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OBJECTIVES Very little is known concerning the physiological role of leptin and growth in the early postnatal period and the association of leptin with other metabolic hormones in preterm infants. This study aims to investigate these relationships, and to explore the longitudinal and dynamic profile of leptin and metabolic hormones including insulin, ACTH, cortisol and FT4 in this category of patient. We also postulate that a rapid increase in body weight and body mass index in the first few weeks of life may be associated with a corresponding increase in serum leptin if the ‘adipoinsular axis’ is active at this stage. DESIGN A longitudinal study in a cohort of preterm infants

In 1993 a territory-wide cross-sectional growth survey on 25,000 Chinese children from birth to 18 years was performed in Hong Kong. Compared to the last growth survey in 1963, definite secular changes were observed. There was an increase of final adult standing height of 3.6 cm in boys and 2.7 cm in girls, in which 1.8 cm and 0.5 cm respectively for boys and girls was accounted for by the sitting height. Thus most of the height increase had occurred in the leg length in girls, but in boys only half of it. The height difference was more marked during the pubertal years because secular change had brought about an earlier sexual maturation, including an advancement of median menarcheal age by 0.5 year, coupled with an earlier growth spurt. This paper also provides the first growth standards for Chinese from birth to 18 years, with percentile charts on both standing height and sexual maturation in boys and girls.

Aims/Introduction: Type 2 diabetes is characterized by dysregulation of immunity, oxidative stress and reduced incretin effects. Experimental studies suggest that glucagon-like peptide (GLP-1) might have immunomodulating effects. We hypothesize that GLP-1 receptor agonist, exendin-4, might reduce inflammatory response in type 2 diabetes. Materials and Methods: Using peripheral blood mononuclear cells (PBM C) sampled from 10 type 2d iabetes and 10 sex- and age-matched control subjects and supernatants from PBMC culture, the expression of phospho-mitogen activated protein kinase (MAPK) signaling pathways in CD4+ T helper lymphocytes and monocytes was analyzed using flow cytometry. Cytokines/chemokines and superoxide anion before and after treatment with exendin-4 were measured by cytometric bead array and chemiluminesence assay, respectively. Results: Compared with control subjects, PBMC from type 2 diabetes patients showed activated MAPK (P38, c-Jun NH2-terminal protein kinase and extracellular signal-regulated kinase) signaling pathway, elevated superoxide anion, increased pro-inflammatory cytokines (tumor necrosis factor-a ,i nterleukin-1b, interleukin-6) and chemokines (CCL5/regulated on activation normal T-cell expressed and secreted and CXCL10/interferon-c-induced protein 10). These changes were attenuated by exendin-4, possibly through the suppression of p38 MAPK. Conclusions: These results suggest that exendin-4 might downregulate pro-inflammatory responses and reduce oxidative stress by suppressing MAPK signaling pathways in type 2 diabetes. (J Diabetes Invest, doi: 10.1111/jdi.12063, 2013)

AIM—To investigate the inter-relation between leptin and other metabolic hormones in preterm and term infants and to explore whether a functional "adipoinsular axis" might exist in preterm newborns. METHODS—A total of 140 preterm and term newborns were prospectively recruited and categorised according to gestation length. Blood samples were taken at 24 hours (day 1), and on day 4-5 of life. RESULTS—Serum leptin, cortisol, free thyroxine, and plasma ACTH on day 1 were significantly higher in term than in preterm infants. The relation between serum leptin and gestation followed a non-linear pattern; the slope of the curve began to increase steeply between 33 and 35 weeks gestation. Serum leptin on day 1 was significantly associated with serum insulin, insulin:glucose ratio, and plasma ACTH in infants less than 34 weeks gestation; serum leptin on day 1 and day 4-5 were significantly correlated with insulin:glucose ratio in infants 34 or more weeks gestation. Significant changes in the pattern of metabolic hormones were observed in the first week of life. Serum insulin and plasma glucose were significantly increased between day 1 and day 4-5; serum leptin was significantly decreased. CONCLUSIONS—The circulating leptin concentration increases markedly after 34 weeks gestation and bears a close temporal relation with the exponential accumulation of body fat mass during that period. The inter-relation between serum leptin and insulin or insulin:glucose ratio before and after 34 weeks gestation indicates that the "adipoinsular axis" is likely to be functional in early (

AIMS—To investigate the effect of maternal diabetes on leptin in term newborns and to determine whether leptin correlates with insulin and its associated biochemical parameters in support of the hypothesis that a functional "adipoinsular axis" might exist at this stage of development. METHODS—A total of 116 term newborns were prospectively enrolled and categorised into three groups: 44 were infants of non-diabetic mothers (control group C); 41 were infants born to mothers with gestational diabetes on dietary treatment (group D); and 31 were infants born to mothers with gestational or pregestational diabetes on insulin treatment (group I). RESULTS—No significant difference in serum leptin was observed between the three groups; the results of the study population were therefore pooled and analysed. Serum leptin correlated significantly with serum insulin, insulin:glucose ratio, birth weight, body length, body mass index, placenta weight, and maternal HbA1c. Female infants had significantly higher serum leptin than male infants. All parameters except placenta weight and body length remained significantly associated with serum leptin when multivariate stepwise regression analysis was applied. Subgroup analysis revealed a significant correlation between serum leptin and cortisol in group D. CONCLUSIONS—There was no significant difference in serum leptin between infants born to diabetic and non-diabetic mothers, though infants born to mothers requiring insulin treatment had the highest median serum leptin concentrations. The significant association between serum leptin and insulin or insulin:glucose ratio supports the hypothesis that a functional adipoinsular axis might exist in term newborns. Furthermore, the significant correlation between maternal HbA1c and circulating leptin of the studied infants suggests that the clinical control of maternal diabetes could affect the regulation of serum leptin in these infants. An active "adipoinsular axis" is likely to exist in term newborns. The clinical control of maternal diabetes may affect the regulation of serum leptin and possibly may also influence the growth of the fetus in utero

