mean ± SD) persisted only for forearm BMD (0.638 ± 0.093 versus 0.698 ± 0.041 g/cm²; P =.01). However, on follow-up visits in the first and second year after curative parathyroidectomy, there was no significant difference in BTMs, BMD at the femoral neck, lumbar spine, and TBS between the 2 groups stratified by baseline PTH.Conclusion: The BMD at the forearm remained significantly worse in individuals with high baseline PTH even at 2 years after surgery, while other parameters including TBS improved significantly from baseline.Abbreviations: 25(OH)D = 25-hydroxyvitamin D; BMD = bone mineral density; BMI = body mass index; BTMs = Bone turnover markers; CTX = C-terminal telopeptide of type 1 collagen; DXA = dual energy X-ray absorptiometry; P1NP = N-terminal propeptide of type 1 procollagen; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; TBS = trabecular bone score     

The effect of adding zinc to vitamin A on IGF-1, bone age and linear growth in stunted children

A randomized, double-blind, placebo controlled trial of a single dose of 200,000 I.U. of vitamin A with daily zinc supplementation was conducted with children in Mojo village, Surabaya City. Children aged 48 to 60 months were randomized to receive a single dose of 200,000 I.U. of vitamin A plus zinc sulfate (n = 12) or a single dose of 200,000 I.U. of vitamin A (n = 12) plus placebo six days a week for six months. Children were evaluated weekly for nutrient intake and for IGF-1, C-reactive protein levels, gamma globulin levels, serum zinc, serum retinol, bone age and the index height for age at six months.At the end of the study, there was a significant increase in the serum retinol level (p < 0.03), serum zinc level (p < 0.03), IGF-1 hormone (p < 0.04) and Z-score height for age (p < 0.001), bone age (p < 0.01), and gamma globulin level (p < 0.04) and a significant decrease in the amount of infection/inflammation measured by CRP level (p < 0.001). There was also a significant correlation between CRP level and height for age (p < 0.01), and between gamma level and height for age (p < 0.01).These results suggest that combined vitamin A and zinc supplementation reduces the risk of infection and increases linear growth among children, and thus may play a key role in controlling infection and stunted growth for children under five years old.     

Axial BMD in Diabetic and Nondiabetic Southeast Asians with HIP Fractures: Do Race and Body Mass Index Matter?

Objective: Obesity is less prevalent in Asian subjects with type 2 diabetes mellitus (T2DM) in contrast to Caucasians. Whether higher axial bone mineral density (BMD) often reported in T2DM is independent of body mass index (BMI) has not been clearly shown. BMD characterization in T2DM patients with hip fractures has also not been performed. We compared the BMD of Asian diabetic and nondiabetic patients with new hip fractures and explored how BMD was influenced by BMI.Methods: We included 255 diabetic and 148 nondiabetic patients. BMD adjusted for age; BMI; race; sex; renal function; and use of statins, proton pump inhibitors, steroids, anticonvulsants, and calcium and/or vitamin D supplements were compared between the groups. We were particularly interested in the BMD comparison between underweight diabetics and nondiabetics with hip fractures.Results: The presence of T2DM was associated with higher BMD (g/cm²) at the femoral neck (0.527 ± 0.103 vs. 0.491 ± 0.102, P<.01) and lumbar spine [LS] (0.798 ± 0.147 vs. 0.723 ± 0.156, P<.01). This association persisted after adjustment for multiple confounding variables including BMI. The age-, BMI-, and sex-adjusted LS BMD was higher in underweight (BMI <18.5 kg/m²) diabetics compared to similar weight nondiabetics (0.733 ± 0.126 vs. 0.649 ± 0.131 g/cm², P = .014).Conclusion: T2DM is independently associated with higher axial BMD in patients with new hip fractures. The finding of higher BMD even in underweight diabetics with hip fractures compared to their nondiabetic counterparts suggests that higher BMD in subjects with T2DM is not due to higher BMI.Abbreviations:BMD = bone mineral densityBMI = body mass indexCV = coefficient of variationDXA = dual-energy X-ray absorptiometryHbA1c = glycated hemoglobinIGF-1 = insulin growth factor-1LS = lumbar spine25(OH)D = 25-hydroxyvitamin DT2DM = type 2 diabetes mellitus     

