Lower Body Weight Research Articles

The combined pioglitazone and topiramate therapy for management of pediatric patients with severe MASLD.

Metabolic dysfunction associated steatotic liver disease (MASLD) is the most common cause of chronic hepatitis in adult and pediatric patients. Adolescents with severe MASLD can demonstrate a more aggressive disease phenotype as they more commonly develop liver fibrosis than BMI matched adults. Therefore, MASLD is the fastest growing indication for liver transplants in young adults. Pioglitazone has been shown to improve liver histology in adult patients with MASLD, and in some studies, it attenuated liver fibrosis. Despite its perceived efficacy, pioglitazone is not widely used, likely due to its side effect profile, specifically increased weight gain. Topiramate lowers body weight in adolescents and in combination with phentermine, is one of the few FDA-approved medications for the management of obesity in children over 12 years of age. We performed a retrospective review of the outcomes in pediatric patients with severe MASLD, treated with the combined pioglitazone and topiramate therapy. Here, we report a case series of seven adolescents with severe MASLD and ≥F2 liver fibrosis treated with the combined pioglitazone and topiramate therapy. The combined therapy improved mean serum ALT from 165 ± 80 U/L to 89 ± 62 U/L after 12 months mean duration of treatment. One patient who completed 24 months of the combined therapy demonstrated a decrease in liver stiffness from 8.9 kPa to 5.6 kPa, as assessed by FibroScan elastography. There was a significant increase in body weight during this time, however, body mass index as a percentage of the 95th percentile adjusted for age and gender did not increase significantly, 151 ± 29% vs. 152 ± 28%. Moreover, waist circumference, mid-upper arm circumference, percent body fat, and muscle mass were not significantly different before and after treatment. Serum lipid levels and hemoglobin A1c also did not change with the treatment. In summary, this case series provides encouraging results about the efficacy of the combined pioglitazone and topiramate therapy for the management of adolescents with severe MASLD, which should be further explored in clinical studies.

Muscle fibre morphometric analysis (MusMA) correlates with muscle function and cardiovascular risk prognosis.

Morphometry of striated muscle fibres is critical for monitoring muscle health and function. Here, we evaluated functional parameters of skeletal and cardiac striated muscle in two experimental models using the Morphometric Analysis of Muscle Fibre tool (MusMA). The collagen-induced arthritis model was used to evaluate the function of skeletal striated muscle and the non-alcoholic fatty liver disease model was used for cardiac striated muscle analysis. After euthanasia, we used haeamatoxylin and eosin stained sections of skeletal and cardiac muscle to perform muscle fibre segmentation and morphometric analysis. Morphometric analysis classified muscle fibres into six subpopulations: normal, regular hypertrophic, irregular hypertrophic, irregular, irregular atrophic and regular atrophic. The percentage of atrophic fibres was associated with lower walking speed (p = 0.009) and lower body weight (p = 0.026), respectively. Fibres categorized as normal were associated with maximum grip strength (p < 0.001) and higher march speed (p < 0.001). In the evaluation of cardiac striated muscle fibres, the percentage of normal cardiomyocytes negatively correlated with cardiovascular risk markers such as the presence of abdominal adipose tissue (p = .003), miR-33a expression (p = .001) and the expression of miR-126 (p = .042) Furthermore, the percentage of atrophic cardiomyocytes correlated significantly with the Castelli risk index II (p = .014). MusMA is a simple and objective tool that allows the screening of striated muscle fibre morphometry, which can complement the diagnosis of muscle diseases while providing functional and prognostic information in basic and clinical research.

Clcn3 deficiency ameliorates high-fat diet-induced obesity and improves metabolism in mice

ObjectiveObesity is defined as excess body fat and is a current health epidemic associated with increased risk for type 2 diabetes and cardiovascular disease. The ClC-3 chloride channel/antiporter, encoded by the Clcn3, is associated with some diseases, like carcinoma, nervous system diseases, and metabolic diseases. To verify the relationship between the Clcn3 and weight including metabolic changes, searching for a new target for metabolic therapy of obesity, we designed the experiment.MethodsThe mice were divided into 4 different groups: Clcn3+/+ mice + high-fat diet (HFD), Clcn3−/− mice + HFD, Clcn3+/+ mice + normal diet (ND), Clcn3−/− mice + ND, and fed for 16 weeks. After the glucose tolerance test and insulin tolerance test, peripheral blood and adipose tissues were collected. Moreover, we performed transcriptome sequencing for the epididymal white adipose tissue from Clcn3+/+ and Clcn3−/− mice with the high-fat diet. Western blotting verified the changes in protein levels of relevant metabolic genes.ResultsWe found that the Clcn3−/− mice had lower body weight and visceral fat, refining glucose and lipid metabolism in HFD-induced mice, but had no effect in normal diet mice. RNA-seq and Western blotting indicated that Clcn3 deficiency may inhibit obesity through the AMPK-UCP1 axis.ConclusionModulation of Clcn3 may provide an appealing therapeutic target for obesity and associated metabolic syndrome.

