Influence of combined aerobic and resistance training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial

OBJECTIVE: To evaluate the effect of combined exercise training on metabolic control, physical fitness and quality of life in adolescents with type 1 diabetes. DESIGN: A double-blind randomized controlled trial with patients receiving combined aerobic and strength or no training. SETTING: University Hospital Ghent (Belgium). SUBJECTS: Sixteen children with type 1 diabetes were randomized into a control group (n = 8) and an intervention group (n = 8). INTERVENTIONS: Patients participated twice a week for 20 weeks in the combined aerobic and strength group. The control group continued their normal daily activities. MAIN MEASURES: Before and after the intervention anthropometric variables (weight, length, BMI, body composition), metabolic control (glycaemia, HbA1c, daily insulin injected), aerobic capacity (peak Vo(2), peak power, peak heart rate, 6-minute walk distance), strength (1 repetition maximum of upper and lower limb, hand grip strength, muscle fatigue resistance, sit-to-stand) and quality of life (SF-36) were assessed. RESULTS: At baseline, none of the measured parameters differed significantly between the two groups. There was no significant evolution in the groups concerning anthropometric indices, glycaemia and HbA1c. However, the daily doses of insulin injected were significantly lowered in the training group (0.96 IU/kg.day pre versus 0.90 IU/kg.day post; P < 0,05), while it was increased in the control group. Physical fitness increased significantly in the training group. General health, vitality and role emotional had a tendency to improve. CONCLUSION: Combined exercise training seemed to lower daily insulin requirement and improve physical fitness, together with better well-being

The influence of dairy consumption, sedentary behaviour and physical activity on bone mass in Flemish children : a cross-sectional study

Background: This cross-sectional study aimed to look for an association in young children between whole body bone mineral content (BMC) and areal bone mineral density (aBMD) and dairy consumption as well as sedentary behaviour (SB) and physical activity (PA). Moreover, we investigated whether there was an interaction effect between dairy consumption and SB or PA on BMC and aBMD. Methods: Healthy children (6-12 years) were recruited from primary schools. Body composition and whole body bone mass were measured with dual-energy X-ray absorptiometry (DXA), dairy consumption was assessed with a food frequency questionnaire (FFQ) and PA and SB with an accelerometer. In total, 272 children underwent a DXA scan. Complete FFQ data were available for 264 children and 210 children had matching data from accelerometry recordings. Regression analyses were used to study the associations between (1) BMC and aBMD and (2) dairy consumption, SB and PA, adjusting for age, gender, pubertal stage, height and body composition. Results: Dairy consumption was positively associated with whole body BMC and aBMD (absolute value as well as z-score), after correction for relevant confounders. SB was negatively associated with aBMD z-score and light PA was positively associated with both BMC and aBMD z-score. No gender differences were found. Moreover, an interaction effect between vigorous PA (VPA) and dairy consumption on aBMD (z-score) and BMC z-score was found, indicating that children with both high VPA and high dairy consumption had higher values for BMC and aBMD of the whole body minus the head. Conclusion: Already at young age, PA and dairy consumption positively influence whole body bone mass assessed by DXA. Moreover, this study indicates clearly that SB is negatively associated with whole body bone density. Promoting regular PA and sufficient dairy consumption in young children and limiting SB can be expected to positively influence their bone mass accumulation, which can help in the prevention of osteoporosis later in life

Proximal aortic stiffening in Turner patients may be present before dilation can be detected : a segmental functional MRI study

