Young Obese Patients Research Articles

Motor Skills of Extremely Obese Children and Adolescents Based on the Multicentre Longitudinal Obesity Database (APV)

Obese children and adolescents often exhibit progressively declining motor skills. To support young obese patients adequately, it is necessary to assess their individual physical and motor abilities, taking the degree of obesity into account. A total of 5 924 children and adolescents (mean age: 12.7±2.5 years, range 6.0-18.0 years, 3 195 girls) were examined in a standardised multicentre evaluation survey (APV). Fitness parameters were correlated with age- and gender-specific BMI-SDS (Standard Deviation Score) Methods: Anthropometric data were collected and patients performed the modified Munich fitness test (mMFT: maximal power, coordination, trunk flexibility) and a 6-min walk-test (aerobic endurance capacity). 33% of patients were extremely obese (BMI>99.5th percentile). Mean BMI-SDS was + 2.32±0.53 (♀-Δ=+ 0.06; p<0.001). The data indicated significant negative correlations between BMI-SDS and selected components of motor performance, especially maximal power (r=- 0,134), and particularly aerobic endurance capacity (r=- 0,214; all p<0.001). Motor performance was significantly below average (n=27 473, 6-18 years), especially among extremely obese patients. Performance in all motor tasks was lower in girls compared to boys, except for trunk flexibility (p<0.001). Correlations were found between BMI-SDS and motor performance. Extremely obese patients and obese girls showed the most pronounced motor deficits. These results emphasize the importance of standardized evaluation of individual motor performance in children and adolescents with obesity.

Increased Gustatory Response Score in Obesity and Association Levels with IL-6 and Leptin.

Background. The aim of this study was to investigate the relationship between the circulating IL-6 and leptin levels with taste alteration in young obese patients. Methods. A retrospective case-control study was conducted in thirty obese patients and thirty age- and sex-matched healthy controls. Results. Circulating levels of IL-6 and leptin were significantly increased in obese patients than in controls. However, catalase and ORAC levels were significantly decreased in obese patients compared to controls. Additionally, obese participants had high scores for the detection of fats (gustatory response scores [GRS]; p < 0.001). Moreover, IL-6 and leptin were strongly associated with GRS alteration among patients with GRS 4 (resp., OR =17.5 [95% CI, 1.56–193.32; p = 0.007]; OR = 16 [95% CI, 1.69–151.11; p = 0.006]). For the Mantel-Haenszel common odds ratio estimate (MH OR), IL-6 and leptin were strongly associated with obesity, in patients with either GRS 4 or GRS > 4 (resp., MH OR = 8.77 [95% CI, 2.06–37.44; p = 0.003]; MH OR = 5.76 [95% CI, 1.64–20.24; p = 0.006]). Conclusions. In a low grade inflammation linked to obesity, taste alteration is associated with high levels of IL-6 and leptin.

Evidence Based Prevention of Type 2 Diabetes: Role of Lifestyle Intervention as Compared to Pharmacological Agents

Background: The global epidemic of type 2 Diabetes Mellitus (T2DM) presents significant challenges to world health both in terms of financial costs as well as morbidity. Thus, considerable research has been focussed on the prevention or delay of the onset of T2DM. Aim: The aim of this article is to review published studies that evaluate lifestyle and pharmacological interventions aimed at preventing T2DM and to compare both these interventions. Methods: We undertook an electronic search of MEDLINE, PubMed, EMBASE and Cochrane Register of Controlled Trials, with the English language restriction and published until May 2015. Five major diabetes prevention trials using lifestyle intervention (LSI) and five using pharmacological intervention were identified. We reviewed the study design, key components, and outcomes for each study aimed to delay T2DM. Results: Both LSI and pharmacological intervention were found to be effective to reduce the risk of developing T2DM in at risk population. LSI with modest goals of weight loss and physical activity is safe, cost saving and prevents or delays the onset of diabetes, even after discontinuation of the treatment providing long term benefits. A Considerable effort from well-trained, multidisciplinary staff is needed to achieve these modest goals. For patients who are unable to achieve the lifestyle goals or those who progress to T2DM despite being on LSI, pharmacological intervention has shown to be effective, especially in younger obese patients. Adverse effects with pharmacological intervention were common. Conclusion: Strong evidence exists for the prevention or delay of type 2 diabetes through lifestyle and pharmacological intervention. LSI with weight loss and increased physical activity are safe, costeffective and are currently recommended for the prevention of diabetes.