Transcriptome profile of sex-related gene expression and effects of cyp19a1 siRNA-silencing on sex differentiation and determination in yellow perch

In this study, we first sequenced the whole genome of the yellow perch (YP, Perca favencens) and screened transcripts of brain, liver, and gonadal tissues from fish of different sexes. By comparing known female sex-related genes in fish such as cyp19a1 and dmrt1 with YP genome, we obtained full-length sequences through genomic homology analysis. Then an experiment was conducted to evaluate the effects of cyp19a1-siRNA interference on gonadal development and sex differentiation and determination in YP. Transcriptome analysis revealed that the gonadal tissue of female YP exhibited predominantly and differentially up-regulated expression of genes than males, and cyp19a1 was predominantly expressed in the gonads while cyp19a2 showed predominant expression in the brain. KEGG pathway enrichment analysis illustrated the metabolic pathways of the top 25 enriched genes and confirmed CYP19 (P450) pathway in YP. For the cyp19a1-siRNA interference experiment, four intermittent in vivo injections of siRNA were administered to interfere with cyp19a1 gene expression in an all-female group of YP. The results collected at 180 dph revealed that the siRNA interference resulted in an incomplete masculinization and hermaphroditism of all-female monosex YP, displaying the presence of male spermatocytes along with female oocytes. In contrast, tissues from the blank control and negative control groups only contained oocytes. The appearance of the gonads in the experimental group appeared more irregular, lacking the smooth surface and typical histoarchitecture observed in the blank control and negative control groups. In addition, the cyp19a1-siRNA treatment group had significantly (P < 0.05) lower body weight than the control groups, indicating that the interference with cyp19a1 might have affected the expression of estrogen, leading to a trend similar to the growth of males; similarly, the gonad weight and GSIs of the cyp19a1 group were significantly (P < 0.05) lower than those in the control groups, suggesting that the cyp19a1-siRNA interference might have led to a trend of male type of gonadal development. Meanwhile, the treatment group had significantly (P < 0.05) higher HSI and VSI levels compared to control groups, indicating that stimulation of external siRNA might have resulted in more vigorous liver metabolism processes. Furthermore, the expression level of the dmrt1 in the treatment group was significantly (P < 0.05) upregulated compared to the control groups, suggesting the correlation roles between these two genes in the regulation of sex development. The findings provide valuable insights for future research into the underlying mechanisms involved and hold significant promise for sex control in aquaculture.

PSI-8 Impact of feeding level on boars from selection to entering the boar stud on trainability and growth measurements

Abstract The objective of this study was to determine if restricting feed in boars at selection impacts growth of boars or training for semen collection. Duroc boars (n = 25) randomly allotted at 6 mo of age to receive one of two levels of restricted feeding (1.8 kg/d, n = 12 or 2.72 kg/d, n = 13) of a corn-soybean meal-based diet formulated to meet NRC (2012) requirements. Diets were fed for 9 wk before training for semen collection where body weight (BW), body condition score (BCS), flank-flank tape measurements, Knauer sow caliper, loin muscle depth, backfat depth, and scrotal width and length were collected every 3 wk. Training for semen collection was conducted 5 d/wk for 2 wk. Boars were given 10 min in the collection pen to successfully mount the dummy and start collection each training session. Training was scored on a scale of 1-5, 1 = no interest and 5 = successful collection. After three successful collections in a row, boars were considered fully trained. All boars had their first production collection on wk 12. Data were analyzed using PROC MIXED and PROC FREQ chi-square in SAS 9.4 with boar serving as experimental unit. Weeks were analyzed individually and overall changes were evaluated. Significance was determined at P &amp;lt; 0.05 and a trend was observed at 0.05 &amp;lt; P ≤ 0.10. Boars fed 2.72 kg/d had increased BW on wk 9 (P &amp;lt; 0.05) and wk 12 (163.6 kg vs 149.8 kg, SE = 2.17; P &amp;lt; 0.001), increased BW gain wk 1-9 (P &amp;lt; 0.01), wk 9-12 (P &amp;lt; 0.001), and overall (49.8 kg vs 34.4 kg, SE = 1.60; P &amp;lt; 0.0001). The 2.72 kg/d boars also had increased backfat depth on wk 9 (P &amp;lt; 0.01) and wk 12 (8.4 mm vs 7.5 mm, SE = 0.17; P &amp;lt; 0.001), larger caliper scores on wk 12 (P &amp;lt; 0.01), greater flank-flank distance on wk 9 (P &amp;lt; 0.01), and increased BCS on wk 12 (3.2 vs 2.7, SE = 0.14; P &amp;lt; 0.01). No differences were observed for loin muscle depth, or scrotal width and length. Feeding level did not affect trainability with approximately 92% of boars being trained at the end of the two-week period in both feeding levels. Boars fed 2.72 kg/d had increased semen volume (128 mL vs 81 mL, SE = 12.1; P &amp;lt; 0.01) on their first production collection on wk 12 with no effects on other semen quality parameters. Overall, feeding boars 1.8 kg/d for 12 weeks following selection resulted in lower body weight and composition measures indicating limit feeding boars at selection could be used to slow growth rates, potentially decreasing structural issues, and increasing longevity of growing boars in the boar stud, with no effects on training for semen collection. Future research is needed to investigate the long-term impacts of the degree of limit feeding growing boars following selection on lifetime semen quality and quantity. Keywords boar, management, nutrition