Radiological properties of 3D printed materials in kilovoltage and megavoltage photon beams

PurposeThis study evaluates the radiological properties of different 3D printing materials for a range of photon energies, including kV and MV CT imaging and MV radiotherapy beams.MethodsThe CT values of a number of materials were measured on an Aquilion One CT scanner at 80 kVp, 120 kVp and a Tomotherapy Hi Art MVCT imaging beam. Attenuation of the materials in a 6 MV radiotherapy beam was investigated.ResultsPlastic filaments printed with various infill densities have CT values of −743 ± 4, −580 ± 1 and −113 ± 3 in 120 kVp CT images which approximate the CT values of low-density lung, high-density lung and soft tissue respectively. Metal-infused plastic filaments printed with a 90% infill density have CT values of 658 ± 1 and 739 ± 6 in MVCT images which approximate the attenuation of cortical bone. The effective relative electron density RED_eff is used to describe the attenuation of a megavoltage treatment beam, taking into account effects relating to the atomic number and mass density of the material. Plastic filaments printed with a 90% infill density have RED_eff values of 1.02 ± 0.03 and 0.94 ± 0.02 which approximate the relative electron density RED of soft tissue. Printed resins have RED_eff values of 1.11 ± 0.03 and 1.09 ± 0.03 which approximate the RED of bone mineral.Conclusions3D printers can model a variety of body tissues which can be used to create phantoms useful for both imaging and dosimetric studies.     

A modelling approach demonstrating micromechanical changes in the tibial cemented interface due to in vivo service

Post-operative changes in trabecular bone morphology at the cement-bone interface can vary depending on time in service. This study aims to investigate how micromotion and bone strains change at the tibial bone-cement interface before and after cementation. This work discusses whether the morphology of the post-mortem interface can be explained by studying changes in these mechanical quantities. Three post-mortem cement-bone interface specimens showing varying levels of bone resorption (minimal, extensive and intermediate) were selected for this study Using image segmentation techniques, masks of the post-mortem bone were dilated to fill up the mould spaces in the cement to obtain the immediately post-operative situation. Finite element (FE) models of the post-mortem and post-operative situation were created from these segmentation masks. Subsequent removal of the cement layer resulted in the pre-operative situation. FE micromotion and bone strains were analyzed for the interdigitated trabecular bone. For all specimens micromotion increased from the post-operative to the post-mortem models (distally, in specimen 1: 0.1 to 0.5 µm; specimen 2: 0.2 to 0.8 µm; specimen 3: 0.27 to 1.62 µm). Similarly bone strains were shown to increase from post-operative to post-mortem (distally, in specimen 1: −185 to −389 µε; specimen 2: −170 to −824 µε; specimen 3: −216 to −1024 µε). Post-mortem interdigitated bone was found to be strain shielded in comparison with supporting bone indicating that failure of bone would occur distal to the interface. These results indicate that stress shielding of interdigitated trabeculae is a plausible explanation for resorption patterns observed in post-mortem specimens.     

Tasa de filtración glomerular estimada y mortalidad posterior al alta en una unidad geriátrica de agudos

ObjectiveTo determine the relationship between estimated glomerular filtration rate (eGFR) and mortality in a retrospective cohort of older adults admitted to an acute care for the elderly (ACE) unit.Materials and methodsThe study included 1,678 patients aged 60 years and over admitted to an AEC, in Cali, Colombia, from 2012 to 2015, and followed- up until 2016. The primary outcome was mortality. Renal function (eGFR) was estimated using Modification of Diet in Renal Disease Study (MDRD-4) equation. The renal function was grouped according to the eGFR (ml/min/1.73 m²) as follows: slightly decreased (≥ 60), moderately decreased (30-59), and severely decreased (< 30). Bivariate survival and multivariate Cox regression analyses were performed.ResultsIn the univariate analysis, patients with severely decreased eGFR had higher mortality than those with a higher eGFR (P = .046). In the group with severely decreased eGFR, survival was lower in the functionally dependent group (Barthel index [IB] < 60) than in the independent group (IB ≥ 60) (log rank test; P = .001). In the multivariate analysis, there was a significant increase in the risk of death in the elderly with severely decreased eGFR (< 30) compared with slightly decreased eGFR (≥ 60) (hazard ratio [HR], 1.44; 95% confidence interval [CI]; 1.02-2.05, P = .039). There was also a significant increase in the risk of death in the dependent elderly compared to the independent ones [HR 1.72; 95% CI; 1.26-2.34, P = .000], those who had the high morbidity (≥ 4) with low albumin (< 3.2 g/dL) compared with those with low morbidity (0-3) and high albumin (≥ 3.2) [HR 1.77; 95% CI; 1.18-2.65, P = .005], and in those with a high (16-102 mg/dL) C-reactive protein (CRP) compared with those with low CRP (0-15) [HR 1.42; 95% CI; 1.01-2.01, P = .043].ConclusionsThe risk of mortality after hospital admission to an AEC unit is greater in patients with eGFR < 30. Poor functional status performance, high comorbidity, low plasma albumin, and increased inflammation markers are additional prognostic factors to be taken into account. The improvement in the functional status could improve the survival after hospitalisation.     