Prise en charge médico-chirurgicale de l’obésité de l’adolescent : quand et comment réaliser la transition vers la prise en charge adulte ?

In young obese patients, the transition from adolescence to adulthood, i.e., the transition from the pediatric to the adult medical team, is a new issue. In particular, it is important to define when and how this transition should be made in the setting of bariatric surgery. Fourteen young obese patients (under the age of 20), who underwent bariatric surgery, were included in the study (nine cases of Roux-en-Y gastric by-pass, three sleeve gastrectomy, one gastric banding). After surgery, the patients were followed in both the pediatric and adult departments (protocol 1) or only in the pediatric department during the 1st year and then in the adult department afterwards (protocol 2). Anthropometric and metabolic data, before and after surgery, and compliance monitoring were analyzed using a retrospective design. Twelve patients completed a questionnaire assessing how they experienced the transition. Before surgery, mean age±SD was 16.3±1.8 years old and mean body mass index (BMI) 55.0±8.6kg/m(2). At 1 year after surgery, mean weight loss was -32.1±8.2% of initial body weight. Adherence to vitamin supplementation was judged to be adequate (vitamins were not taken less than once a week) for only 57.5% patients. Mean follow-up was 34.8±25.1 months [95% CI, 9.5-78.4]. None of the patients was lost to follow-up. Compliance was significantly better for patients following protocol 2. Adolescents reported being satisfied with meetings and newsletters about surgery, specific to this age group (91.7%). They also reported that information on the adult department was sufficient and 91.7% of them expressed satisfaction on the first outpatient visit in the adult department. However, all patients spontaneously reported having difficulties identifying members of the different teams: nutritionist pediatrician, nutritionist, and adult surgeon. These preliminary data suggest that, in obese adolescents, it is important to differentiate the transition period and the time and preparation for bariatric surgery. A prospective follow-up with a larger number of subjects and recommendations are needed to better define and improve the specific clinical management of obese adolescents transitioning to adulthood.

IGF-1 and Insulin Resistance Are Major Determinants of Common Carotid Artery Thickness in Morbidly Obese Young Patients.

We assessed the relationship between insulin resistance, serum insulin-like growth factor 1 (IGF-1) levels, and common carotid intima-media thickness (CC-IMT) in morbidly obese young patients. A total of 249 patients (aged 37.9 ± 9.8 years, body mass index [BMI] 45.6 ± 8.3 kg/m(2)) were evaluated (metabolic tests, serum IGF-1 measurements, homeostasis model assessment-insulin resistance [HOMA-IR], and ultrasonographically assessed CC-IMT) in a research program for bariatric surgery candidates. After adjusting for age, gender, BMI, systolic blood pressure, uric acid, antihypertensive and lipid-lowering treatment, metabolic syndrome, and metabolic class, both HOMA-IR and IGF-1 z-score were significantly associated with CC-IMT. These results were confirmed in logistic regression analysis, in which age (β = 1.11, P = .001), gender (β = 3.19, P = .001), HOMA-IR (β = 1.221, P = .005), and IGF-1 z-score (β = 1.734, P = .009) were the only independent determinants of abnormal CC-IMT, presumably modulating the effect of the other risk factors included in the regression. Area under the receiver-operating characteristic curve for the model was 0.841 (confidence interval: 0.776-0.907; P < .001). In conclusion, in morbidly obese young adults, insulin resistance and IGF-1 z-score are significantly associated with CC-IMT, independent of other major cardiovascular risk factors.

Bilirubin is independently associated with oxidized LDL levels in young obese patients.