69 Effect evaluation of two sources of zinc at EU-authorized level on growth performance and gut health of piglets with a low or normal birth weight

Abstract This study aimed to investigate the effect of ZnSO4 or a porous form of ZnO, at EU-authorized level, on growth performance, gut health and colon microbiota in low and normal birth body weight (BBW) piglets. At birth, 64 piglets were chosen by their BBW and divided into low BBW (LBBW &amp;lt; 1 kg; 32 piglets) and normal BBW (NBBW &amp;gt; 1 kg; 32 piglets). At weaning, 25 d old (d 0), piglets were allocated into four groups (8 piglets/group, 2 pigs/replicate) and fed a standard diet plus 120 ppm of Zn from ZnSO4 or from a porous source of Zn (HZ - HiZox, Animine, France). Groups were balanced for litter of origin and category of BBW. Piglets were weighed weekly until d 21 post-weaning. The prevalence of diarrhea was determined by the fecal index (percentage of animals with fecal score &amp;gt; 3), and feed intake per pen was recorded daily. On d 9 and d 21, one piglet/replicate was slaughtered, and jejunum tissue was collected for morphology, colon content for microbiota analyzes, and distal jejunum pH was measured. Performance, pH, and morphometric parameters were analyzed using a linear mixed model, fecal index using a generalized linear mixed model with a Poisson distribution, including treatment, class of BBW and their interaction as fixed factors, and the litter as random factor. The statistical analysis on alpha, beta diversity and taxonomic composition were carried out using phyloseq, vegan and microbiomeMarker packages. Piglets in the NBBW group had greater BW throughout the study (P &amp;lt; 0.01). The treatment HZ tended to increase the average daily gain (ADG) at d 9-14 (P &amp;lt; 0.10), and significantly increased the gain to feed ratio (G:F) ratio (P &amp;lt; 0.05) at d 0-14. The HZ-fed piglets had a greater G:F in the overall period (P = 0.04). Additionally, the jejunum pH of the HZ-fed piglets was reduced (P = 0.02) at d 21. An interaction was observed between treatment and BBW for fecal index during d 0-14 and d 0-21 (P &amp;lt; 0.01), in which HZ decreased the index in LBBW. An interaction was also observed in villus height (P = 0.05) and absorptive mucosal surface (P = 0.02) on d 21, that resulted greater in NBBW piglets fed ZnSO4. For Beta diversity, using the Adonis test, BBW category tended to affect the microbial structure at d 9 (R2 = 0.04; P = 0.07) and significantly affected the bacterial structure (R2 = 0.05, P = 0.03) at d 21. At d 21, the NBBW piglets fed ZnSO4 had a greater abundance of Succinivibrio which is able to degrade complex carbohydrates, while the NBBW piglets fed HZ had a greater abundance of Ruminococcus gauvreauii which is linked to the production of short chain fatty acids (SCFAs). The use of HZ seems can be a part of the strategy to replace the pharmacological level of ZnO.

Chemical Composition of Newborn Piglets with Different Weights at Birth in Sows with a High Reproductive Performance.

