Umbilical Level Research Articles

Interscapular Fat Is Strongly Associated with Insulin Resistance

Subcutaneous abdominal adipose tissue (SCAAT), visceral adipose tissue (VAT), fat in the neck area [interscapular fat (IF)], and liver fat (LF) are associated with metabolic traits related to insulin resistance. Whole-body magnetic resonance imaging and spectroscopy offer a unique approach to quantify fat depots in larger cohorts. The objective was to study 1) the impact of the aforementioned fat depots on insulin sensitivity in a cross-sectional design and 2) changes in these fat depots and in insulin sensitivity during a lifestyle intervention (LI). One hundred eighty-seven subjects were included in the cross-sectional study. Follow-up data during LI were available in 172 subjects. Body fat depots were quantified by whole-body magnetic resonance imaging, and representative reference slices at the umbilical level (SCAAT, VAT) and at the level of the shoulder joint (IF) were analyzed. LF was measured by (1)H-magnetic resonance spectroscopy. Insulin sensitivity was estimated from an oral glucose tolerance test. Cross-sectionally, SCAAT, VAT, IF, and LF were negatively associated with IS (all P < 0.0001). The change in insulin sensitivity during LI was associated with the changes in these fat depots (all P < 0.001). In a multivariate model, the change in insulin sensitivity during LI adjusted for gender, age, LF, and IF at baseline was associated with change in IF (P < 0.01) and with change in LF (P < 0.0001). IF represents a subcutaneous fat depot determining whole-body IS, both cross-sectionally and during LI. The impact of LF and IF on insulin sensitivity appears to be independent from each other. Additional studies are needed to clarify the metabolic properties of IF.

Thyroid function screening of cord blood in infants born to mothers complicated with hypothyroidism during pregnancy

Objective To evaluate the clinical significance of thyroid stimulating hormone (TSH) and thyroid autoantibodies (anti-TGAb and anti-TPOAb) in cord blood of infants of mothers complicated with hypothyroidism and the influencing factors of neonatal thyroid function. Methods Clinical data of 67 singleton pregnant women complicated with hypothyroidism in Peking Union Medical College Hospital were analyzed retrospectively. Thyroid function and its autoantibody levels in maternal, cord blood and neonatal serum at 5-7 d after birth were compared. Umbilical TSH level and its affecting factors were also investigated. The results of TSH was expressed as median (25th-75th percentile). Results (1) Umbilical TSH levels were elevated in 9. 0% (6/67) of all infants born to mothers complicated with hypothyroidism. (2) No correlation was found in TSH levels between cord blood and venous blood in neonates 5-7 d after birth. Umbilical TSH levels were significantly higher in infants born vaginally than in those born abdominally [10. 20(6. 10-12. 80) mU/L vs 5. 86(4.02-7.74) mU/L,P=0.001]. Higher umbilical TSH levels were also detected in those complicated with fetal distress and preterm birth compared with those withoutere [fetal distress: (10. 36(6. 61-13. 37) mU/L and 6. 89(4. 18-9. 70) mU/L, P = 0. 046; preterm birth: 8. 90(7. 60-10. 33) mU/L and 6.84(4.17-9. 80) mU/L,P=0. 046,0. 049)]. (3) The anti-TGAb levels in cord blood were positively correlated with that in neonatal serum at 5-7 d after birth (r=0. 960, P = 0. 000), and the same was true for anti-TGPOAb levels (r= 0. 975, P = 0. 000). Maternal thyroid autoantibody levels (anti-TGAb and anti-TPOAb) had significant effect on umbilical antibody levels (P = 0. 003 and 0. 000, respectively), but not on the neonatal TSH levels (P>0. 05). Conclusions Umbilical TSH levels are affected by many delivery factors which may limit its prediction role on congenital hypothyroidism. However, there is an increased risk of elevated umbilical TSH, anti-TGAb and anti-TPOAb levels among these patients which may increase the risk of congenital hypothyroidism. Further follow up of these infants is warranted. Key words: Pregnancy complications; Hypothyroidism; Fetal blood; Thyrotropin