BackgroundBilirubin can prevent lipid oxidation in vitro, but the association in vivo with oxidized low-density lipoprotein (Ox-LDL) levels has been poorly explored. Our aim is to the association of Ox-LDL with total bilirubin (TB) levels and with variables related with metabolic syndrome and inflammation, in young obese individuals.Findings125 obese patients (13.4 years; 53.6% females) were studied. TB, lipid profile including Ox-LDL, markers of glucose metabolism, and levels of C-reactive protein (CRP) and adiponectin were determined. Anthropometric data was also collected.In all patients, Ox-LDL correlated positively with BMI, total cholesterol, LDLc, triglycerides (TG), CRP, glucose, insulin and HOMAIR; while inversely with TB and HDLc/Total cholesterol ratio (P < 0.05 for all). In multiple linear regression analysis, LDLc, TG, HDLc and TB levels were significantly associated with Ox-LDL (standardized Beta: 0.656, 0.293, −0.283, −0.164, respectively; P < 0.01 for all). After removing TG and HDLc from the analysis, HOMAIR was included in the regression model. In this new model, LDLc remained the best predictor of Ox-LDL levels (β = 0.665, P < 0.001), followed by TB (β = −0.202, P = 0.002) and HOMAIR (β = 0.163, P = 0.010).ConclusionsLower bilirubin levels may contribute to increased LDL oxidation in obese children and adolescents, predisposing to increased cardiovascular risk.

Association of Cardiac Pro-Β-Type Natriuretic Peptide Levels with Metabolic Risk Factors in Young Obese Egyptian Patients: A Focus on Normotensive vs. Hypertensive Patients

Objective: In practice, there is increasing recognition of the importance of BNP in the pathophysiology, diagnosis and prognosis of ischemic cardiac dysfunction and heart failure. The association of BNP to obesity and characteristics of the metabolic syndrome in adults and aged patients is well established, but that in pediatrics needs thorough elucidation. Methods: The aim of this study was to assess the association of plasma β-type natriuretic peptide (BNP) levels and metabolic risk factors in 40 young (average age was 13-17 years) obese normo- and hypertensive patients. This is achieved by assessment of serum levels of glucose, insulin, lipid profile as well as the proinflammatory cytokines, TNF- α, interleukin (IL)-6 and IL-23. The assessed metabolic indicators were compared with that of healthy control young subjects with normal BP (120/80 mmHg). Results: Contrasting the reported studies in adult persons, the result of the present study showed that β-type natriuretic peptide (BNP) levels are positively associated with characteristics of the metabolic syndrome; Blood pressure, BMI, HOMA index and the lipid profile in both obese groups. The hypertensive obese group exhibited an increased proinflammatory state, leading to the increased levels of serum levels of TNF-α, IL-6 and IL-23, compared to the obese normotensive group. Conclusion: Early detection of pro-BNP levels in pre-HTN stage is an effective method of prevention of cardiovascular disease. Moreover, proinflammatory mediators, TNF-α, IL-6 should be included in primary screening tests for evaluation of hypertensive patients. However, the prognostic relevance of increased pro-BNP for risk of developing cardiac insufficiency in severely obese patients needs to be further evaluated.

ENDOTHELIUM-DEPENDENT DILATION IN PATIENTS WITH TYPE 1 DIABETES WITH MICROANGIOPATHY, ILL SINCE CHILDHOOD AND YOUNG ADULTS WITH OBESITY

In the result of the study it was revealed the attenuation of endothelium dilation in patients with type 1 diabetes with microangiopathy, ill since childhood and young adults with obesity. It was found that weakening endothelium dilation with type 1 diabetes with microangiopathy associated with hyperglycemia and dyslipidemia. In young obese patients the attenuation of endothelium dilation is associated with body mass index, an indicator of insulin resistance and lipid metabolism. Detect changes point to the development of endothelial dysfunction in patients with type 1 diabetes with microangiopathy, ill since childhood and young people with obesity, as well as its possible factors.

English

Spinal anesthesia can be challenging in young obese patients and in elderly age group (>65yrs). The surface landmarks observed by clinical palpation can be less helpful in these patients (1-7).The purpose of this study is to do pre procedural ultrasound and clinical examination of the lumbar spine in the same group of patients and comparing them to space finally in which the procedure was performed. The aim is to find out the usefulness of sonography in assessing the difficulty of spinal anesthesia in young patients ( 40 years expertise is still needed in using this technique. This calls in for routine use of pre procedural sound screening for all anticipated difficult spinals.