The present study aimed to quantify and update the data on the body composition (energy nutrients) of newborn piglets of different body weights at the time of birth, as well as of the placenta mass. Data were collected from newborn piglets (n = 25) from modern genetic lines which were stillborn or died within the first 24 h of life after being crushed to death with various body weights at birth (<0.8 kg (n = 5); 0.8-1.2 kg (n = 5); >1.2-1.6 kg (common birth weight, n = 10) and >1.6 kg (n = 5)). The placenta (n = 20) of sows from a conventional breeding farm were collected, too. The body composition of newborns of "normal" (>1.2-1.6 kg) and even lighter (0.8-1.2) weights still indicated a "normal" composition. In the case of a lower body weight of piglets <0.8 kg at birth, the crude ash (24.1%) and crude protein (8.21%) contents were higher, but the crude fat (16.1%), carbohydrate (57.4%), and gross energy (3.60%) contents were lower. The placental composition in comparison to the piglet body composition was characterized by higher crude protein contents (24.3%) and lower crude ash (31.6%), crude fat (9.08%), and carbohydrate (55.6%) contents. In conclusion, the energy and protein accumulation in the total mass of fetuses and placentas increased by 75% and 64%, respectively, in comparison to times in which the litter size varied around 10-12 piglets, essentially as a result of the larger fetal mass and not of a different body composition.

Assessing the effects of cold storage regimes of North American Bombus Gynes

AbstractBumble bees are the primary commercial pollinators for greenhouse‐grown crops and managing them requires insight into the Bombus life cycle. However, some aspects of the life cycle are not fully understood. Once mated, adult Bombus gynes can be stored for a short term at a constant low temperature (CLT). However, survival rates for some species are low during CLT, particularly when storage periods exceed a month. To address this, we tested the hypothesis that Bombus gynes stored in a fluctuating thermal regime (FTR) have increased survival compared to gynes stored in CLT. Specifically, the FTR had a baseline temperature of 2°C, with a daily fluctuation to 20°C relative to the CLT of 2°C with no warming pulse. We tested the effects of FTR on gyne survival and post‐cold storage lipid content in three species used for commercial pollination in North America: B. vosnesenskii, B. huntii and B. impatiens. We further assessed how additional factors influence cold storage survival, including gyne body weight, body size and colony age. Survival responses varied among species. Bombus vosnesenskii and B. huntii had a lower survival rate in FTR compared to CLT, but B. impatiens gynes had a significantly higher survival rate in FTR. We did not observe significant effects of FTR on lipid stores for any species, but survival increased with an increasing initial weight prior to cold storage. Moreover, gynes produced later in the colony life cycle had lower body weight and decreased survival compared to early emerging gynes. Our study provides insight into how cold storage conditions interact with colony and gyne characteristics to influence captive overwintering survival. Our findings have economic applications for improving commercial rearing and efforts for conservation rearing of at‐risk Bombus species.

Baroreflex Sensitivity as a Surrogate Biomarker for Concurrently Assessing the Severity of Arterial Stiffness and Cardiovascular Autonomic Neuropathy in Individuals with Type 2 Diabetes

This study aimed to investigate whether baroreflex sensitivity (BRS) could serve as a reliable metric for assessing cardiovascular autonomic neuropathy (CAN) and concurrently act as a surrogate biomarker for evaluating the severity of arterial stiffness and CAN in individuals diagnosed with type 2 diabetes mellitus (T2DM). Participants underwent brachial–ankle pulse wave velocity (baPWV) as well as autonomic function evaluations encompassing the Sudoscan-based modified composite autonomic scoring scale (CASS), baroreflex sensitivity, and heart rate variability in time domains and frequency domains. Linear regression analysis was performed to evaluate the influence of independent variables on baPWV and modified CASS. Participants with higher baPWV values were older, with longer diabetes duration, lower body weight, body mass index, waist circumference, elevated systolic and diastolic blood pressure, and mean arterial blood pressure. They also exhibited a higher prevalence of retinopathy as the underlying disease and reduced estimated glomerular filtration rate. Multiple linear regression analysis revealed that age and BRS were significantly associated with baPWV while diabetes duration, UACR, and BRS were significantly associated with modified CASS. Our study confirms the significant association of BRS with baPWV and modified CASS in T2DM, highlighting its pivotal role in linking microvascular and macrovascular complications. This supports BRS as a surrogate marker for assessing both the severity of arterial stiffness and cardiovascular autonomic neuropathy in T2DM, enabling the early identification of complications.

Peripheral Blood Stem Cell Harvesting in Young Children Weighing Less Than 15 Kilograms