Effects of Long-term Administration of Indigestible Dextrin on Visceral Fat Accumulation

[Abstract] We conducted a clinical trail in order to evaluate the effects of continual ingestion of indigestible dextrin on both glucose and lipid metabolism, and fat accumulation and its distribution in human subjects. There were twelve male subjects with either serum total – cholesterol level more than 220 mg/dl or triacylglycerol level more than 150 mg/dl. Subjects were concurrently ingested 10g of indigestible dextrin with meal (3 times/day) for three month. Each was subjected to a glucose tolerance test and CT scan at umbilical level, and also taken blood sample to measure the clinical laboratory data before and after the test period. Compared to the starting levels, percent body fat in all the subjects and the area of visceral fat in subjects with obesity were significantly decreased. Although the average peak level of serum glucose was more than 200 mg/dl at 60 min after 75 g glucose administration, glucose tolerance was improved and the average levels of serum glucose at 30, 60, and 120 min were significantly reduced after the test period. Likewise, serum total-cholesterol and triacylglycerol levels were significantly reduced. No adverse event such as diarrhea was observed through the test period. In conclusion, continual ingestion of indigestible dextrin is useful for reducing the body fat accumulation, especially visceral fat.

Prenatal Organochlorine Exposure and Behaviors Associated With Attention Deficit Hyperactivity Disorder in School-Aged Children

Organochlorines are environmentally persistent contaminants that readily cross the placenta, posing a potential risk to the developing fetus. Evidence for neurodevelopmental effects at low levels of these compounds is growing, though few studies have focused on behavioral outcomes. The authors investigated the association between prenatal polychlorinated biphenyl (PCB) and p,p'-dichlorodiphenyl dichloroethylene (p,p'-DDE) levels and behaviors associated with attention deficit hyperactivity disorder (ADHD), measured with the Conners' Rating Scale for Teachers (CRS-T), in a cohort of 607 children aged 7-11 years (median age, 8.2 years) born in 1993-1998 to mothers residing near a PCB-contaminated harbor in New Bedford, Massachusetts. The median umbilical cord serum level of the sum of 4 prevalent PCB congeners (118, 138, 153, and 180) was 0.19 ng/g serum (range, 0.01-4.41 ng/g serum). The authors found higher risk for ADHD-like behaviors assessed with the CRS-T at higher levels of PCBs and p,p'-DDE. For example, the authors found higher risk of atypical behavior on the Conners' ADHD Index for the highest quartile of the sum of 4 PCB congeners versus the lowest quartile (risk ratio = 1.76, 95% confidence interval: 1.06, 2.92) and a similar relation for p,p'-DDE. These results support an association between low-level prenatal organochlorine exposure and ADHD-like behaviors in childhood.

The Relationship Between Waist Circumference and the Risk of Stroke and Myocardial Infarction in a Japanese Urban Cohort

Body mass index is most commonly used as the obesity index. Recently, waist circumference (WC) has been shown to be associated with the risk of cardiovascular disease (CVD). However, no studies have observed an association between WC and CVD in Japan. We examined the relationships of WC and body mass index with CVD in a Japanese urban population. We studied 5474 Japanese individuals (aged 30 to 79 years without CVD at baseline) who completed a baseline survey and received follow-up through December 2005. WC was measured at the umbilical level of participants in the standing position to the nearest 1 cm. The Cox proportional hazard ratios for CVD according to the quartiles of WC were calculated after adjustment for age, smoking, and drinking status. During a mean follow-up of 11.7 years, 207 strokes and 133 myocardial infarctions were documented. In women, compared with the lowest quartile (WC <70 cm), the hazard ratio (95% CIs) after adjusting for age, smoking, and drinking in the highest quartile (WC >or=84 cm) were 1.85 (1.03 to 3.31) for CVD and 2.64 (1.16 to 6.03) for stroke. However, no such relationships of WC with CVD or stroke risk were observed in men. After further adjustment of hypertension, diabetes, and hypercholesterolemia, all of the mentioned relationships were not statistically significant. No associations of body mass index with CVD or strokes were observed. WC may be a better predictor for CVD or stroke in Japanese women.

