Obesity in adolescents is associated with metabolic risk factors for type 2 diabetes, particularly insulin resistance and excessive accumulation of intrahepatic triglyceride (IHTG). The purpose of ...this study was to evaluate the effect of moderate weight loss on IHTG content and insulin sensitivity in obese adolescents who had normal oral glucose tolerance. Insulin sensitivity, assessed by using the hyperinsulinemic–euglycemic clamp technique in conjunction with stable isotopically labeled tracer infusion, and IHTG content, assessed by using magnetic resonance spectroscopy, were evaluated in eight obese adolescents (BMI ≥95th percentile for age and sex; age 15.3 ± 0.6 years) before and after moderate diet‐induced weight loss (8.2 ± 2.0% of initial body weight). Weight loss caused a 61.6 ± 8.5% decrease in IHTG content (P = 0.01), and improved both hepatic (56 ± 18% increase in hepatic insulin sensitivity index, P = 0.01) and skeletal muscle (97 ± 45% increase in insulin‐mediated glucose disposal, P = 0.01) insulin sensitivity. Moderate diet‐induced weight loss decreases IHTG content and improves insulin sensitivity in the liver and skeletal muscle in obese adolescents who have normal glucose tolerance. These results support the benefits of weight loss therapy in obese adolescents who do not have evidence of obesity‐related metabolic complications during a standard medical evaluation.
•Wave–current flow in an ocean basin is simulated using RANS model with k–epsilon turbulence model.•A regular wave in deep water conditions propagating on favourable currents is investigated.•The ...numerical results allowed identify the region in the basin where the Rayleigh formulation can be applied.•Good agreement was found between the numerical and analytical solution based on Rayleigh formulation.
Wave–current flow is a phenomenon that is present in many practical engineering situations. Over the past several decades, this type of flow has been increasingly investigated under controlled laboratory conditions. This paper presents a numerical study of wave–current flow in the ocean basin of the LabOceano (COPPE/UFRJ). A homogeneous multiphase model based on the RANS equations and the k–ɛ turbulence model implemented in ANSYS-CFX code were used. A cross section of the ocean basin was represented. A regular wave with a height of 0.08m and a period of 1.80s (i.e., a wave steepness of H/L=0.016), propagating on favourable currents, was simulated. The behaviour of the free surface elevation over time and the streamlines along the basin for wave and wave–current flows were presented. The numerical results were compared to the non-viscous theory given by the Rayleigh equation applied to the problem of wave–current interaction. Good agreement was found between the wave length estimated by the numerical results and the analytical solutions, with a deviation of less than 2%.
Primary hepatic functional paraganglioma is a rare form of extra-adrenal catecholamine-secreting tumor. Definitive treatment of functioning paraganglioma is challenging because of the critical ...location of the tumor frequently in close proximity to vital structures and risk of excessive catecholamine release during operative manipulation. We report the multidisciplinary management approach for a case of unresectable primary hepatic functional paraganglioma with invasion into the hepatic veins and suprahepatic vena cava.
To our knowledge, this is the first report showing that orthotopic liver transplantation is curative for patients with unresectable primary hepatic paraganglioma. For locally advanced unresectable hepatic paraganglioma that involves the intrapericardial vena cava, a meticulous pre- and intraoperative medical management and transabdominal intrapericardial vascular control of the suprahepatic vena cava during orthotopic liver transplantation allows for complete extirpation of the tumor and achieves optimal outcome.
•Orthotopic liver transplantation is a curative treatment for patients with unresectable primary hepatic paraganglioma.•A meticulous pre- and intraoperative medical management of the patient's hemodynamics is crucial during orthotopic liver transplantation for unresectable primary hepatic paraganglioma.•For a tumor invading the suprahepatic inferior vena cava, a transabdominal intrapericardial vascular control of the suprahepatic vena cava during orthotopic liver transplantation allows for a complete extirpation of the tumor and achieves optimal outcome.
BACKGROUND:Nonalcoholic fatty liver disease (NAFLD) and insulin resistance are common in overweight adolescents. OBJECTIVE:The purpose of this study was to determine the relation between NAFLD and ...insulin sensitivity in liver and skeletal muscle by studying overweight adolescents with a normal or high intrahepatic triglyceride (IHTG) content, who were matched for age, sex, body mass index (BMI; in kg/m²), and Tanner stage. DESIGN:Stable-isotope-labeled tracer infusion and the hyperinsulinemic-euglycemic clamp procedure were used to assess skeletal muscle and hepatic insulin sensitivity, and magnetic resonance spectroscopy was used to assess the IHTG content in 10 overweight (BMI = 35.9 ± 1.3) adolescents with NAFLD (IHTG = 28.4 ± 3.4%) and 10 overweight (BMI = 36.6 ± 1.5) adolescents with a normal IHTG content (3.3 ± 0.5%). RESULTS:The baseline plasma glucose concentration and the rate of appearance of glucose in plasma were the same in subjects with a normal (87.1 ± 1.2 mg/dL, 16.2 ± 1.1 μmol · kg fat-free mass⁻¹ · min⁻¹) or high (89.2 ± 2.5 mg/dL, 16.3 ± 1.2 μmol · kg fat-free mass⁻¹ · min⁻¹) IHTG content. However, compared with subjects who had a normal IHTG content, subjects with NAFLD had a lower hepatic insulin sensitivity index, based on baseline glucose kinetics and insulin concentrations (4.0 ± 0.5 compared with 2.4 ± 0.4; P < 0.05) and an impaired increase in glucose uptake during insulin infusion (169 ± 28.1% compared with 67 ± 9.6% above baseline; P < 0.01). In addition, the plasma triglyceride concentration was greater and the plasma HDL-cholesterol concentration was lower in subjects with NAFLD than in those with a normal IHTG content. CONCLUSION:An elevated IHTG content in overweight adolescents is associated with dyslipidemia and with insulin-resistant glucose metabolism in both liver and skeletal muscle.