OBJECTIVES To establish a registry for Chinese children with onset of type 1 (insulin dependent) diabetes mellitus before 15 years of age and to determine the incidence of childhood onset type 1 diabetes mellitus in Chinese children in Hong Kong. RESEARCH DESIGN AND METHODS A registry was established in 1997 to collect childhood diabetes cases retrospectively from all districts in Hong Kong. The study included all newly diagnosed cases of diabetes with onset < 15 yr of age from 1st January 1984 to 31 December 1996. Primary ascertainment was based on review of medical records at all regional public hospitals in Hong Kong and survey of all the registered practitioners in Hong Kong. The secondary source of validation was made impractical, if not impossible, because of the recent implementation of the Personal Data Privacy Ordinance in Hong Kong. RESULTS A total of 255 diabetic cases were identified, 227 type 1 diabetes mellitus (218 were Chinese), 18 type 2 diabetes mellitus and 11 secondary diabetes. 246 patients were Chinese and 9 non-Chinese. The age-standardized incidence of type 1 and type 2 diabetes mellitus in southern Chinese children in Hong Kong was 1.4/100,000/yr and 0.1/100,000/yr respectively for children < 15 yr of age during the study period. The incidence rates for type 1 diabetes were 0.9, 1.5 and 1.7 per 100,000/yr for 0-4 years, 5 to 9 years and 10 to 14 years age-groups respectively. The incidence for males was 1.2/100,000/yr and for females 1.7/100,000/yr. A significant increase in the incidence was demonstrated during the study period by simple linear regression (slope 0.14/100,000/year, r2 = 0.73, p = 0.0002) CONCLUSIONS A diabetic registry is established in Hong Kong. This study documents a very low incidence rate of childhood type 1 diabetes mellitus in southern Chinese children in Hong Kong and we have seen an increasing incidence of the disease in the past 13 years.

to patients in the ICU. Over the next five years there will be studies to optimize the use of these drugs and devices for specific indications (e.g. surfactants, aerosol antibiotics) and for specific applications such as high flow nasal delivery, delivery during noninvasive mechanical ventilation, and delivery to the intubated and mechanically ventilated patient. Large coordinated critical care research networks provide the ability to conduct well controlled clinical trials to determine the patient population, medications, dosage and duration of therapy, appropriate devices, and potential risks of these new therapies for the critically ill infant and child.

Background Interleukin (IL)-4 and IL-13 are crucial Th2 cytokines, and their biological responses are mediated by signal transducer and activators of transduction 6 (STAT-6). The gene encoding STAT-6 ( STAT6 ) was linked to asthma and total IgE levels in genome-wide screens. Polymorphisms C1309T (intron 17) and C1570T (intron 18) of STAT6 were also associated with total IgE levels in Caucasian sib-pair families. Rationale We investigate the association between asthma-related phenotypes and the above STAT6 polymorphic markers in Hong Kong Chinese children. Methods Asthmatics younger than 18 years old and non-allergic controls were recruited among those managed in pediatric clinics of a university teaching hospital in Hong Kong. Plasma total IgE concentration was measured by micro-particle immunoassay whereas FEV 1 was determined by spirometer. The C1309T and C1570T polymorphisms in STAT6 were genotyped by polymerase chain reaction and restriction fragment length polymorphism. Results Two hundred forty-three patients and 60 controls were recruited. Logarithmic transformed plasma total IgE levels were higher in patients than controls (2.53 ± 0.69 versus 1.88 ± 0.79; P STAT6 C1309T and C1570T were also in strong linkage disequilibrium ( P 1 . Haplotype analysis confirmed the absence of significant association between these STAT6 intronic polymorphisms and asthma-related phenotypes. Conclusion In this cohort of Chinese children, there is no association between asthma and atopy phenotypes and intronic polymorphisms at positions 1309 and 1570 of STAT6 .

Rationale Th2-specific chemokines including macrophage-derived chemokine (MDC), thymus and activation-regulated chemokine (TARC) and eotaxin are important mediators for allergic airway inflammation. We investigate whether these chemokines are measurable in exhaled breath condensate and their relation to childhood asthma. Methods Patients aged 7 to 18 years old with physician-diagnosed asthma were eligible. Exhaled breath condensate was collected by disposable collection kits (RTubes, Respiratory Research Inc., Charlottesville, VA, USA) whereas fractional exhaled nitric oxide level (FENO) was measured by chemiluminescence (NOA280i, Sievers Instruments, Boulder, CO, USA). Concentrations of MDC, TARC, and eotaxin in EBC were measured using sandwich enzyme immunoassay. Results Forty-eight children with persistent asthma (PA), 36 children with intermittent asthma (IA) and 18 controls were recruited. MDC and eotaxin were present in EBC from all subjects, whereas TARC could be measured in EBC from 33 (32%) subjects only. The median MDC concentration in EBC was higher in PA (117 pg/ml) as compared to IA (106 pg/ml; p=0.003) and controls (105 pg/ml; p=0.003). Among patients with PA, MDC concentrations in EBC decreased with increasing dose of inhaled corticosteroid, with the median values being 122 pg/ml for low-dose, 117 pg/ml for intermediate-dose and 76 pg/ml for high-dose (p=0.005 for trend). FENO was significantly higher in asthmatics than controls (p Conclusions Our results suggest that MDC is increased in EBC from children with PA, and MDC concentrations in EBC decreases with increasing dosage of inhaled corticosteroid in these patients.