Diabetic retinopathy is associated with visceral fat accumulation in Japanese type 2 diabetes mellitus patients

The presence of diabetic retinopathy (DR) and increased of visceral fat accumulation (VFA) are associated with high mortality in type 2 diabetes mellitus patients. This preliminary study was therefore designed to test the hypothesis that DR is associated with insulin resistance and VFA in type 2 diabetes mellitus patients without insulin treatment. A total of 102 type 2 diabetes mellitus patients were divided into 2 groups: DR group (age, 60 ± 6 years [mean ± SD]; n = 31) and no diabetic retinopathy (NDR) group (59 ± 5 years, n = 71). The level of blood glucose was assessed by fasting plasma glucose, fasting immunoreactive insulin, homeostasis model assessment index, and hemoglobin A 1c. The fat distribution was evaluated by measuring the VFA by abdominal computed tomography at the umbilical level. The body mass index and waist circumference were higher in the DR group than in the NDR group ( P < .001 and P < .0005, respectively). Plasma levels of triglyceride were higher, whereas high-density lipoprotein cholesterol was lower, in the DR group than in the NDR group ( P < .005 and P < .0001, respectively). Fasting plasma glucose ( P < .0005), insulin concentrations ( P < .0001), homeostasis model assessment index ( P < .0001), and VFA ( P < .0001) levels were higher in the DR group than in the NDR group. Multivariate logistic analysis revealed that DR was independently predicted by high VFA and insulin resistance. The results of this preliminary study indicate that the presence of DR was associated with high VFA and insulin resistance in Japanese patients with type 2 diabetes mellitus.

Umbilical Cord Ghrelin in Term and Preterm Newborns and its Relation to Metabolic Hormones and Anthropometric Measurements

The aim of the study was to assess umbilical cord ghrelin level in term and preterm newborns and its relation to other metabolic hormones and anthropometric measurements. A cross sectional comparative study included 50 normal appropriate-for-gestational-age newborns (25 full-terms; 25 preterm). Assessment of anthropometric measurements, cord levels of ghrelin, leptin, insulin and glucose were done to all newborns. Umbilical cord ghrelin was detected in all newborns. There was no significant difference between term and preterm groups regarding ghrelin, insulin and glucose. Leptin was significantly lower in preterm than term group. Sex and mode of delivery had no effects regarding all studied variables. There was no overall correlation between ghrelin and gestational age, anthropometric measurements, leptin, insulin or glucose in all newborns. Preterm group demonstrated significant correlations between ghrelin and weight, body mass index and abdominal circumference. An overall significant correlation was found between leptin and gestational age and anthropometric measurements in all newborns. In preterm group leptin correlated with weight, length, subscapular skin-fold thickness and abdominal circumference. To conclude the umbilical cord ghrelin was relatively invariable at birth between 30 and 41 weeks gestation showing no gestational age-related variation, unlike leptin, which was lower in preterm group indicating increased adipose mass and placental maturation with increased gestational age.

Diferentes aferições do diâmetro abdominal sagital e do perímetro da cintura na predição do HOMA-IR

The correlation between the increase in visceral fat and insulin resistance makes the sagittal abdominal diameter and the waist perimeter as potential tools for the prediction of insulin resistance.To assess the reproducibility of different measurements of the sagittal abdominal diameter and the waist perimeter and analyze the discriminating power of the measurements when predicting insulin resistance.A total of 190 adult males were studied. The sagittal abdominal diameter (smallest girth, larger abdominal diameter, umbilical level and midpoint between the iliac crests) and the waist perimeter (umbilical level, smallest girth, immediately above the iliac crest and midpoint between the iliac crest and the last rib) were measured at four different sites. Insulin resistance was assessed by the homeostasis model of assessment-insulin resistance (HOMA-IR) index.All measurements presented an intraclass correlation of 0.986-0.999. The sagittal abdominal diameter measured at the smallest girth (r=0.482 and AUC=0.739+/-0.049) and the waist perimeter measured at the midpoint between the last rib and the iliac crest (r=0.464 and AUC=0.746+/-0.05) presented the highest correlations with the HOMA-IR and the best discriminating power for HOMA-IR according to the ROC analysis (p<0.001).The sagittal abdominal diameter and waist perimeter showed to be highly reproducible and the sagittal abdominal diameter (smallest girth) and waist perimeter (midpoint between the iliac crest and the last rib) presented the best performance when predicting HOMA-IR. Further studies in other groups of the Brazilian population must be carried out to allow the use of these indicators of insulin resistance in the population as a whole, following standardized procedures.

