The effect of LRP5 polymorphisms on bone mineral density is apparent in childhood

Bone mass acquired during childhood is the primary determinant of adult bone mineral density (BMD) and osteoporosis risk. Bone accrual is subject to genetic influences. Activating and inactivating LRP5 gene mutations elicit extreme bone phenotypes, while more common LRP5 polymorphisms are associated with normal variation of BMD. Our aim was to test the hypothesis that LRP5 gene polymorphisms influence bone mass acquisition during childhood. The association between LRP5 gene polymorphisms and bone size and mineralization was examined in 819 unrelated British Caucasian children (n = 429 boys) aged 9 years. Height, weight, pubertal status (where available), total-body and spinal bone area, bone mineral content (BMC), BMD, and area-adjusted BMC (aBMC) were assessed. Dual-energy X-ray absorptiometry (DXA)-gene associations were assessed by linear regression, with adjustment for age, gender, pubertal status, and body size parameters. There were 140, 79, 12, and 2 girls who achieved Tanner stages I-IV, respectively, and 179 and 32 boys who achieved Tanner stages I and II, respectively. The rs2306862 (N740N) coding polymorphism in exon 10 of the LRP5 gene was associated with spinal BMD and aBMC (each P = 0.01) and total-body BMD and aBMC (P = 0.04 and 0.03, respectively). Adjusting for pubertal stage strengthened associations between this polymorphism and spinal BMD and aBMC (P = 0.01 and 0.002, respectively). Individuals homozygous for the T allele had greater spinal BMD and aBMC scores than those homozygous for the C allele. A dose effect was apparent as the mean spinal BMD and aBMC of heterozygous TC individuals were intermediate between those of their TT and CC counterparts. The N740N polymorphism in exon 10 of LRP5 was associated with spinal BMD and aBMC in pre- and early pubertal children. These results indicate that LRP5 influences volumetric bone density in childhood, possibly through effects on trabecular bone formation.

Impact of ethnicity upon body composition assessment in Sri Lankan Australian children

Objectives: Obesity is a disease with excess body fat where health is adversely affected. Therefore it is prudent to make the diagnosis of obesity based on the measure of percentage body fat. Body composition of a group of Australian children of Sri Lankan origin were studied to evaluate the applicability of some bedside techniques in the measurement of percentage body fat. Methods: Height (H) and weight (W) was measured and BMI (W/H2) calculated. Bioelectrical impedance analysis (BIA) was measured using tetra polar technique with an 800 μA current of 50 Hz frequency. Total body water was used as a reference method and was determined by deuterium dilution and fat free mass and hence fat mass (FM) derived using age and gender specific constants. Percentage FM was estimated using four predictive equations, which used BIA and anthropometric measurements. Results: Twenty-seven boys and 15 girls were studied with mean ages being 9.1 years and 9.6 years, respectively. Girls had a significantly higher FM compared to boys. The mean percentage FM of boys (22.9 ± 8.7%) was higher than the limit for obesity and for girls (29.0 ± 6.0%) it was just below the cut-off. BMI was comparatively low. All but BIA equation in boys under estimated the percentage FM. The impedance index and weight showed a strong association with total body water (r 2 = 0.96, P < 0.001). Except for BIA in boys all other techniques under diagnosed obesity. Conclusions: Sri Lankan Australian children appear to have a high percentage of fat with a low BMI and some of the available indirect techniques are not helpful in the assessment of body composition. Therefore ethnic and/or population specific predictive equations have to be developed for the assessment of body composition, especially in a multicultural society using indirect methods such as BIA or anthropometry.