There is evidence that dopamine receptors D2 (
DRD2
) and D4 (
DRD4
) polymorphisms may influence substance use disorders (SUD) susceptibility both individually and through their influence in the ...formation of DRD2–DRD4 heteromers. The dopaminergic role on the vulnerability to addiction appears to be influenced by sex. A cross-sectional study with 307 crack cocaine addicts and 770 controls was conducted. The influence of
DRD2
rs2283265 and
DRD4
48 bp VNTR in exon 3 variants, as well as their interaction on crack cocaine addiction susceptibility and severity were evaluated in women and men separately. An association between the
DRD2
T allele and crack cocaine addiction was found in women. In this same group, interaction analysis demonstrated that the presence of
DRD2
-T allele and concomitant absence of
DRD4
-7R allele were associated with risk for crack cocaine addiction. No influence of
DRD2
and
DRD4
variants was observed in men regarding addiction severity. This study reinforces the role of dopaminergic genes in externalizing behaviors, especially the influence of DRD2–DRD4 interaction on SUD. This is the fourth sample that independently associated the DRD2–DRD4 interaction with SUD itself or related disorders. In addition, our findings point out to a potential difference of dopaminergic neurotransmission across sex influencing addiction susceptibility.
Accurate detection of recurrent colorectal carcinoma remains a diagnostic challenge. The purposes of this study were to assess the accuracy of 18FDG-PET in patients with recurrent colorectal ...carcinoma in detecting liver metastases compared with computed tomography (CT) and CT portography, detecting extrahepatic metastases compared with CT and evaluating the impact on patient management.
Fifty-two patients previously treated for colorectal carcinoma presented on 61 occasions with suspected recurrence and underwent 18FDG-PET of the entire body. PET, CT and CT portography images were analyzed visually. The final diagnosis was obtained by pathology (n = 44) or clinical and radiological follow-up (n = 17). The impact on management was reviewed retrospectively.
A total of 166 suspicious lesions were identified. Of the 127 intrahepatic lesions, 104 were malignant, and of the 39 extrahepatic lesions, 34 were malignant. Fluorine-18-fluorodeoxyglucose imaging was more accurate (92%) than CT and CT portography (78% and 80%, respectively) in detecting liver metastases and more accurate than CT for extrahepatic metastases (92% and 71%, respectively). Fluorine-18-fluorodeoxyglucose detected unsuspected metastases in 17 patients and altered surgical management in 28% of patients.
These data identify that 18FDG-PET is the most accurate noninvasive method for staging patients with recurrent metastatic colorectal carcinoma and plays an important role in management decisions in this setting.
Background and Aims
Many children with primary sclerosing cholangitis (PSC) receive oral vancomycin therapy (OVT) or ursodeoxycholic acid (UDCA). There is a paucity of data on whether these ...medications improve outcomes.
Approach and Results
We analyzed retrospective data from the Pediatric PSC Consortium. Children treated with OVT were matched 1:1:1 to those treated with UDCA or managed with observation (no treatment) based on the closest propensity score, ensuring similar baseline characteristics. Two hundred sixty‐four patients (88 each with OVT, UDCA, or observation) had matching propensity scores and were similar in demographics, phenotype, immunosuppression, baseline biochemistry, and hepatic fibrosis. After 1 year in an intention‐to‐treat analysis, all outcome metrics were similar regardless of treatment group. In OVT, UDCA, and untreated groups, respectively: Gamma‐glutamyltransferase normalized in 53%, 49%, and 52% (P = not significant NS), liver fibrosis stage was improved in 20%, 13%, and 18% and worsened in 11%, 29%, and 18% (P = NS), and the 5‐year probability of liver transplant listing was 21%, 10%, and 12% (P = NS). Favorable outcome was associated with having a mild phenotype of PSC and minimal hepatic fibrosis.
Conclusions
We presented the largest‐ever description of outcomes on OVT in PSC and compared them to carefully matched patients on UDCA or no therapy. Neither OVT nor UDCA showed improvement in outcomes compared to a strategy of observation. Patients progressed to end‐stage liver disease at similar rates. Spontaneous normalization of biochemistry is common in children receiving no therapy, particularly in the majority of children with a mild phenotype and an early stage of disease. Placebo‐controlled treatment trials are needed to identify effective treatments for pediatric PSC.
A major problem in the field of adsorbents is that binders (kaolin clay, bentonite) introduced to bind zeolites and ensure the needed mechanical strength, are not able to sorb gases like CO2 and N2, ...and decrease the overall adsorption capacity. To solve this problem, one of the pathways is to introduce a binder able to sorb such gases. Thus, in this study, the physical and mechanical properties of a novel binder based on metakaolin and its composite with zeolite 4A in the granular form were studied. Metakaolin was used as a precursor for alkali-activated binder, which was synthesized using an 8M NaOH activation solution. Raw materials were characterized using granulometry, X-ray diffraction (XRD), and differential thermal analysis (DTA); and final products were characterized using density measurements, a compressive strength test, XRD, Brunauer–Emmett–Teller (BET) analysis, and scanning electron microscopy (SEM). Alkali-activated metakaolin was found to be efficient as a binding material when data for morphological properties were analyzed. A relationship was observed—by increasing the liquid-to-solid ratio (L/S), compressive strength decreased. Zeolite granule attrition was higher than expected: 2.42% and 4.55% for ZG-0.8, 3.64% and 5.76% for ZG-1.0, and 2.73% and 4.85% for ZG-1.2, measured at 4 and 5 atmospheres, respectively.
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