Sitagliptin and metformin alone or in combination in patients with polycystic ovarian syndrome (PCOS): a pilot study

OBJECTIVE: To identify the relationship between diabetes associated peptide hormones (DAPH) and inflammatory markers in follicular fluid and serum of obese and lean polycystic ovary syndrome (PCOS) patients with in vitro fertilization (IVF) cycle parameters and pregnancy outcomes. DESIGN: Prospective Descriptive Study. MATERIALS AND METHODS: An IRB approved study of three groups of IVF patients 30 kg/m2; n1⁄48), lean PCOS (BMI<25 kg/m2; n1⁄412), and donor or tubal factor controls (n1⁄411). PCOS was diagnosed by Rotterdam criteria. Serumwas collected prior to IVF cycle initiation. Follicular fluid was collected at retrieval. A Human Diabetes 10plex Assay was used to quantify DAPH. A Human Cytokine 27-plex Assay was used to quantify inflammatory markers. Results were analyzed using one-way ANOVA with Tukey post hoc analysis using SPSS v 21. Significance was defined as p<0.05. RESULTS: Of the 10 DAPH assessed, C-peptide, insulin, and leptin had significant associations. Obese PCOS patients had higher levels of C-peptide (194.4 163.5 pg/mL), insulin (172.6 113.6 pg/mL), and leptin (10,046.1 4920.2pg/mL) in follicular fluid compared to lean PCOS and controls. A difference in C-peptide (p<0.03), insulin (p<0.01), and leptin (p1⁄40.04) was noted between obese and lean PCOS follicular fluid. A difference in C-peptide (p<0.03) and insulin (p<0.01) was noted between obese PCOS and control follicular fluid. Obese PCOS had higher levels of serum leptin (5575.5 1650.2pg/mL), with a difference in leptin concentrations noted between obese PCOS and controls (p1⁄40.01), and obese and lean PCOS (p<0.01). Higher levels of C-peptide (p<0.04) and leptin (p1⁄40.01) in the follicular fluid were associated with increased gonadotropin usage. A trend toward fewer oocytes retrieved (p1⁄40.06), and significantly lower number of normally fertilized zygotes (p<0.04) was seen with higher C-peptide levels. A trend toward an increased clinical pregnancy rate was noted with lower serum leptin levels (p1⁄40.08). There was no significant difference in inflammatory marker concentration or pregnancy outcomes between the groups. CONCLUSION: Elevated levels DAPH, which are highly correlated with adverse long-term health outcomes, are present in young obese PCOS patients undergoing IVF. DAPHs may play a role in the need for higher gonadotropin dosing in IVF cycles and suboptimal oocyte fertilization in this patient population. Supported by: Funding provided through a Merck Investigator Studies Program Grant.

Efficacy and safety of the glucagon-like peptide-1 receptor agonist lixisenatide versus the dipeptidyl peptidase-4 inhibitor sitagliptin in young (

ObjectiveTo compare the efficacy and safety of the once-daily prandial glucagon-like peptide-1 receptor agonist lixisenatide with the dipeptidyl peptidase-4 inhibitor sitagliptin in patients aged <50 years affected by obesity and type 2 diabetes mellitus (T2DM). Materials and methodsThis was a 24-week, double-blind, randomized, parallel-group study. Obese patients with T2DM inadequately controlled on metformin were randomized to lixisenatide 20 μg once-daily injection (n = 158) or once-daily oral sitagliptin 100 mg (n = 161). The primary endpoint was the proportion of patients with a glycated hemoglobin (HbA1c) <7% and ≥5% weight loss at 24 weeks. ResultsThe proportion of patients that achieved the primary endpoint was 12.0% for lixisenatide versus 7.5% for sitagliptin; weighted average of proportion difference: 4.6%, p = 0.1696). A total of 40.7% of patients achieved HbA1c <7% with lixisenatide versus 40.0% with sitagliptin. Lixisenatide produced greater reductions in body weight (LS mean difference: −1.3 kg, p = 0.0006) and postprandial plasma glucose after a standardized meal test (LS mean difference: −34.4 mg/dL [−1.9 mmol/L], p = 0.0001) versus sitagliptin. There was a similar incidence of treatment-emergent adverse events (63.9% vs. 60.9%) and serious treatment-emergent adverse events (1.9% vs. 1.9%), with low rates of symptomatic hypoglycemia (0.6% vs. 1.9%) for lixisenatide and sitagliptin, respectively, and no cases of severe hypoglycemia. ConclusionIn obese patients aged <50 years with T2DM, the proportion of patients with an HbA1c <7% with weight loss ≥5% was similar between groups. Lixisenatide, however, resulted in significantly greater reductions in body weight and postprandial plasma glucose excursions than sitagliptin. Tolerability was similar between groups.