Centile reference charts for total energy expenditure in infants from 1 to 12 months

Background: A knowledge of energy expenditure in infancy is required for the estimation of recommended daily amounts of food energy, for designing artificial infant feeds, and as a reference standard for studies of energy metabolism in disease states. Objectives: The objectives of this study were to construct centile reference charts for total energy expenditure (TEE) in infants across the first year of life. Methods: Repeated measures of TEE using the doubly labeled water technique were made in 162 infants at 1.5, 3, 6, 9 and 12 months. In total, 322 TEE measurements were obtained. The LMS method with maximum penalized likelihood was used to construct the centile reference charts. Centiles were constructed for TEE expressed as MJ/day and also expressed relative to body weight (BW) and fat-free mass (FFM). Results: TEE increased with age and was 1.40,1.86, 2.64, 3.07 and 3.65 MJ/day at 1.5, 3, 6, 9 and 12 months, respectively. The standard deviations were 0.43, 0.47, 0.52,0.66 and 0.88, respectively. TEE in MJ/kg increased from 0.29 to 0.36 and in MJ/day/kg FFM from 0.36 to 0.48. Conclusions: We have presented centile reference charts for TEE expressed as MJ/day and expressed relative to BW and FFM in infants across the first year of life. There was a wide variation or biological scatter in TEE values seen at all ages. We suggest that these centile charts may be used to assess and possibly quantify abnormal energy metabolism in disease states in infants.

Acute liver failure in children : a regional experience

Objective: To review the outcome of acute liver failure (ALF) and the effect of liver transplantation in children in Australia. Methodology: A retrospective review was conducted of all paediatric patients referred with acute liver failure between 1985 and 2000 to the Queensland Liver Transplant Service, a paediatric liver transplant centre based at the Royal Children's Hospital, Brisbane, that is one of three paediatric transplant centres in Australia. Results: Twenty-six patients were referred with ALF. Four patients did not require transplantation and recovered with medical therapy while two were excluded because of irreversible neurological changes and died. Of the 20 patients considered for transplant, three refused for social and/or religious reasons, with 17 patients listed for transplantation. One patient recovered spontaneously and one died before receiving a transplant. There were 15 transplants of which 40% (6/15) were < 2 years old. Sixty-seven per cent (10/15) survived > 1 month after transplantation. Forty per cent (6/15) survived more than 6 months after transplant. There were only four long term survivors after transplant for ALF (27%). Overall, 27% (6/22) of patients referred with ALF survived. Of the 16 patients that died, 44% (7/16) were from neurological causes. Most of these were from cerebral oedema but two patients transplanted for valproate hepatotoxicity died from neurological disease despite good graft function. Conclusions: Irreversible neurological disease remains a major cause of death in children with ALF. We recommend better patient selection and early referral and transfer to a transplant centre before onset of irreversible neurological disease to optimize outcome of children transplanted for ALF.

Analysis of body composition in individuals with high bone mass reveals a marked increase in fat mass in women but not men

Context: High bone mass (HBM), detected in 0.2% of dual-energy x-ray absorptiometry (DXA) scans, is characterized by raised body mass index, the basis for which is unclear. Objective: To investigate why body mass index is elevated in individuals with HBM, we characterized body composition and examined whether differences could be explained by bone phenotypes, eg, bone mass and/or bone turnover. Design, Setting, and Participants: We conducted a case-control study of 153 cases with unexplained HBM recruited from 4 UK centers by screening 219 088 DXA scans. Atotal of 138 first-degree relatives (of whom 51 had HBM) and 39 spouses were also recruited. Unaffected individuals served as controls. Main Outcome Measures: We measured fat mass, by DXA, and bone turnover markers. Results: Amongwomen, fat mass was inversely related to age in controls (P<.01), but not in HBM cases (P<.96) in whom mean fat mass was 8.9 [95% CI 4.7, 13.0] kg higher compared with controls (fully adjusted mean difference, P<.001). Increased fat mass in male HBM cases was less marked (gender interaction P = .03). Compared with controls, lean mass was also increased in female HBM cases (by 3.3 [1.2, 5.4] kg; P<.002); however, lean mass increases wereless marked than fat mass increases, resulting in 4.5% lower percentage lean mass in HBM cases (P<.001). Osteocalcin was also lower in female HBM cases compared with controls (by 2.8 [0.1, 5.5]μg/L; P = .04). Differences in fat mass were fully attenuated after hip bone mineral density (BMD) adjustment (P = .52) but unchanged after adjustment for bone turnover (P < .001), whereas the greater hip BMD in female HBM cases was minimally attenuated by fat mass adjustment (P<.001). Conclusions: HBM is characterized by a marked increase in fat mass in females, statistically explained by their greater BMD, but not by markers of bone turnover. Copyright © 2013 by The Endocrine Society.