Correlation of Fat Distribution in Whole Body MRI With Generally Used Anthropometric Data

: Obesity is a commonly known risk for many diseases such as metabolic syndrome and cardiovascular disease. Especially important is the discrimination of the adipose tissue inside the abdomen and the subcutaneous adipose tissue. Aim of this study was to compare the whole body fat distribution, and the volume of different adipose tissue compartments respectively, with anthropometric data. : Sixty-eight volunteers (20 males, 48 females, 42.3 +/- 15.4 years) were investigated in the context of 2 whole body magnetic resonance imaging (MRI) studies which compared the body fat distribution of depressive and bulimic patients with healthy controls. Unpublished data acquired in these studies were analyzed retrospectively.The sample consisted of 38 healthy volunteers, 17 patients with a depressive syndrome and 13 women suffering from bulimia nervosa. Individual body volume, total adipose tissue (TAT) volume, subcutaneous adipose tissue (SCAT) volume at the trunk, and visceral adipose tissue (VAT) volume were determined, using whole body MRI. Additionally, body fat profiles were standardized and a mean body distribution was calculated. Other modalities to acquire body fat content were: skin fold caliper, body impedance (3 different devices) and simple anthropometric data (Waist to Hip Ratio [WHR], Body Mass Index [BMI], distance of the aponeurosis of the rectus abdominis muscle to the ventral rim of the abdominal aorta (measured in MRI images on umbilical level) (AD) and subcutaneous adipose tissue thickness at the same level). The different modalities were correlated with the MRI data. : There were highly significant correlations between the skin fold data and TAT (Spearman coefficient 0.668, P >/= 0.0004) and SCAT (0.662, P >/= 0.0004). But there was no correlation with VAT. Impedance data revealed significant correlations of TAT and SCAT (Spearman 0.7, P >/= 0.0004).Simple anthropometric data like waist and hip circumference, WHR, and BMI revealed significant correlations (Spearman coefficient around 0.7-0.4, P < 0.05) with the fat compartments TAT, VAT, and SCAT.The standardized body fat slices and the VAT slices were correlated with the anthropometric data and impedance data to explore specific areas along the body axis where the correlations were higher or weaker. Skinfold data, BMI, and body impedance data yielded significant correlations with TAT along the whole body axis, as well as with VAT in almost the whole analyzed area. However, there was no special body region with locally higher correlations. WHR depicted high correlations with whole VAT, and regional TAT at the abdomen (and not with the other body regions) especially in women. Therefore, it seems to be the best marker for abdominal fat and VAT in this study. : We compared different body measures and body fat devices with the whole body fat distribution acquired by MRI. Generally, there were significant correlations of all modalities with body fat content (TAT) and mainly with SCAT. Correlations with VAT compartment were much weaker and an adequate estimation of VAT is, therefore, not possible. Only WHR revealed significant correlations with the fat in the body center, but only in women. If it is important to investigate especially the VAT which is responsible for a higher cardiovascular risk, risk for a metabolic syndrome and that is correlated with the course of different psychiatric diseases, cross sectional techniques such as MRI can not be substituted by simpler methods.