Should we always change bad dietary habits in obese children or not?

That is the question coming out by a psychological point of view, reviewing the cases we have treated in our service recently. Treating childhood obesity with multidisciplinary approach we detected some problems in obese families in term of psychological dynamics frequently. We analyzed cases seen in 2012: 157 people aging mean 11.35 y (sd 3.02), with starting BMI mean 27.28 (sd 4.22); we detected both psychological aspects related to the family and to the child. We found mild-severe problems in 48% of cases in the family area (1) bad quality in relationship between parents (24% infighting with divorced one or being about to separate); (2) severe health problems in families which are able to lead to global emotional distress (38%). Furthermore in term of psycho-physical state we saw in 35% of children evaluated several health evidences in addition to overweight like: dyslexia or specific learning disabilities (26%), behavior diseases (15%), anxiety or emotional distress (24%), tics (5%), migraine (8%); 7% showed neurological pathologies (like cognitive delays) or organic pathologies associated (15%). Binge eating and related obesity seem to be an answer to psychological request in term of emotional distress of the origin familiar unit. So we have really to effort the importance of psychological approach at the same time of nutritional and environmental attention due to young obese patients. Nevertheless we can recommend to value in a very strong way how a radical change could be destabilizing in term of emotional homeostasis when important changes in food habits occur.

Role of micro RNAs in obesity-mediated premature cardiac ageing in patients

Background: Obesity results in signs of increased oxidative stress, pro-apoptotic activation, impaired mitochondrial biogenesis and function in cardiomyocytes and disturbances in whole-body glucose metabolism and adipocytokine release in young obese patients. These disturbances resemble many of the changes otherwise observed in older patients, suggesting a prematurely aged phenotype in young obese patients. MicroRNAs are small noncoding RNAs that posttranscriptionally control gene expression. They have emerged as diagnostic tools and are currently investigated as novel therapeutic options to preserve cardiac function. Here, we investigated the effect of obesity on expressional patterns of micro RNAs (miRNAs) in right atrial (RA) tissue of patients. These data were compared with data obtained from the RA of rats undergoing caloric restriction (CR, -40%) in order to identify micro RNAs mutually regulated by CR or obesity.

Assessment of autonomic function with heart rate turbulence and heart rate variability in young obese patients

Background: Sudden cardiac death (SCD) is a main cause of cardiovascular mortality in developed countries. Obesity-related impairment of the cardiovascular system may be exist even at the young age, and progress asymptotical for decades before clinical manifestations present in. Death may be sudden in obese individuals with or with- out arrhythmias Heart rate turbulence (HRT) and Heart rate variability (HRV) both of which reflects autonomic dysfunction is a proven non-invasive electrocardiographic predictor of cardiac death. Aims & Objectives: To evaluate autonomic function with Heart rate turbulence (HRT) and Heart rate variability (HRV) in young obese patients without comorbidities. Materials and Methods: 60 young patients with age ≤35 of body mass index (BMI) ≥30 (average 34.12 ± 2.59) and 40 young healthy patients with ≤35 of BMI <25 (23.25 ± 1.14) matched age and sex were divided in two groups (group 1: obese patients and group 2: Non-obese patients respectively). 24 hours ambulatory holter ECG recordings were obtained from all patients. Turbulence onset (TO), Turbulence slope (TS), Time domain HRV (SDNN, mean RR, RMSSD, sNN50 were analysed and compared between two groups. Results: RMSSD (ms) and Total sNN50 was decreased in obese patients compared to non- obese patients (32.57 ± 7.40 vs 40.15 ± 6.80; p: 0.003 and 8616 ± 5300 vs 10920 ± 6700; p<0,001 respectively) and SDNN (ms) was decreased in obese patients compared those with no-obese. (122.79±23.19 vs 164.52±15.48 p<0,001 respectively). TS and TO was different between groups (8.85 ± 6.67 vs. 15.96 ± 12.37; p < 0,001 and 0.45 ± 1.62 vs -0.22 ± 0.32 respectively). Conclusion: Autonomic dysfunction in young obese patients without comorbidities was impaired. These patients may be under risk of adverse cardiovascular outcome including fatal cardiac arrhythmias.