Unemployment rates and population changes in Spain

Published as an article in: Journal of Applied Economics, 2004, vol. VII, pages 47-76.

Untersuchungen des Zanderbestandes in den deutschen Küstengewässern der Ostsee von 1992 bis 2002

Pike-perch is an important resource for the coastal fishery in the brackish waters of the eastern part of the coast. For the conservation of the stocks regulation measures (minimum landing size, closed season and minimum mesh size) have been introduced since many years. Basic biological material of the last decade sampled from the commercial fishery and for recruitment by a standard trawl survey. For the “Eastern stock” this paper presents the results concerning age distribution, year-class strengths, growth, proportion spawners, natural mortality and yield-per-recruit analyses.

A study on the growth of Pseudotolithus elongatus, Chrysichthys nigrodigitatus and Cynoglossus goreensis occurring in the Cross River Estuary

Samples of Pseudotolithus elongatus, Chrysichthys nigrodigitatus and Cynoglosus goreensis obtained from the Cross River Estuary (which is most probably the largest estuary water system along the coast of West Africa) between January 1980 and May 1981 were evaluated on basis of population dynamic analytical method postulated by Pauly (1980) for tropical fish stocks. Growth parameters were obtained for the fish species. Wherever possible, these results were compared to those obtained by Longhurst (1964d) and LeGuen (1971) in other West African waters. On the whole, results obtained in this study tend to indicate that the growth of the croaker, bagrid catfish and the sole in the Cross River Estuary is allometric, the third and fourth year-classes of P. elongatus the second and third class-year of C. nigrodigitatus and the fourth, fifth and sixth year classes of C. goreensis dominated in the age distribution of these fish species

Redução de peso na prevenção primária de acidente vascular cerebral

Como as doenças cardiovasculares (DCV) constituem a principal causa de morte na maioria dos países e as tendências de mortalidade não se apresentam totalmente elucidadas nos países em desenvolvimento, torna-se adequado explorar a evolução da mortalidade das DCV, dando ênfase ao acidente vascular cerebral (AVC) no Brasil. Devido à prevalência de AVC e também devido à associação causal entre sobrepeso ou obesidade e AVC não ser clara, é importante avaliar o efeito da perda de peso na prevenção primária de AVC. Baseado no fato do rimonabant ser a primeira droga de uma nova classe de medicamentos promissora não apenas na redução de peso, mas por sua influência sobre os fatores de risco cardiovascular, torna-se pertinente estabelecer sua eficácia e segurança. Inicialmente, para traçar um panorama sobre a epidemiologia das DCV no Brasil, com ênfase em AVC, foram realizados dois estudos com as tendências temporais de mortalidade por DCV ao longo das três últimas décadas, investigando as diferenças entre as regiões do país e entre indivíduos de diversas faixas etárias e de ambos os sexos, (artigo I e II). Além disso, duas revisões sistemáticas foram realizadas: uma para avaliar o efeito da perda de peso na prevenção primária de AVC; a segunda para investigar o uso do medicamento rimonabant no tratamento da obesidade (artigo III e IV). As taxas de mortalidade de AVC diminuíram substancialmente nas últimas três décadas, de 68,2 a 40,9 por 100 000 habitantes. Essa redução foi detectada em ambos os sexos de todas as faixas etárias, e nas diferentes regiões do país, sendo mais acentuadas nas regiões mais ricas (artigo I). A mesma tendência foi observada nas demais DCV, que em geral apresentaram uma redução anual média de 3,9%. As maiores reduções foram encontradas para AVC (média de 4,0% ao ano) seguido por doença coronariana (média de 3,6% ao ano) (artigo II). Não existem estudos avaliando o efeito da redução de peso na prevenção primária de AVC (artigo III). Houve um efeito doseresposta com o uso do rimonabant: comparado com placebo, 20 mg da droga produziu uma redução de peso maior (4,9 kg) em 4 ensaios clínicos com duração de 1 ano. Foram observadas melhoras nos marcadores de risco cardiovascular. Porém 5 mg comparado com placebo mostrou apenas uma redução de 1,3 kg a mais do peso. A maior dose também provocou maiores efeitos adversos. Perdas no seguimento foram de aproximadamente 40% (artigo IV). Durante as últimas décadas, a mortalidade por DCV em geral e AVC diminiu consistentemente no Brasil, porém a magnitude do declínio variou de acordo com as diferenças socioeconômicas. Amplas intervenções poderiam ter mais êxito se planejadas de acordo com as desigualdades sociais e diferenças culturais. Os achados apontam para a necessidade da realização de ensaios clínicos randomizados controlados avaliando a perda de peso na prevenção primária do AVC, devido à alta relevância dessa condição. Como intervenções não são totamente eficazes no tratamento da obesidade, a prevenção, englobando um conjunto articulado de ações, permanece a forma mais eficiente de controlá-la. O medicamento rimonabant apresentou modesta perda de peso, porém os resultados obtidos devem ser interpretados com cautela de acordo com as deficiências na qualidade metodológica apresentadas por todos os estudos. São necessárias pesquisas de alta qualidade para avaliar a eficácia e a segurança do rimonabant em períodos mais longos.