Haematological and biochemical parameters and tissue accumulations of cadmium in Oreochromis niloticus exposed to various concentrations of cadmium chloride

Oreochromis niloticus, weighing 36.45 ± 1.12 g were exposed to 10%, 20% and 30% of the LC₅₀ of CdCl₂ which represents treatments (T1)1.68, (T2)3.36 and (T3)5.03 mg/l, respectively, for a period of 10, 20 and 30 days. It was found that, compared to a control group reading of 0.19 ± 0.03 μg/g dry weight, accumulation of Cd in the gills was significantly (p < 0.05) increased in samples ranging between 7.64 ± 0.86 and 61.73 ± 0.82 μg/g dry weight from T1 at 10 days to T3 at 30 days. The accumulation of Cd in the liver, meanwhile, was also observed to significantly increase (p < 0.05) with increasing time and concentrations with results ranging between 3.21 ± 0.12 and 181.61 ± 1.32 compared to the control group results of 0.29 ± 0.04 μg/g dry weight. Although muscles exhibited lower levels of accumulation than the gills and liver they still showed the same pattern of increase compared to the control group, with a significant difference ranging between 0.32 ± 0.02 and 2.16 ± 0.08 compared to the control group results of 0.03 ± 0.001 μg/g dry weight. Also, haematological parameters such as red blood cells (RBCs), haemoglobin (Hb) and haematocrit (Hct) were reduced in fish exposed to Cd at all periods, with significant differences (p < 0.05). Plasma glucose concentration showed a significant increase. Total protein levels of fish showed a significant reduction (p > 0.05) for all exposed treatments. Also, the total lipid level increased significantly as fish were exposed to increasing cadmium concentrations, compared to control fish. Finally, the activities of aspartate aminotransferase (AST IU/l) and alanine aminotransferase (ALT IU/l) showed a significant increase (p < 0.05) with increasing time and concentrations.     

Effects of water potential on mycelial growth,sclerotial production,and germination of Rhizoctonia solani from potato

The effects of osmotic and matric potential on mycelial growth, sclerotial production and germination of isolates of Rhizoctonia solani [anastomosis groups (AGs) 2-1 and 3] from potato were studied on potato dextrose agar (PDA) adjusted osmotically with sodium chloride, potassium chloride, glycerol, and matrically with polyethylene glycol (PEG) 6000. All isolates from AGs 2-1 and AG-3 exhibited fastest mycelial growth on unamended PDA (−0.4 MPa), and growth generally declined with decreasing osmotic and matric potentials. Growth ceased between −3.5 and −4.0 MPa on osmotically adjusted media, and at −2.0 MPa on matrically adjusted media, with slight differences between isolates and osmotica. Sclerotium yield declined with decreasing osmotic potential, and formation by AG 2-1 and AG-3 isolates ceased between −1.5 and −3.0 MPa and −2.5 and −3.5 MPa, respectively. On matrically adjusted media, sclerotial formation by AG 2-1 isolates ceased at −0.8 MPa, whereas formation by AG-3 isolates ceased at the lower matric potential of −1.5 MPa. Sclerotial germination also declined with decreasing osmotic and matric potential, with total inhibition occurring over the range −3.0 to −4.0 MPa on osmotically adjusted media, and at −2.0 MPa on matrically adjusted media. In soil, mycelial growth and sclerotial germination of AG-3 isolates declined with decreasing total water potential, with a minimum potential of −6.3 MPa permitting both growth and germination. The relevance of these results to the behaviour of R. solani AGs in soil and their pathogenicity on potato is discussed.     

