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Background:The influence of insulin and insulin resistance (IR) on children’s weight and fat gain is unclear.Objective:To evaluate insulin and IR as predictors of weight and body fat gain in children at high risk for adult obesity. We hypothesized that baseline IR would be positively associated with follow-up body mass index (BMI) and fat mass.Subjects/Methods:Two hundred and forty-nine healthy African American and Caucasian children aged 6–12 years at high risk for adult obesity because of early-onset childhood overweight and/or parental overweight were followed for up to 15 years with repeated BMI and fat mass measurements. We examined baseline serum insulin and homeostasis model of assessment-IR (HOMA-IR) as predictors of follow-up BMI Z-score and fat mass by dual-energy X-ray absorptiometry in mixed model longitudinal analyses accounting for baseline body composition, pubertal stage, sociodemographic factors and follow-up interval.Results:At baseline, 39% were obese (BMI⩾95th percentile for age/sex). Data from 1335 annual visits were examined. Children were followed for an average of 7.2±4.3 years, with a maximum follow-up of 15 years. After accounting for covariates, neither baseline insulin nor HOMA-IR was significantly associated with follow-up BMI (Ps>0.26), BMIz score (Ps>0.22), fat mass (Ps>0.78) or fat mass percentage (Ps>0.71). In all models, baseline BMI (P<0.0001), body fat mass (P<0.0001) and percentage of fat (P<0.001) were strong positive predictors for change in BMI and fat mass. In models restricted to children without obesity at baseline, some but not all models had significant interaction terms between body adiposity and insulinemia/HOMA-IR that suggested less gain in mass among those with greater insulin or IR. The opposite was found in some models restricted to children with obesity at baseline.Conclusions:In middle childhood, BMI and fat mass, but not insulin or IR, are strong predictors of children’s gains in BMI and fat mass during adolescence.

Postoperative liver failure is a rare complication after living donor liver resection. This is a case report of a 22-year-old healthy donor who was rescued with liver transplantation 11 days after right hemihepatectomy. Nine months later the patient is alive, and has fully recovered from his multiple organ failure. According to a review of the literature, there are four additional living liver donors, who received a liver transplant. Our own patient is the only survivor, so far. This case demonstrates that even in supposedly healthy living donors postoperative complications cannot be completely prevented. Although liver failure is rare in these patients, timely transplantation may need to be considered as the only life-saving treatment.

AbstractUnderstanding how culling practices impact target populations is essential in identifying optimum strategies for controlling population size. Red fox (Vulpes vulpes) populations are subject to attempted control throughout much of their range due to their impacts on livestock and game, and disease transmission (e.g., rabies); however, the efficacy of different methods in controlling fox populations is low. For mesomammal species, experimental approaches are often limited by issues of scale. We used an individual-based, spatially explicit population model to investigate the efficacy of different culling practices in artificial landscapes. Model outputs were the number of social groups, the fox population before and after breeding, the extent of successful dispersal within the landscape, and the number of migrants out of the landscape. We investigated 4 different population management strategies using our model: 1) hunting with hounds, 2) winter shooting, 3) culling at the den in spring, and 4) fertility control. Population density in the absence of control was most strongly related to carrying capacity and the extent of immigration from surrounding fox populations. Culling at the den was most successful at suppressing fox populations, while fertility control was least effective, but the effect depended on the carrying capacity of the landscape. We conclude that effective control of populations at landscape scales (e.g., 1,600 km2) is not feasible or practical unless immigration from outside populations is low or can be controlled. These results can be used to inform policy on the management of United Kingdom (UK) fox populations and contribute to the ongoing debate on hunting with hounds as practiced in the UK.

SummaryThis report summarises conclusions from an evidence-based workshop which evaluated major clinical strategies for the management of the full spectrum of gastro-oesophageal reflux disease, with an emphasis on medical management. The disease was defined by the presence of oesophageal mucosal breaks or by the occurrence of reflux induced symptoms severe enough to impair quality of life. Endoscopy negative patients were recognised as the most common subgroup; most of these patients can be diagnosed by a well structured symptom analysis. There is a consistent hierarchy of effectiveness of available initial and long term therapies that applies for all patient subgroups. Lifestyle measures were judged to be of such low efficacy that they were rejected as a primary therapy for all patient subgroups. Proton pump inhibitor therapy was considered the initial medical treatment of choice because of its clearly superior efficacy which results in the most prompt achievement of desirable outcomes at the lowest overall medical cost. It was acknowledged that most of patients require long term management and that any maintenance therapy should be chosen by step down to the regimen that is still effective, but least costly. Endoscopic monitoring of routine long term therapy was considered inappropriate, on the basis that control of symptoms is an acceptably reliable indicator of healing in patients with oesophagitis. Laparoscopic antireflux surgery was recognised as a significant therapeutic advance, the results of which, however, depend substantially on the experience of the surgeon. There are currently no published direct comparisons of cost and efficacy outcomes of optimal medical and surgical therapies for reflux disease. To a significant degree, the choice between medical and surgical therapy should depend on informed patient preference. Substantial advances have occurred recently in the understanding and treatment of reflux disease. By contrast, there has been relatively little research into the best strategies for capitalisation on these advances. This is a fertile field for future research.

Cancer of the oesophagus has great diversity in geographical distribution and incidence. The rate of oesophageal cancer has been increasing in some areas and the reasons for this are not clear. This review outlines fascinating epidemiological aspects and the risk factors for squamous cell carcinoma of the oesophagus. While in the Western world the effects of alcohol and tobacco are substantial preconditions, worldwide other factors, such as diet, nutritional deficiencies, environmental exposure and infectious agents (especially papillomavirus and fungi), play a significant role. Chronic irritation of the oesophagus appears to participate in the process of carcinogenesis, particularly in patients with thermal and/or mechanical injury, achalasia, oesophageal diverticulum, chronic lye stricture, radiation therapy, injection sclerotherapy and gastric resection before the appearance of oesophageal tumour. The association of Plummer–Vinson syndrome, coeliac disease, tylosis and scleroderma with oesophageal cancer has also been reviewed.

Although in vitro studies suggest that cholinergic induced contractions and spontaneous tone are mediated by two different cellular pathways, this has not been shown in vivo. The purpose of this study was to distinguish these types of contractions in the feline lower esophageal sphincter (LES) through use of i.v. selective pharmacologic antagonists. Continuous infusion of the calcium channel antagonist verapamil (16-128 micrograms/kg/min) caused a dose-dependent inhibition of bethanechol induced and tonic pressure change. At 32.0 micrograms/kg/min, verapamil produced significantly greater inhibition of bethanechol induced contractions when compared with inhibition of basal LES tone (57.4 versus 4.8%, P less than .02, n = 5). Verapamil also caused a parallel decrease in LES spike activity associated with bethanechol induced contractions. In contrast, lower doses of nitroprusside (0.5 micrograms/kg/min) inhibited LES tone by over 50% (50.6 +/- 21.8%) yet had no significant effect (16.8 +/- 23.4%) on bethanechol induced contractions. Also, inhibition of basal LES tone correlated poorly with its effect on associated spike activity. It is concluded that in the in vivo feline LES, spike dependent cholinergic contractions can be distinguished from LES tone by the use of low dose verapamil and nitroprusside, respectively. This selective inhibition suggests that two cellular mechanisms mediate LES contractions and that these pathways can be distinguished pharmacologically in vivo.