Spatial-temporal excess mortality patterns of the 1918-1919 influenza pandemic in Spain

Background: The impact of socio-demographic factors and baseline health on the mortality burden of seasonal and pandemic influenza remains debated. Here we analyzed the spatial-temporal mortality patterns of the 1918 influenza pandemic in Spain, one of the countries of Europe that experienced the highest mortality burden. Methods: We analyzed monthly death rates from respiratory diseases and all-causes across 49 provinces of Spain, including the Canary and Balearic Islands, during the period January-1915 to June-1919. We estimated the influenza-related excess death rates and risk of death relative to baseline mortality by pandemic wave and province. We then explored the association between pandemic excess mortality rates and health and socio-demographic factors, which included population size and age structure, population density, infant mortality rates, baseline death rates, and urbanization. Results: Our analysis revealed high geographic heterogeneity in pandemic mortality impact. We identified 3 pandemic waves of varying timing and intensity covering the period from Jan-1918 to Jun-1919, with the highest pandemic-related excess mortality rates occurring during the months of October-November 1918 across all Spanish provinces. Cumulative excess mortality rates followed a south-north gradient after controlling for demographic factors, with the North experiencing highest excess mortality rates. A model that included latitude, population density, and the proportion of children living in provinces explained about 40% of the geographic variability in cumulative excess death rates during 1918-19, but different factors explained mortality variation in each wave. Conclusions: A substantial fraction of the variability in excess mortality rates across Spanish provinces remained unexplained, which suggests that other unidentified factors such as comorbidities, climate and background immunity may have affected the 1918-19 pandemic mortality rates. Further archeo-epidemiological research should concentrate on identifying settings with combined availability of local historical mortality records and information on the prevalence of underlying risk factors, or patient-level clinical data, to further clarify the drivers of 1918 pandemic influenza mortality.