Cadmium,lead and mercury concentrations and their influence on morphological parameters in blood donors from different age groups from southern Poland

Due to industrial development, environmental contamination with metals increases which leads to higher human exposure via air, water and food. In order to evaluate the level of the present exposition, the concentrations of metals can be measured in such biological materials as human blood. In this study, we assessed the concentrations of cadmium (Cd), mercury (Hg) and lead (Pb) in blood samples from male blood donors from southern Poland (Europe) born in 1994 (n = 30) and between 1947 and 1955 (n = 30). Higher levels of Pb were seen in the group of older men (4.48 vs 2.48 μg/L), whereas the Hg levels were lower (1.78 vs 4.28 μg/L). Cd concentrations did not differ between age groups (0.56 μg/L). The levels of Cd and Pb in older donors were significantly correlated (Spearman R 0.5135). We also observed a positive correlation between the number of red blood cells (RBC) and Hg concentrations in the older group (Spearman R 0.4271). Additionally, we noted numerous correlations among morphological parameters. Based on our results, we can state that metals influence the blood morphology and their concentrations in blood vary among age groups.     

Development to the blastocyst stage of immature pig oocytes arrested before the metaphase-II stage and fertilized in vitro

In vitro fertilization (IVF) and embryonic development of mature and meiotically arrested porcine oocytes were compared in the present study. After in vitro maturation (IVM) of cumulus-oocyte complexes for 48 h, 75.4% of them extruded a visible polar body (PB). Most of the oocytes with a first polar body (PB+ group) were at the metaphase-II (M-II) stage (91.4%). Most of the oocytes without a visible polar body (PB− group) appeared to be arrested at the germinal vesicle (GV) (41.6%) and metaphase-I (M-I) (34.0%) stages. After IVF of oocytes (day of IVF = Day 0), there was no difference between PB⁺ and PB⁻ groups in rates of sperm penetration, mono-spermy, however oocyte activation rate after penetration was greater in the PB+ than in the PB− group (P < 0.05). On Day 2, there was no difference between rates of embryos cleaved at the 2–4 cell stages in PB+ and PB− groups (42.1 ± 48.8% and 33.6 ± 2.1%, respectively). On Day 4, the rate of PB+ embryos developing beyond the 4-cell stage was greater than that of PB− embryos (P < 0.05, 31.7 ± 3.9% and 14.1 ± 1.5%, respectively), and PB+ embryos had more cells than the PB− embryos (P < 0.05, 8.3 ± 0.4 and 6.0 ± 0.8 cells, respectively). On Day 6, a greater proportion of PB+ embryos developed to the blastocyst stage than did PB− embryos (P < 0.05, 34.6 ± 2.4% and 20.7 ± 2.8%, respectively). However, when the GV oocytes of the PB− group were not included in recalculations, there was no difference in blastocyst rates between M-I arrested and M-II oocytes (35.3 and 34.6%, respectively). The number of blastomere nuclei in embryos obtained from the PB+ group (52.0 ± 2.5) was greater than that from the PB− group (P < 0.05, 29.1 ± 2.8). The proportion of degenerated parts in the blastocysts, as determined by morphological appearance, was the same in the PB+ and PB− groups. Although the quality of PB+ embryos was enhanced as compared with that of the PB− group, the proportion of inner cell mass and trophectoderm cells in PB+ and PB− blastocysts did not differ (1:1.9 and 1:2.2, respectively). Chromosome analysis revealed that PB+ blastocysts had more diploidy (P < 0.05, 69.7%) than did PB− blastocysts (44.0%), whereas PB− blastocysts had more triploid cells (P < 0.05, 34.0%) than did PB+ oocytes (8.4%). These results indicate that pig oocytes arrested before the M-II stage (M-I oocytes) undergo cytoplasmic maturation during maturation culture and have the same ability to develop to blastocysts after IVF as M-II oocytes, but some of them resulted in degeneration or delayed development with poor embryo quality.     