Autologous peripheral blood stem cell (PBSC) transplantation is crucial in pediatric cancer treatment, and tandem transplantation is beneficial in certain malignancies. Collecting PBSCs in small children with low body weight is challenging. We retrospectively analyzed data of pediatric cancer patients weighing <15 kg who underwent autologous PBSC harvesting in our hospital. Collections were performed in pediatric intensive care unit over 2 or 3 consecutive days, to harvest sufficient stem cells (goal ≥2 × 106 CD34+ cells/kg per apheresate). From April 2006 to August 2021, we performed 129 collections after 50 mobilizations in 40 patients, with a median age of 1.9 (range, 0.6-5.6) years and a body weight of 11.0 (range, 6.6-14.7) kg. The median CD34+ cells in each apheresate was 4.2 (range, 0.01-40.13) × 106/kg. 78% and 56% of mobilizations achieved sufficient cell dose for single or tandem transplantation, respectively, without additional aliquoting. The pre-apheresis hematopoietic precursor cell (HPC) count was highly correlated with the CD34+ cell yield in the apheresate (r = 0.555, P < 0.001). Granulocyte colony-stimulating factor alone was not effective for mobilization in children ≥2 years of age, even without radiation exposure. By combining the pre-apheresis HPC count ≥20/μL and the 3 significant host factors, including age <2 years, no radiation exposure and use of chemotherapy, the prediction rate of goal achievement was increased (AUC 0.787).

The Effects of Ketogenic Diet on Brain Gene Expressions in Type 2 Diabetes Background

Type 2 diabetes mellitus (T2DM) is a major risk factor of a number of neurodegenerative diseases (NDDs). Ketogenic diet (KD) has significant beneficial effects on glycemic control and may act effectively against NDDs, but the mechanism remains unclear. In this study, we aimed to investigate the potential effects of KD on gene expressions in the brains of T2DM model mice. Male db/db mice at the age of 9 weeks were fed with KD or normal diet to the age of 6 months, and the whole brains were subjected to mRNA-seq analysis for differentially expressed genes. KD significantly lowered fasting glucose and body weights in db/db mice (P < 0.05), and the expression of 189 genes in the brain were significantly changed (P < 0.05, |log2| > 1). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed that the differentially expressed genes upon KD are involved in inflammatory responses and the functions of biosynthesis. In inflammatory responses, NF-κB signaling pathway, viral protein interaction with cytokine and cytokine receptor, and cytokine-cytokine receptor interaction pathways were enriched, and in biosynthesis pathways, genes functioning in lipid and amino acid metabolism, protein synthesis, and energy metabolism were enriched. Moreover, consistent with the gene set enrichment analysis results, proteasomal activity measured biochemically were enhanced in KD-fed T2DM mice. These data may facilitate the understanding of how KD can be protective to the brain in T2DM background. KD could be a new strategy for the prevention of NDDs in T2DM patients.

Association of preexisting anti-thyroid antibodies and body mass index with prognosis of lung cancer patients treated with PD-1/PD-L1 inhibitors

Abstract Objectives Immune checkpoint inhibitors are a new beneficial medication in the treatment of cancer. Whether preexisting TPOAb was related to longer overall survival (OS) is controversial. This retrospective study analyzed the OS and progression-free survival (PFS) of patients with lung cancer, and explored predictive factors associated with the efficacy of PD-1/PD-L1 inhibitors treatment. Methods Patients with lung cancer who were hospitalized in the First Affiliated Hospital of Wenzhou Medical University between January 1, 2020 and December 30, 2020 were enrolled. Thyroid function, TPOAb, TGAb, and prognostic nutritional index levels and body mass index were analyzed. Supervising physicians independently assessed patient staging, OS, and PFS. Demographic data, pathological type, and previous treatment history were also collected. Results In total, this study enrolled 69 patients, with ages of 46–80 years old. Patients with lower weight showed reduced OS and PFS rates relative to those with normal weight and overweight (p&lt;0.05). The single patient with large cell neuroendocrine carcinoma (LCNEC) exhibited a 1-, 1.5- and 2-year OS rate lower than that of the patients diagnosed with squamous cell carcinoma, small cell lung cancer, or adenocarcinoma (p&lt;0.05). This LCNEC patient also had lower 1-, 1.5-, and 2-year PFS rates compared to adenocarcinoma patients (p&lt;0.05). TPOAb and TGAb levels were unrelated to OS or PFS. Multivariate Cox regression analyses revealed a positive association between body mass index, OS, and PFS. Conclusions Patients with lower body weight were predictive of poorer survival outcomes when receiving PD-1/PD-L1 inhibitors treatment as compared to patients with normal weight and overweight. However, positive baseline TGAb and TPOAb levels were not associated with increased OS or PFS in patients with lung cancer.

Differential Modulation by Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) of Mesenteric Fat and Macrophages and T Cells in Adipose Tissue of Obese fa/fa Zucker Rats.