大兴安岭北段晚中生代火山岩地球化学特征及其地质意义

This thesis mainly concentrates on the geochronology, prtrology, elemental geochemistry and Sr-Nd-Pb-Hf isotopic geochemistry of the volcanic rocks in north Da’Hinggan Mountain. By analyzing the data obtained in this study and data from other people, this thesis explored the age distribution, petrology and mineralogy and geochemistry characteristics of the volcanic rocks in north Da’Hinggan Mountain. Furthermore, this thesis speculated upon the source characteristics of these volcanic rocks and their implications for the tectonic evolution and crust accretion. According to the twenty Ar-Ar ages, four zircon U-Pb SHRIMP ages and two Zircon U-Pb LA-ICP-MS ages, the duration of the eruption of the Late Mesozoic volcanic rocks in north Da’Hing Mountain was about 160Ma-106Ma. Most of these volcanic rocks belong to early Cretaceous and the late Jurassic volcanic rocks are only restricted in Manzhouli. The bulk of the late Mesozoic volcanic rocks are high-K calc-alkaline rocks. Only a small portion of these volcanic rocks are shoshonites. These rocks are mainly intermediate or acid and the basic rocks usually have higher alkaline contents. Rock types are very complex in this region. These volcanic rocks have a large TiO2 variation and the Al2O3 and alkaline contents are high. From the point of mineralogy, the plagioclases in these volcanic rocks are oligoclases, andesines and labradorites, and the labradorites are more common. Most pyroxenes in these volcanic rocks are augites which belong to clinopyroxene. The source of the Late Mesozoic volcanic rocks was an enriched lithospheric mantle. When the magma en route to the surface it was contaminated by crust material slightly and had some fractional crystallization. These rocks which mainly belong to high-K calc-alkaline series were one of the results of postorogenic tectonic-magmatic activities. The upwelling in late Mesozoic supplied heat to melt the enriched lithospheric mantle which was resulted from the subduction of paleo-Asian Ocean and/or Mengol-Okhotsk ocean. These late Mesozoic volcanic rocks are also important to the upper crustal accretion of north Da’Hinggan Mountain since the late Mesozoic. These volcanics and the contemporary emplacement of granites and the basaltic underplating in combination fulfilled the crust accretion history in north Da’Hinggan Mountain in Late Mesozoic.

特提斯喜马拉雅带晚白垩世-始新世沉积源区分析及其构造意义

Tethyan Himalayan Sequence (THS) is located at the frontier of the India-Asia collision zone, which can preserve critical information about collision. This paper reports detailed petrology, geochemistry, spinels electron microprobe data, and in situ U-Pb ages and Lu-Hf isotopic data on detrital zircons from the late Cretaceous to early Eocene strata in Gyantze and Gamba area, south Tibet that provide important constraints on the early tectonic evolution of the India-Asia collision. In Gyantze, the lithic arkose in Zongzhuo mélange is characterized by, SiO2 =80.4%, Al2O3=8.6%, Na2O=1.6%, K2O=1.1%, LaN/YbN=8.90, and εNd (0) =-10.27. Spinels compositions are characterized by low TiO2 (generally <0.1%) and a Cr number mainly between 70 and 80. The largest population of detrital zircons is within the 73-169Ma range with high εHf (t) and > 500 Ma with complex εHf (t) values. The lithic arkose in Rilang conglomerate is characterized by, SiO2 =56.5%, Al2O3=15.6%, Na2O=4.7%, K2O=0.6%, LaN/YbN=5.00-5.29, and εNd (0) =1.92. Spinels of 2006T98 display high TiO2 (generally >0.2%) and a Cr number mainly between 70 and 85, other spinels are characterized by low TiO2 (generally <0.2%) and a Cr number mainly between 60 and 90. The largest population of detrital zircons is within 90-146 Ma range with high εHf (t). The lithic arkose in Jiachala formation is characterized by, SiO2 =64.6%, Al2O3=12.1%, Na2O=1.9%, K2O=1.8%, LaN/YbN=7.73-9.13, and εNd (0) =-5.52~-8.43. Spinels in the Jiachala formation have low TiO2 (generally <0.2%) and a Cr number between 39 and 88. Detrital zircons have a wide range of age distribution of 82-3165Ma with complex εHf (t). In Gamba, The quartze sandstone in Jidula formation is characterized by, SiO2=97.4%, Al2O3=0.9%, Na2O=0.03%, K2O=0.18%, LaN/YbN=18.70-21.684, and εNd (0) between -13.1~-7.4. While the lithic arkose in Zhepure formation is characterized by, SiO2=68.4%, Al2O3=7.3%, Na2O=1.15%, K2O=0.52%, LaN/YbN=6.09-8.99, and εNd(0)=-5.8~-6.3. Based on our geochemical analysis, spinles electron microprobe data, U–Pb ages and Hf isotope data for detrital zircons of the late Cretaceous-Eocene strata in Gyantze and Gamba, southern Tibet, the following major conclusions can be drawn: 1. In Gyantze, the Zongzhuo mélange was mainly derived from accretionary prism/THS of continental slop and Gangdese arc. Rilang conglomerate was totally from Gangdese arc. The Jiachala formation was derived from THS, suture zone and Gangdese arc. 2. In Gamba, the Jidula formation was from India craton, while the Zhepure formation was derived from THS, suture zone and Gangdese arc. 3. The deposite of Zongzhuo mélange and Rilang conglomerate (73-55Ma) marks the collision between India and Asia. 4. Late Paleocene-Eocene tectonic evolution is consistent with foreland basin system.