Abdominal Fat in Children Measured by Ultrasound and Computed Tomography

The prevalence of childhood obesity is increasing rapidly. Visceral fat plays an important role in the pathogenesis of metabolic and cardiovascular diseases. Currently, computed tomography (CT) is broadly seen as the most accurate method of determining the amount of visceral fat. The main objective was to examine whether measures of abdominal visceral fat can be determined by ultrasound in children and whether CT can be replaced by ultrasound for this purpose. To assess whether preperitoneal fat thickness and area are good approximations of visceral fat at the umbilical level, we first retrospectively examined 47 CT scans of nonobese children (body mass index <30 kg/m 2; median age 7.9 y [95% range 1.2 to 16.2]). Correlation coefficients between visceral and preperitoneal fat thickness and area were 0.58 ( p < 0.001) and 0.76 ( p < 0.001), respectively. Then, to assess how preperitoneal and subcutaneous fat thicknesses and areas measured by ultrasound compare with these parameters in CT, we examined 34 nonobese children (median age 9.5 [95% range 0.3 to 17.0]) by ultrasound and CT. Ultrasound measurements of preperitoneal and subcutaneous fat were correlated with CT measurements, with correlation coefficients ranging from 0.75–0.97 (all p < 0.001). Systematic differences of up to 24.0 cm 2 for preperitoneal fat area (95% confidence interval –29.9 to 77.9 cm 2) were observed when analyzing the results described by the Bland-Altman method. Our findings suggest that preperitoneal fat can be used as an approximation for visceral fat in children and that measuring abdominal fat with ultrasound in children is a valid method for epidemiological and clinical studies. However, the exact agreement between the ultrasound and CT scan was limited, which indicates that ultrasound should be used carefully for obtaining exact fat distribution measurements in individual children. (E-mail: v.jaddoe@erasmusmc.nl)

Donor Site Sensitivity After Breast Reconstruction With Deep Inferior Epigastric Artery Perforator Flap

The aim of this study was to examine pressure sensitivity at the donor site after breast reconstruction with deep inferior epigastric artery perforator (DIEAP). In a cross-sectional survey, 2 groups of patients were analyzed. The DIEAP group consisted of 30 women who had previously had secondary breast reconstruction with DIEAP flap after mastectomy for breast cancer. The control group consisted of 7 women with no previous abdominal incisions planned for secondary breast reconstruction with DIEAP. Pressure thresholds were tested within the margins of the abdominal wall using Semmes-Weinstein monofilaments. In the DIEAP group a pattern of higher pressure thresholds was observed in the proximity of the scar. Comparing the 2 groups, significant higher pressure thresholds were found in the DIEAP group in the scar on both sides and in the midline from the scar to the umbilical level. Our data show that the abdominoplasty performed during breast reconstruction with DIEAP reduces cutaneous sensitivity in the donor site area.

High Incidence of Metabolically Active Brown Adipose Tissue in Healthy Adult Humans

OBJECTIVEThe significant roles of brown adipose tissue (BAT) in the regulation of energy expenditure and adiposity are established in small rodents but have been controversial in humans. The objective is to examine the prevalence of metabolically active BAT in healthy adult humans and to clarify the effects of cold exposure and adiposity.RESEARCH DESIGN AND METHODSIn vivo 2-[18F]fluoro-2-deoxyglucose (FDG) uptake into adipose tissue was measured in 56 healthy volunteers (31 male and 25 female subjects) aged 23–65 years by positron emission tomography (PET) combined with X-ray computed tomography (CT).RESULTSWhen exposed to cold (19°C) for 2 h, 17 of 32 younger subjects (aged 23–35 years) and 2 of 24 elderly subjects (aged 38–65 years) showed a substantial FDG uptake into adipose tissue of the supraclavicular and paraspinal regions, whereas they showed no detectable uptake when kept warm (27°C). Histological examinations confirmed the presence of brown adipocytes in these regions. The cold-activated FDG uptake was increased in winter compared with summer (P < 0.001) and was inversely related to BMI (P < 0.001) and total (P < 0.01) and visceral (P < 0.001) fat areas estimated from CT image at the umbilical level.CONCLUSIONSOur findings, being against the conventional view, indicate the high incidence of metabolically active BAT in adult humans and suggest a role in the control of body temperature and adiposity.