Polyunsaturated fatty acids (PUFAs) can alter adipose tissue function; however, the relative effects of plant and marine n3-PUFAs are less clear. Our objective was to directly compare the n3-PUFAs, plant-based α-linolenic acid (ALA) in flaxseed oil, and marine-based eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) in high-purity oils versus n6-PUFA containing linoleic acid (LA) for their effects on the adipose tissue and oral glucose tolerance of obese rats. Male fa/fa Zucker rats were assigned to faALA, faEPA, faDHA, and faLA groups and compared to baseline fa/fa rats (faBASE) and lean Zucker rats (lnLA). After 8 weeks, faEPA and faDHA had 11-14% lower body weight than faLA. The oral glucose tolerance and total body fat were unchanged, but faEPA had less mesenteric fat. faEPA and faDHA had fewer large adipocytes compared to faLA and faALA. EPA reduced macrophages in the adipose tissue of fa/fa rats compared to ALA and DHA, while faLA had the greatest macrophage infiltration. DHA decreased (~10-fold) T-cell infiltration compared to faBASE and faEPA, whereas faALA and faLA had an ~40% increase. The n3-PUFA diets attenuated tumour necrosis factor-α in adipose tissue compared to faBASE, while it was increased by LA in both genotypes. In conclusion, EPA and DHA target different aspects of inflammation in adipose tissue.

[Dance-specific eligibility of vocational ballet students - examinations at a governmental training institution for classical ballet].

During their training, pre-professional ballet students are confronted with physical stresses comparable to those of competitive sports. In competitive sports, there are mandatory and binding aptitude tests to ensure that the growing athlete meets the requirements. In ballet, there are no such mandatory examinations preceding the start of training. For adult professional dancers, musculoskeletal ideals could be isolated from the dance medicine literature. However, only a few studies describe musculoskeletal characteristics of pre-professional ballet students. It is neither known at what age a student should meet the ideal measurements for an adult nor what deviations from the ideal can be considered normal. This study aims to describe sociodemographic and musculoskeletal characteristics of pre-professional ballet students and discusses to what extent they already meet or deviate from dance-specific eligibility criteria for adult professional ballet dancers. In this study, n = 414 female and n = 192 male students of John Cranko School (JCS) were seen by an experienced orthopaedist and dance physician. Mean age was 13.9 years (SD 3.5, range 5-22 years). Their medical history was taken (age; nationality; start of ballet/training) and a physical examination was performed (height/weight; symmetry of shoulder girdle, spine, waist triangles; pelvic tilt; tibial torsion; range of motion of base of index finger joint, spine, hips, ankle and base of great toe joint). Subsequently, the results of this study were compared with suitability criteria for adult professional ballet dancers that had been isolated from the dance medicine literature for a previous article. Examinees were from 49 different nations. 34.6% of the female subjects (≥16 years) were between 165 and 170 cm and 33.3% of the male subjects (≥18 years) were between 178 and 185 cm tall. 45.0% of those examined showed low body weight (<10th percentile, BMI <18.5 kg/m²). The trunk of 61.0-84.8% of those examined was erect and symmetrical. 25.2% had scoliosis. Half (53.5%) were found to have a bilateral external rotation of the hips of at least 60°, and 68.7% had a bilateral internal rotation between 20 and 50°. 87.3% exhibited a bilateral tibial torsion between 15 and 40°. A bilateral en dehors of 90° was calculated for 25.0%. In 9.1% of those examined, the upper ankle joints presented a dorsiflexion of at least 25°, and in 70.2%, a plantarflexion of at least 70° was seen. In 88.0%, the metatarsophalangeal joint of the great toe was 90° (f) and 80° (m) on both sides. The results of this study showed that pre-professional ballet students fulfil many characteristics of adult professional ballet dancers. High values already among young age groups suggest a ballet-specific selection. Nevertheless, not all students fulfil the theoretical "ideal measurements" for professional classical ballet. These anatomical limits should be considered individually in training to protect the growing pre-professional ballet dancer. The high ballet-specific anatomical demands, but especially the large number of students with a low body weight, underline the necessity of mandatory aptitude tests at the beginning and regular check-ups in the course of training to avert compensatory mechanisms and their consequential damage and to screen for eating disorders and disorders of eating behaviour.

Infant exposure to ochratoxin A, zearalenone, and deoxynivalenol from the consumption of milk formula and baby cereal in Chile