Changing epidemiology of serious bacterial infections in febrile infants without localizing signs.

OBJECTIVE: Historically, management of infants with fever without localizing signs (FWLS) has generated much controversy, with attempts to risk stratify based on several criteria. Advances in medical practice may have altered the epidemiology of serious bacterial infections (SBIs) in this population. We conducted this study to test the hypothesis that the rate of SBIs in this patient population has changed over time. PATIENTS AND METHODS: We performed a retrospective review of all infants meeting FWLS criteria at our institution from 1997-2006. We examined all clinical and outcome data and performed statistical analysis of SBI rates and ampicillin resistance rates. RESULTS: 668 infants met criteria for FWLS. The overall rate of SBIs was 10.8%, with a significant increase from 2002-2006 (52/361, 14.4%) compared to 1997-2001 (20/307, 6.5%) (p = 0.001). This increase was driven by an increase in E. coli urinary tract infections (UTI), particularly in older infants (31-90 days). CONCLUSIONS: We observed a significant increase in E. coli UTI among FWLS infants with high rates of ampicillin resistance. The reasons are likely to be multifactorial, but the results themselves emphasize the need to examine urine in all febrile infants <90 days and consider local resistance patterns when choosing empiric antibiotics.

Risk factors for and estimated incidence of community-associated Clostridium difficile infection, North Carolina, USA.

We determined estimated incidence of and risk factors for community-associated Clostridium difficile infection (CA-CDI) among patients treated at 6 North Carolina hospitals. CA-CDI case-patients were defined as adults (>18 years of age) with a positive stool test result for C. difficile toxin and no hospitalization within the prior 8 weeks. CA-CDI incidence was 21 and 46 per 100,000 person-years in Veterans Affairs (VA) outpatients and Durham County populations, respectively. VA case-patients were more likely than controls to have received antimicrobial drugs (adjusted odds ratio [aOR] 17.8, 95% confidence interval [CI] 6.6-48] and to have had a recent outpatient visit (aOR 5.1, 95% CI 1.5-17.9). County case-patients were more likely than controls to have received antimicrobial drugs (aOR 9.1, 95% CI 2.9-28.9), to have gastroesophageal reflux disease (aOR 11.2, 95% CI 1.9-64.2), and to have cardiac failure (aOR 3.8, 95% CI 1.1-13.7). Risk factors for CA-CDI overlap with those for healthcare-associated infection.

Fractures in myelomeningocele.

BACKGROUND: In patients with myelomeningocele (MMC), a high number of fractures occur in the paralyzed extremities, affecting mobility and independence. The aims of this retrospective cross-sectional study are to determine the frequency of fractures in our patient cohort and to identify trends and risk factors relevant for such fractures. MATERIALS AND METHODS: Between March 1988 and June 2005, 862 patients with MMC were treated at our hospital. The medical records, surgery reports, and X-rays from these patients were evaluated. RESULTS: During the study period, 11% of the patients (n = 92) suffered one or more fractures. Risk analysis showed that patients with MMC and thoracic-level paralysis had a sixfold higher risk of fracture compared with those with sacral-level paralysis. Femoral-neck z-scores measured by dual-energy X-ray absorptiometry (DEXA) differed significantly according to the level of neurological impairment, with lower z-scores in children with a higher level of lesion. Furthermore, the rate of epiphyseal separation increased noticeably after cast immobilization. Mainly patients who could walk relatively well were affected. CONCLUSIONS: Patients with thoracic-level paralysis represent a group with high fracture risk. According to these results, fracture and epiphyseal injury in patients with MMC should be treated by plaster immobilization. The duration of immobilization should be kept to a minimum (<4 weeks) because of increased risk of secondary fractures. Alternatively, patients with refractures can be treated by surgery, when nonoperative treatment has failed.