Aerobic Fitness and Glycemic Variability in Adolescents with Type 1 Diabetes

ObjectiveThis study examines the association of fitness on glycemic variability (GV) in adolescents with type 1 diabetes mellitus (T1DM). GV has been associated with high frequency of hyper-and hypoglycemia.MethodsNineteen adolescents with T1DM, ages 14 to 19 years, underwent aerobic fitness testing to determine their maximal aerobic capacity (VO₂ max). A continuous glucose monitoring (CGM) device was placed on each subject and worn for 3 to 5 days until a return visit when the subjects underwent a 1-hour treadmill exercise session. Mean amplitude of glycemic excursion (MAGE) was calculated from the CGM data collected between the 2 study visits. Metabolic equivalent (MET), a measure of accumulated metabolic workload during the exercise session, was also calculated.ResultsMean VO₂ max was 46.6 ± 6.8 mL/kg/min, with a range of 34.8 to 57.0 mL/kg/min. Mean MET during the exercise session was 577.2 ± 102.4 and ranged from 354.3 to 716.2 METs. There was an inverse association between VO₂ max and MAGE (r = − 0.46; 95% confidence interval [CI], − 0.01 to − 0.76; P = .048). MET load and MAGE also had an inverse relationship (r = − 0.48; 95% CI, − 0.03 to − 0.77; P = .037).ConclusionGV is inversely associated with fitness and MET load. Aerobic fitness should be promoted in adolescents with T1DM not only because of its multiple beneficial effects but also due to a possible association with GV, leading to fewer extremes in hypo-and hyperglycemia. (Endocr Pract. 2014;20:566-570)     

Frequency of Continuous Glucose Monitoring use and Change in Hemoglobin A1C for Adults With Type 1 Diabetes in a Clinical Practice Setting

ObjectiveTo estimate the frequency of continuous glucose monitoring (CGM) use and change in hemoglobin A1c (HbA1c) compared to self-monitoring of blood glucose (SMBG) alone in adults with type 1 diabetes in a clinical practice setting.MethodsWe retrospectively identified 66 adult type 1 diabetes patients at the Barbara Davis Center for Diabetes (BDC) who first initiated CGM between 2006 and 2011 and 67 controls using SMBG. The frequency of CGM use was estimated from survey recall and defined as the mean number of days/month of CGM use during a maximum follow-up of 10 months. Change in HbA1c was calculated as the difference between the baseline value and the lowest follow-up value.ResultsThe mean change in HbA1c for CGM users was − 0.48% (95% confidence interval [CI]: − 0.67, − 0.28) and for SMBG users was − 0.37% (95% CI: − 0.56, − 0.18). The between-group mean difference in change in HbA1c, adjusted for patient characteristics, was − 0.11% (95% CI: − 0.38, 0.16), whereas the subgroup with a baseline HbA1c ≥ 7.0% and users of CGM ≥ 21 days/month was − 0.36% (95% CI, − 0.78, 0.05). Nearly half (n = 32, 48%) used CGM < 21 days/month. The reasons for low frequency of CGM use or discontinuation included sensor costs, frequency of alarms, inaccuracy, and discomfort.ConclusionsThese CGM data from clinical practice suggest a trend toward decreasing HbA1c for adults with type 1 diabetes, especially in patients with higher baseline HbA1c and higher frequency of CGM use. Future studies are needed to assess the use of CGM in larger populations of clinical practice adult type 1 diabetes patients. (Endocr Pract. 2014;20:1007-1015)     

The ability of plasma to stimulate fibroblast cholesterol efflux is associated with the − 629C→A cholesteryl ester transfer protein promoter polymorphism: Role of lecithin:cholesterol acyltransferase activity