Visceral fat accumulation is a significant risk factor for white matter lesions in Japanese type 2 diabetic patients

The presence of white matter lesions (WML) is an important prognostic factor for the development of stroke. The elevated visceral fat accumulation (VFA) has been reported to be closely related to the development of atherosclerosis. This preliminary study was therefore designed to test the hypothesis that the presence of WML correlates with VFA and insulin resistance in type 2 diabetic patients not receiving insulin treatment. Based on brain magnetic resonance imaging (MRI), 95 type 2 diabetic patients were divided into two groups: WML-positive group (aged 59 +/- 7 years, mean +/- SD n = 37) and WML-negative group (aged 58 +/- 5, years, n = 58). The level of blood glucose was assessed by fasting plasma glucose (FPG), fasting immunoreactive insulin, homeostasis model assessment (HOMA) index, and haemoglobin A1c. The fat distribution was evaluated by measuring the visceral fat accumulation by abdominal computerized tomography at the umbilical level. The body mass index was higher in the WML-positive group than in the WML-negative group (P < 0.005). Plasma levels of triglycerides were higher while high-density lipoprotein cholesterol was lower in the WML-positive group than in the WML-negative group (P < 0.05 and P < 0.01, respectively). FPG (P < 0.01), insulin concentrations (P < 0.0001), HOMA index (P < 0.0001) and VFA (<0.0001) levels were higher in the WML-positive group than in the WML-negative group. Multivariate logistic analysis revealed that WML was independently predicted by the high VFA and insulin resistance (P < 0.001, P < 0.0001, respectively). The results of this preliminary study indicate that the presence of WML was associated with the high VFA and insulin resistance in Japanese patients with type 2 diabetes mellitus. Further larger cohort studies are warranted to confirm these findings.

Hepatitis C virus infection enhances insulin resistance induced by visceral fat accumulation

To clarify the impact of visceral obesity on hepatitis C virus (HCV)-infected patients, we examined the relationship between insulin resistance development and visceral fat accumulation. We analyzed 87 HCV-infected patients with mild fibrosis (stage 1 or 2) in comparison with 125 sex- and age-matched patients with non-alcoholic fatty liver disease (NAFLD). The degree of visceral fat area (VFA; cm(2)) at the umbilical level was measured by abdominal computed tomography and divided into two grades: no visceral obesity, VFA<100 and visceral obesity, VFA>/=100. Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI). Pancreatic beta-cell function was evaluated by homeostasis model assessment of beta-cell function (HOMA-beta). Serum soluble tumour necrosis factor (TNF)-receptors 1 and 2 and adiponectin were measured. Insulin resistance evaluated by HOMA-IR and QUICKI was correlated with visceral fat accumulation, and was higher in HCV patients than in NAFLD patients with visceral obesity. HOMA-beta was higher in HCV patients than in NAFLD patients for each VFA grade. Serum-soluble TNF-receptors 1 and 2 were higher in HCV patients than in NAFLD patients with visceral obesity. Hepatitis C virus infection is a risk factor for development of insulin resistance, particularly in patients with visceral obesity.

Bilateral absence of the tendinous intersections of the rectus abdominis muscle

The rectus abdominis muscle is well known to be segmented by tendinous intersections into a certain number of serially arranged compartments. The tendinous intersections are present only on the anterior aspect and fused with anterior sheat of the muscle. Since the rectus abdominis is used as a graft, there are lots of studies in the literature about the rectus abdo- minis muscle and its intersections. In the dissection of a 64-year-old man at the Department of Anatomy of Ege University Medicine Faculty, an anatomical form of the rectus abdominis muscle not described in the available literature was encoun- tered. Both rectus muscles, right and left, were symmetrical but there were not any tendinous intersections on them. The total length of the muscle was 30 cm for both sides. The width at the umbilical level was 5.7 cm on the right side and 5.4 cm on the left side. The thickness of the muscle at the umbilical level was 0.5 cm for both sides. This previously unreported variation is very interesting for clinical approaches since the transverse rectus abdominis flap is an important reconstructive tool, particularly in reconstruction of the breast following mastectomy.