Ochratoxin A (OTA), zearalenone (ZEN), and deoxynivalenol (DON) are mycotoxins whose exposure is associated with various adverse health effects, including cancer and renal disorders, estrogenic effects, and immunosuppressive and gastrointestinal disorders, respectively. Infants (<2 years) are the most vulnerable group to mycotoxins, representing a unique combination of restricted food consumption types, low body weight, lower ability to eliminate toxins, and more future years to accumulate toxins. This study aimed to estimate the infant́s exposure to OTA, DON, and ZEN due to the consumption of milk formula and baby cereals in Chile.Milk formula samples (n = 41) and baby cereals (n = 30) were collected and analyzed using commercial ELISA kits for OTA, DON, and ZEA determination. Exposure was assessed by the Estimated Daily Intake (EDI) approach (mean and worst-case scenario, WCS) with the levels found in a modified Lower Bound (mLB) and Upper Bound (UB); ideal consumption (<6m, 7–12 m, and 13–24 m); adjusted by the weight of each group. The risk was estimated by comparing the EDI with a reference tolerable daily intake or by the margin of exposure (MOE) in the case of OTA.DON and OTA occurrence in infant formula were 34 % and 41 %, respectively. The co-occurrence between these mycotoxins was 22 %. Mycotoxin contents were below LOQ values except for OTA determined in one sample (0.29 ng/ml). No milk formulae were contaminated with ZEN. In the case of baby cereals, the occurrences were 17 % for OTA, 30 % for DON, and 7 % for ZEN, all below LOQ. Co-occurrence was seen in two samples between ZEN and OTA. According to exposure calculations, the MOE for OTA was less than 10,000 in all models for milk formula between 0 to 12 months of age and in the UB and WCS for cereal consumption. Health concerns were observed for DON in the WCS and UB for milk consumption in all ages and only in the UB WCS for cereal consumption. Considering the high consumption of milk formula in these age groups, regulation of OTA and other co-occurring mycotoxins in infant milk and food is strongly suggested.

Inappropriate Peak Inspiratory Flow Rate in the Patients with Stable Chronic Obstructive Pulmonary Disease in Korea.

Inhalation therapy efficacy hinges on proper peak inspiratory flow rate (PIFR) attainment, yet the prevalence of inappropriate PIFR among patients with chronic obstructive pulmonary disease (COPD) remains unstudied in Korea. This study aimed to assess the prevalence of inappropriate PIFR, its correlation with COPD assessment test (CAT) scores, and factors associated with suboptimal PIFR. We enrolled 108 patients with COPD who had been using the same inhaler for at least one year without exacerbations. PIFR was measured using an inspiratory flow meter (In-Check™ DIAL G16). Demographic, clinical, pulmonary function, and CAT score data were collected. Inappropriate was defined as PIFR < 60L/min for dry power inhaler (DPI) users or > 90L/min for aerosol device users. The cohort comprised 87 (80.6%) men, mean age 71.0 ± 8.5 years, with mean post-bronchodilator forced expiratory volume in one second of 69.1 ± 1.8% predicted. Twenty-nine (26.9%) used aerosol devices, 76 (70.4%) used DPIs, and three (2.8%) used both. Inappropriate PIFRs were found in 17.2% of aerosol device users and 42.1% of DPI users. CAT scores were significantly higher in inappropriate PIFR group than appropriate PIFR group (11.2 ± 7.7 vs 7.5 ± 4.9, P = 0.003). In DPI users, female, shorter height, lower body weight and MVV (maximal voluntary ventilation) were associated with inappropriate PIFR. Prevalence of inappropriate PIFR among patients with COPD is 17.2% for aerosol device users and 42.1% for DPI users. Suboptimal PIFR correlates with female gender, shorter stature, lower weight and MVV in DPI users.

Body weight loss is a simple and useful indicator of prognosis and predictive tolerability in the first year of nintedanib therapy in patients with interstitial lung disease

BackgroundNintedanib is generally safe and well tolerated and can improve prognosis in patients with various interstitial lung diseases (ILDs). Appropriate management of adverse events of nintedanib is important to ensure its long-term persistent use. Weight loss is a routinely assessed adverse event in clinical practice. This study aimed to elucidate whether body weight change in the first year of nintedanib therapy can indicate prognosis and predict tolerability in patients with ILD. MethodsWe analysed 245 consecutive ILD patients treated with nintedanib. We calculated the slope of body weight change using baseline weight and that recorded closest after the first year and then categorized percent change in body weight at this time. Significant weight loss was defined as that ≥5%. ResultsSubjects included 67 patients with idiopathic pulmonary fibrosis (IPF) and 76 with non-IPF progressive fibrosing-ILD including fibrotic hypersensitivity pneumonitis (n = 16), unclassifiable (n = 35), connective tissue disease-ILD (n = 21), and nonspecific interstitial pneumonia (n = 4). Older age, low body weight at initial examination, significant weight loss, and lower %FVC were significant predictors of discontinuation of nintedanib. Patients with weight loss ≥5% over the first year showed worse survival than those with weight loss <5% regardless of whether IPF existed or BMI indicated obesity. ConclusionsCareful monitoring of body weight change might suggest useful information for predicting long-term use of nintedanib and mortality risk in ILD patients treated with nintedanib. Appropriate body weight management is needed to prevent adverse events of nintedanib itself.

Being an Anorectic versus Having Anorexia: Should the DSM Diagnostic Criteria Be Modified?