A recent population-based study showed that cholesteryl ester transfer protein (CETP) gene variations, which relate to lower plasma CETP, may predict increased cardiovascular risk, in spite of higher HDL cholesterol. Among other functions, CETP activity contributes to cellular cholesterol efflux, an early step in the anti-atherogenic reverse cholesterol transport (RCT) process. We hypothesized that cellular cholesterol efflux stimulating capacity of plasma could be associated with CETP gene variation. In this study, we tested the extent to which the ability of plasma to promote cholesterol efflux from cultured human fibroblasts is associated with CETP gene variation. In 223 men, the − 629C→A CETP promoter polymorphism, plasma lipids, CETP mass, cholesteryl ester transfer (CET), lecithin:cholesterol acyltransferase (LCAT) activity and the ability of plasma to promote cholesterol efflux from human skin fibroblasts, obtained from a single normolipidemic donor, were determined. In − 629CC homozygotes (n = 52), cholesterol efflux, plasma CETP mass, CET and LCAT activity were higher, whereas HDL cholesterol was lower compared to − 629 AA homozygotes (n = 62) and − 629CA + AA carriers (n = 171) (P < 0.05 to P < 0.001). Univariate correlation analysis showed that cellular cholesterol efflux was related to CETP genotype (P = 0.04), plasma CET (P<0.05), LCAT activity (P < 0.001) and apo A–I (P < 0.05). Multiple linear regression analysis confirmed the independent association of cellular cholesterol efflux to plasma with CETP genotype. In conclusion, an association of cellular cholesterol efflux with the − 629C→A CETP polymorphism, possibly also involving LCAT activity, could provide a mechanism explaining why CETP gene variation, which relates to lower plasma CETP, does not confer diminished cardiovascular risk.     

Patients at risk for trace element deficiencies: Bariatric surgery

Obesity is a worldwide epidemic associated with diseases such as diabetes mellitus and cardiovascular disease. Current methods for weight loss are not very effective, particularly for those with morbid obesity. Surgical therapy may be recommended for those with a BMI ≥ 40 kg/m², or BMI ≥ 35 kg/m² with co-morbidities. This therapy can produce significant weight loss and improve/resolve co-morbidities including hypertension and hyperlipidemia. Yet successes may be tempered by adverse effects on trace element absorption and status. A PubMed literature search identified studies from January 1980 to February 2013 for inclusion in a meta-analysis. Publications that contained keywords ‘bariatric surgery or gastric bypass,’ ‘trace element or mineral or zinc or iron or copper or iodine or manganese’, and ‘absorption or status or rate or level’ were identified. Inclusion criteria were human markers that reflect changes in trace element status before and after bariatric surgery. The meta-analysis found a decrease in blood copper, zinc, hemoglobin, as well as an increase in iron, regardless of the type of surgery. The pooled effect sizes and 95% confidence intervals were 0.17 and −0.09 to 0.43 for plasma/serum iron (p = 0.20); −0.49 and −0.67 to −0.31 for blood hemoglobin (p = 0.00); −0.47 and −0.90 to −0.05 for plasma/serum copper (p = 0.03); −0.77 and −1.20 to −0.35 for plasma/serum zinc (p = 0.00). Differences in levels of these minerals pre- and post-surgery may have been influenced by the time period after surgery, a pre-existing deficiency, type and dose of vitamin–mineral supplements, and malabsorption due to elimination of parts of the gastrointestinal tract.     

Sedentary work and the risks of colon and rectal cancer by anatomical sub-site in the Canadian census health and environment cohort (CanCHEC)

BackgroundSedentary behaviour is a potential risk factor for colorectal cancer. We examined the association between sedentary work, based on body position, and colorectal cancer risk in Canadians.MethodsA working body position category (a. sitting; b. standing and walking; c. sitting, standing, and walking; d. other) was assigned to occupations reported by 1991 Canadian Census respondents based on national occupational counselling guidelines. Adjusted hazard ratios (HRs) and 95% confidence intervals (CI) were estimated for cancers of the colon (overall, proximal, and distal) and rectum in men and women newly diagnosed from 1992 to 2010.ResultsCompared to “sitting” jobs, men in occupations with “other” (non-sitting, −standing, or −walking) body positions had a weakly significant reduced colon cancer risk (HR = 0.93, 95% CI: 0.89, 0.98) primarily attributed to protection at the distal site (HR = 0.90, 95% CI: 0.84, 0.97). Men in “standing and walking” and “sitting, standing, and walking” jobs did not have significantly reduced colon cancer risks. No effects were observed for rectal cancer in men or colon and rectal cancer in women.ConclusionThe two significant findings of this analysis should be followed-up in further investigations with additional information on potential confounders. Null findings for rectal cancer were consistent with other studies.