Glucose Intolerance and Cardiometabolic Risk in Children Exposed to Maternal Gestational Diabetes Mellitus in Utero

The goal was to examine the carbohydrate tolerance and cardiometabolic risk among children exposed to maternal gestational diabetes mellitus in utero. In this study, 164 Chinese children whose mothers had participated in a previous study on the screening and diagnosis of gestational diabetes mellitus (63 had gestational diabetes mellitus and 101 had normal glucose tolerance during the index pregnancies) underwent follow-up evaluations at a median age of 8 years (range: 7-10 years). Children's weight, height, hip and waist circumferences, and blood pressure were measured, and weight-adjusted oral glucose tolerance tests were performed. Six children (3.7%) demonstrated impaired glucose regulation or diabetes mellitus at the follow-up evaluation. Children exposed to maternal gestational diabetes mellitus had significantly higher systolic (94+/-1.2 vs 88+/-0.9 mmHg) and diastolic (62+/-0.8 vs 57+/-0.6 mmHg) blood pressure values and lower high-density lipoprotein cholesterol (1.58+/-0.04 vs 1.71+/-0.03 mmol/L) levels, after adjustment for age and gender. A high (>or=90th percentile) umbilical cord insulin level at birth was associated with abnormal glucose tolerance in the offspring. Maternal gestational diabetes mellitus increases the offspring's cardiometabolic risk, and in utero hyperinsulinemia is an independent predictor of abnormal glucose tolerance in childhood.

Vasoactivity to and Endogenous Release of Vascular Endothelial Growth Factor in the in vitro Perfused Human Placental Lobule from Pregnancies Complicated by Preeclampsia

Vascular endothelial growth factor (VEGF) is a potent, physiologically relevant, vasodilator of the human term fetoplacental vasculature of placental lobules from normal pregnancy. There is evidence that VEGF and its receptors are dysregulated in preeclampsia (PE). Here, we used dual perfusion of the human placental lobule to test the hypothesis that the VEGF vasodilatory effect on the fetoplacental circulation is altered in PE and examined how vascular responsiveness relates to circulating levels of free VEGF in fetal sera in this disease. Umbilical cord sera and fetal venous perfusate concentrations of free VEGF from pregnancies complicated with PE were significantly lower compared to the normal group ( P < 0.05 and P < 0.01, respectively). There was elevated in vitro placental release of the sequestrating soluble receptor, sVEGFR-1, into the fetal-side perfusate with PE compared to the normal group ( P < 0.05). The umbilical sera PlGF-1 level was higher by an order of magnitude in the fetal circulation in PE compared to normal pregnancy ( P < 0.0001), with the placenta appearing to contribute appreciably to these levels. Placental net contribution to maternal systemic free VEGF levels appeared to be negligible in both groups. sVEGFR-1 levels were elevated in the maternal-side venous perfusate with PE compared to the normal pregnancy ( P < 0.01). Perfused lobules from PE pregnancy exhibited an enhanced fetoplacental vasodilatory response to exogenous VEGF ( P < 0.001), with a longer recovery time ( P < 0.05), compared to the normal control group. Extrapolation of our combined functional and biochemical data suggests that a decrease in the in vivo circulating levels of free VEGF in PE is likely to contribute to compromised fetoplacental vascular patency in this disease.

Indicadores de gordura abdominal: antropometria vs absortometria de raio-x de dupla energia