The Diagnostic and Statistical Manual of Mental Disorders classifies “anorexia nervosa” as a mental disorder, yet individuals with anorexia often characterize it as an identity. The author describes the identity of being an anorectic and compares it with what it takes to have anorexia in the diagnostic sense. This furthers the existing scholarship on anorexia and identity, most notably by revealing a disconnect between being an anorectic and having anorexia: Some individuals inhabit the identity of being an anorectic but do not have anorexia because they do not have a significantly low body weight. The author explores whether expanding the diagnostic criteria for anorexia would be beneficial for anorectics by examining the implications of classifying the identitive phenomenon of being an anorectic in terms of a medical concept of mental disorder. In the short term, the answer depends on whether being an anorectic calls for interventions that require a diagnosis. Either way, it would be beneficial to develop nonmedical frameworks for understanding anorexia that facilitate interventions that do not require a diagnosis. Understanding being an anorectic as an identity lays the scaffolding for a nonmedical way of conceptualizing anorexia that illuminates innovative approaches to assisting anorectics.

Evaluation of Postoperative Outcomes After Enterostomy Closure in Low Body Weight Infants: A Multi-Center Retrospective Analysis.

The minimum weight for enterostomy closure (EC) in infants remains debated with the current acceptable cut-off of >2kg. As enterostomy-related complications or high enterostomy output (>30cc/kg/d) may prohibit a premature infant from reaching 2kg, additional data is needed to evaluate the safety of EC in infants <2kg. The objective of this study was to evaluate postoperative outcomes in low body weight (<2kg) infants undergoing EC compared to larger infants. We performed a multi-center retrospective analysis from 1/1/2012-12/31/2022 of all infants (age <1 year) who were <4kg at time of EC. Primary outcomes included postoperative complications and 30-day mortality. Non-parametric analysis was performed using the Kruskal-Wallis one-way analysis of variance and chi-square tests. Univariable logistic regression was performed to identify factors associated with postoperative complications. Of 92 infants, 15 infants (16.3%) underwent EC at <2kg, 16 (17.4%) at 2-2.49kg, 31 (33.7%) at 2.5-2.99kg, and 30 (32.6%) at ≥3kg. Infants <2kg at time of EC exhibited higher rates of hyperbilirubinemia (P = .030), neurologic comorbidities (P = .030), and high enterostomy output (P = .041). There was no difference in postoperative complications (P = .460) or 30-day mortality (P = .460) between the <2kg group and larger weight groups. Low body weight was not associated with an increased risk for developing a postoperative complication (OR: 1.001, 95% CI: 1.001-1.001; P = .032). Our findings suggest that EC in infants <2kg may be safe with comparable postoperative outcomes to larger weight infants. Thus, the timing of EC should be based on the infant's physiologic status, in contrast to a predetermined minimum weight cut-off.

Pharmacokinetics of Edoxaban 15 mg in Very Elderly Patients with Nonvalvular Atrial Fibrillation: A Subanalysis of the ELDERCARE-AF Study.

We evaluated the pharmacokinetics (PK) of low-dose (15 mg) edoxaban in very elderly patients (≥80 years) with nonvalvular atrial fibrillation (NVAF) and high bleeding risk. This subanalysis of the phase 3, randomized, double-blind, placebo-controlled, multicenter ELDERCARE-AF study evaluated edoxaban plasma concentrations and compared them with the Japanese population of the ENGAGE AF-TIMI 48 and Japanese severe renal impairment (SRI) studies. The PK analysis population included 451 patients, 53.8% of whom concomitantly used antiplatelet drugs, 41.0% had SRI, and 38.0% had low body weight. Edoxaban plasma concentrations at trough and 1 to 3 hours post-dose in ELDERCARE-AF were 17.3 ± 13.9 (n = 427) and 93.3 ± 57.8 ng/mL (n = 447), respectively. These values were slightly higher than the 15 mg group in ENGAGE AF-TIMI 48 (n = 79; 12.4 ± 12.1 and n = 115; 78.7 ± 45.0 ng/mL, respectively), lower than the ENGAGE AF-TIMI 48 high-dose reduced to 30 mg group (n = 83; 25.1 ± 36.6 and n = 111; 150 ± 91.6 ng/mL, respectively), but similar to the Japanese SRI study (n = 39; 18.4 ± 11.2 and n = 40; 96.8 ± 48.3 ng/mL, respectively). ELDERCARE-AF patients with SRI and low body weight (≤45 kg) had higher concentrations than those without, and those taking antiplatelet drugs had lower concentrations than those who were not. PK data support edoxaban 15 mg once daily for very elderly NVAF patients with high bleeding risk, with caution for patients with SRI and/or low body weight.