Metformin added to intensive insulin therapy reduces plasma levels of glycated but not oxidized low‑density lipoprotein in young patients with type 1 diabetes and obesity in comparison with insulin alone: a pilot study

There are scarce data about the effect of metformin on lipid profile in patients with type 1 diabetes. The present study is the first prospective clinical trial evaluating the effect of combined therapy of metformin and insulin on the pool of oxidized and glycated low‑density lipoproteins (LDL) in young patients with type 1 diabetes and concomitant obesity. A total of 33 obese patients with type 1 diabetes treated with intensive insulin therapy were randomized into a group where metformin was added. The remaining 19 patients continued to receive intensive insulin therapy (control group). In all patients, lipid profile and glycemia were assessed using routine laboratory tests. Oxidized and glycated LDL were measured using commercially available kits. Laboratory tests were performed at baseline and at a control visit after 6 months of treatment. A significant decrease in the levels of glycated hemoglobin, fasting plasma glucose, postprandial glucose, average glucose, triglycerides, glycated LDL, and body mass index was observed in the group receiving combined therapy. A similar decrease was not observed in the control group. The remaining lipid parameters were not changed during follow‑up in any of the groups. Addition of metformin to intensive insulin therapy in young obese patients with type 1 diabetes results in a significant reduction of glycated LDL levels. This can be possibly explained by better glucose control, which improved insulin sensitivity of the peripheral tissues and reduced body mass in this patient group.

New evidence for an association between liver enzymes and pancreatic islet β-cell dysfunction in young obese patients

To explore the relationship between serum liver enzymes and both the glucose tolerance status and insulin secretion in young obese patients. A total of 734 young obese patients (BMI ≥ 25 kg m(-2)) and 231 lean healthy volunteers matched in age (BMI < 23 kg m(-2)) were enrolled in this cross-sectional observational study. The 734 obese patients were subdivided to three groups (OB-NGR, OB-IGR, and OB-DM) according to their glucose tolerance status. FSIVGTT was performed to assess the degree of insulin sensitivity (SI) and islet secretion function (AIRg). The disposition index (DI; product of SI and AIRg) was calculated as an integrated measurement of insulin secretion and insulin action after compensating for insulin resistance. The extent and distribution of hepatic fat infiltration was assessed using the liver/spleen ratio (L/S ratio) with CT scan. ALT and GGT levels in OB-NGR, OB-IGR, and OB-DM groups were significantly increased compared to the normal controls, and were incrementally increased in turn in the three groups, whereas DI decreased at the same time. One standard deviation increment in ALT and GGT increased the risk of β-cell dysfunction after controlling for potential confounders such as sex, age, BMI, waist-hip ratio, and blood pressure. Even after the adjustment of the serum lipid profile and L/S ratio, the odds ratio of ALT remained statistically significant (OR, 1.603; 95 % CI, 1.225-2.096). Serum levels of liver enzymes showed an independent close relationship with insulin secretion capacity. Excluding the impact of a fatty liver, increased ALT and GGT levels indicated a significant association with the attenuation of pancreatic β-cell function. This study provides the possibility that elevated liver enzymes might be treated as simple biomarkers of early insulin secretion deficit in type 2 diabetes, especially in young obese patients.