Excessive abdominal fat contributes to the development of chronic nontransmissible diseases. Dual emission X Ray absorptiometry (DXA) is a simple to administer technique that allows abdominal fat percentage (%abdominalFDXA) to be determined. Anthropometric measurements, which have been validated and are of low cost, such as the abdominal circumferences 2.5cm above the umbilical scar (ABC2,5) and level with the umbilical scar (ABCum), are used as indicators of abdominal fat. Skin folds (SF) are little used for this purpose. The objective of this study was to verify which of these anthropometric indicators best correlates with and best explains abdominalFDXA. The sample was made up of 22 women (43.9±11.6 years; 34.7±8.3 %G totalDXA) and 18 men (31.9±11.6 years; 19.0±8.0 %G totalDXA) who were measured for ABC2.5, ABCum, suprailiac SF (SI), midaxillary SF (AM) and abdominal SF (AB), while abdominalF (L1-L4) was measured by DXA. Pearson’s correlation and multivariate linear regression (“enter” method) were employed to verify the anthropometric measurements’ correlations and percentage of explanation with relation to abdominalFDXA. Strong correlations and significant levels of explanation (p&lt;0.05) were observed for both women and men using ABC2.5 (0.90; 81% and 0.89; 78%), ABCum (0.90; 83% and 0.83; 69%), SF AB (0.82; 67%) and SF AM for men (0.81; 66%) and while they were moderate in both sexes for SF SI (0.51; 26% and 0.73; 53%) and for AM in women (0.74; 54%). It was concluded that ABC2.5, ABCum and abdominal skin folds can be used as indicators of abdominal obesity, since they offer the best correlation and greatest explanatory power for abdominal FDXA.

Abdominal fat indicators: anthropometry vs dual energy x-ray absortometry

Excessive abdominal fat contributes to the development of chronic nontransmissible diseases. Dual emission X Ray absorptiometry (DXA) is a simple to administer technique that allows abdominal fat percentage (%abdominalFDXA) to be determined. Anthropometric measurements, which have been validated and are of low cost, such as the abdominal circumferences 2.5cm above the umbilical scar (ABC2,5) and level with the umbilical scar (ABCum), are used as indicators of abdominal fat. Skin folds (SF) are little used for this purpose. The objective of this study was to verify which of these anthropometric indicators best correlates with and best explains abdominalFDXA. The sample was made up of 22 women (43.9±11.6 years; 34.7±8.3 %G totalDXA) and 18 men (31.9±11.6 years; 19.0±8.0 %G totalDXA) who were measured for ABC2.5, ABCum, suprailiac SF (SI), midaxillary SF (AM) and abdominal SF (AB), while abdominalF (L1-L4) was measured by DXA. Pearson’s correlation and multivariate linear regression (“enter” method) were employed to verify the anthropometric measurements’ correlations and percentage of explanation with relation to abdominalFDXA. Strong correlations and significant levels of explanation (p<0.05) were observed for both women and men using ABC2.5 (0.90; 81% and 0.89; 78%), ABCum (0.90; 83% and 0.83; 69%), SF AB (0.82; 67%) and SF AM for men (0.81; 66%) and while they were moderate in both sexes for SF SI (0.51; 26% and 0.73; 53%) and for AM in women (0.74; 54%). It was concluded that ABC2.5, ABCum and abdominal skin folds can be used as indicators of abdominal obesity, since they offer the best correlation and greatest explanatory power for abdominal FDXA.

Pseudo- Meigs' syndrome caused by uterine smooth muscle tumor of uncertain malignant potential with low vascular endothelial growth factor expression

Smooth muscle tumor of uncertain malignant potential (STUMP) presenting as pseudo-Meigs' syndrome with low vascular endothelial growth factor (VEGF) expression has not been reported in previous literature. Here, we report a case of uterine STUMP associated with ascites and pleural effusion, which was resolved completely after hysterectomy. A 47-year-old woman presented to the clinic with a complaint of progressive abdominal distension for several months. A large movable, painless pelvic mass located upward above the umbilical level was palpated. Sonography and computed tomography showed a hypervascular solid pelvic mass measuring 20 × 17 × 15 cm in size associated with ascites and right pleural effusion. Laparotomy revealed a large uterine mass with ascites in the abdomen. Total hysterectomy and left-side salpingo-oophorectomy were performed. The final pathologic report revealed a STUMP tumor with low expression of VEGF by immunohistochemistry. A follow-up chest X-ray revealed that the pleural effusion was resolved completely 1 week postoperatively. The patient is doing well without recurrence in the following 2 years. Uterine STUMP tumor may cause pseudo-Meigs' syndrome. However, the ascites or the pleural effusion may not be induced by VEGF, known as vascular permeability factor, in our case.