Fournier’s Gangrene in a Patient with Obesity and B-lymphoma

We present a case of Fournier's gangrene disease in a young obese patient with coexistent B-lymphoma. It remains controversial if obesity constitutes a predisposing factor for an individual to develop necrotizing fasciitis. On the other hand, only few cases of patients with coexistence of B-lymphoma and Fournier's gangrene disease have been reported. A 30-years-old obese man was admitted to emergency department with fever (38.7 °C), pain, erythema and swelling extended from the left scrotum to the left lower abdominal quadrant. He was confused, with low urinary excretion and septic shock's signs. The clinical findings were characteristics of Fournier's gangrene disease. Furthermore during physical examination a massive, painless and motionless mass in the left breast was revealed. The patient required urgent surgical debridement of the affected area and pus drainage. Biopsies of the breast mass were received by excision. Pus and blood cultures yielded Staphylococci coagulase(-), Klebsiella and Proteus sp. Intravenous antibiotic treatment with Meropeneme and Clindamycine started immediately. Repeated debridement was often performed. Pathology examination of the massive tissue revealed a diffuse B-lymphoma of large cells (Germinal center B-cell like- GCB). The patient was discharged from the hospital 35 days later. Afterwards, he was treated with chemotherapeutic agents for malignant lymphoma at the oncological department. The aim of this case's presentation is to mention that young obese patients with Fournier's gangrene disease should be particularly investigated due to the possible occurrence of another not obvious predisposing factor, such as a malignant disease.

TaqIA polymorphism in dopamine D2 receptor gene complicates weight maintenance in younger obese patients

ObjectiveThe A1 allele of the TaqIA polymorphism in the dopamine D2 receptor gene (rs1800497) has been associated with obesity. However, the effect of the polymorphism on the success in weight loss and/or weight maintenance during weight-loss programs has not been evaluated thus far. MethodsThe rs1800497 was genotyped in 202 (135 female, 67 male) severely obese individuals with an initial body mass index of 41.7 ± 0.5 kg/m2 who participated in a weight-loss program consisting of a weight-loss phase with a formula diet (12 wk) and a weight-maintenance phase (40 wk). Measurements were collected at baseline, after the weight-loss phase, and at the end of the weight-maintenance phase at 1 y. ResultsGenotyping revealed 4 A1A1, 67 A1A2, and 131 A2A2 genotype carriers. Of the 202 subjects in the program, 66.8% completed the program and 33.2% terminated prematurely. Neither the attrition rate (P = 0.44) nor the overall weight loss was influenced by the different genotypes (P = 0.96). However, younger A1+ participants (A1A1 and A1A2) had a higher body mass index at all time points (baseline, P = 0.04; after weight loss, P = 0.05; after weight maintenance, P = 0.02). They also showed less overall weight loss (P = 0.05), which derived mainly from a greater weight regain during the maintenance phase (P = 0.02). ConclusionIn this program, younger A1+ participants exhibited problems in maintaining weight loss during a weight-loss program.

Efficiency of Physical Therapy for Improving Hemodynamic Parameters in Young Obese Patients

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Risk factors for revision surgery after humeral head replacement: 1,431 shoulders over 3 decades

To assess the long-term risk of revision surgery and its predictors after humeral head replacement (HHR). We used prospectively collected data from the Mayo Clinic Total Joint Registry and other institutional electronic databases. Revision-free survival for HHR at 5, 10, and 20 years was calculated by use of Kaplan-Meier survival analysis. We used univariate and multivariate-adjusted Cox regression analyses to examine the association of age, gender, body mass index (BMI), comorbidity assessed by Deyo-Charlson index, American Society of Anesthesiologists class, implant fixation (cemented vs uncemented), and underlying diagnosis with the risk of revision surgery. Hazard ratios with 95% confidence intervals (CIs) and P values are presented. During the study period (1976-2008), 1,359 patients underwent 1,431 shoulder HHRs. The mean age was 63 years, 63% of patients were female, the mean BMI was 28 kg/m(2), and 60% of implants were cemented. During the follow-up, 114 HHRs were revised. At 5, 10, and 20 years, the shoulder implant survival rate was 93.6% (95% CI, 92.1%-95%), 90% (95% CI, 88%-92%), and 85% (95% CI, 81.8%-88.4%), respectively. In multivariate-adjusted analyses, older age was associated with a lower hazard of revision, with a hazard ratio of 0.97 (95% CI, 0.96-0.99; P < .001), and higher BMI was associated with a higher hazard ratio of 1.04 (95% CI, 1.01-1.08; P = .02). Long-term survival of HHR at 20 years was excellent. Obesity and younger age are risk factors for a higher revision rate after HHR. Further studies should investigate the biologic rationale for these important associations. Surgeons can discuss these differences in revision risk with patients, especially young obese patients.