Background: To study segmental structural and functional aortic properties in Turner syndrome (TS) patients. Aortic abnormalities contribute to increased morbidity and mortality of women with Turner syndrome. Cardiovascular magnetic resonance (CMR) allows segmental study of aortic elastic properties. Method: We performed Pulse Wave Velocity (PWV) and distensibility measurements using CMR of the thoracic and abdominal aorta in 55 TS-patients, aged 13-59y, and in a control population (n = 38; 12-58y). We investigated the contribution of TS on aortic stiffness in our entire cohort, in bicuspid (BAV) versus tricuspid (TAV) aortic valve-morphology subgroups, and in the younger and older subgroups. Results: Differences in aortic properties were only seen at the most proximal aortic level. BAV Turner patients had significantly higher PWV, compared to TAV Turner (p = 0.014), who in turn had significantly higher PWV compared to controls (p = 0.010). BAV Turner patients had significantly larger ascending aortic (AA) luminal area and lower AA distensibility compared to both controls (all p < 0.01) and TAV Turner patients. TAV Turner had similar AA luminal areas and AA distensibility compared to Controls. Functional changes are present in younger and older Turner subjects, whereas ascending aortic dilation is prominent in older Turner patients. Clinically relevant dilatation (TAV and BAV) was associated with reduced distensibility. Conclusion: Aortic stiffening and dilation in TS affects the proximal aorta, and is more pronounced, although not exclusively, in BAV TS patients. Functional abnormalities are present at an early age, suggesting an aortic wall disease inherent to the TS. Whether this increased stiffness at young age can predict later dilatation needs to be studied longitudinally

Bone size and bone strength are increased in obese male adolescents

Context: Controversy exists on the effect of obesity on bone development during puberty. Objective: Our objective was to determine differences in volumetric bone mineral density (vBMD) and bone geometry in male obese adolescents (ObAs) in overlap with changes in bone maturation, muscle mass and force development, and circulating sex steroids and IGF-I. We hypothesized that changes in bone parameters are more evident at the weight-bearing site and that changes in serum estradiol are most prominent. Design, Setting, and Participants: We recruited 51 male ObAs (10-19 years) at the entry of a residential weight-loss program and 51 healthy age-matched and 51 bone-age-matched controls. Main Outcome Measures: vBMD and geometric bone parameters, as well as muscle and fat area were studied at the forearm and lower leg by peripheral quantitative computed tomography. Muscle force was studied by jumping mechanography. Results: In addition to an advanced bone maturation, differences in trabecular bone parameters (higher vBMD and larger trabecular area) and cortical bone geometry (larger cortical area and periosteal and endosteal circumference) were observed in ObAs both at the radius and tibia at different pubertal stages. After matching for bone age, all differences at the tibia, but only the difference in trabecular vBMD at the radius, remained significant. Larger muscle area and higher maximal force were found in ObAs compared with controls, as well as higher circulating free estrogen, but similar free testosterone and IGF-I levels. Conclusions: ObAs have larger and stronger bones at both the forearm and lower leg. The observed differences in bone parameters can be explained by a combination of advanced bone maturation, higher estrogen exposure, and greater mechanical loading resulting from a higher muscle mass and strength

THREE DIMENSIONAL ARTHROKINEMATIC ANALYSIS OF THE LATE PREPARATORY PHASE OF HANDBALL THROWING

INTRODUCTION: At full cocking, functional instability of the glenohumeral (GH) joint is commonly found in handball players. In the past, 2D radiography was used to examine the in vivo translation of the humeral head (HH) on the glenoid cavity (GC). Considering the restraint validity of 2D methods to estimate 3D motion, 3D intra-articular GH kinematical data were obtained on the late cocking phase of handball throwing, using fast helical CT scanning. METHODS: Based on the CT data, 3D bone reconstructions of 3 asymptomatic and 3 functionally unstable GH joints (1 internal impingement, 2 with minor anterior GH instability) in handball players were acquired from a position with the shoulder in 90° abduction and 90° external rotation, and from a position of full cocking assessed on an individual basis. Kinematic analysis was based on a least squares method and linked to the finite helical axis (FHA) concept. After virtual disarticulation, a local frame was embedded on the GC. Subsequently, the GH FHA parameters of direction, rotation and shift were decomposed on this local frame. The displacement of the center of curvature of the HH was related to the GC. Based on an analytic error propagation model, the estimates of the rotation angle, the direction vector and the shift showed highly accurate results. The estimate of the position vector was insufficient for a mathematical analysis and therefore obtained graphically in the finite plane of motion, perpendicularly situated on the FHA. Subsequently, GH contact areal displacement of the mating articular surfaces was analyzed in this finite plane of motion. RESULTS: Towards full cocking, the HH of the asymptomatic shoulders practically did not externally/internally rotate on the local GC frame. The internal impingement demonstrated an accentuated GH external rotation, attended by a dysfunction in scapular setting, with a normal posterior translation of the HH on the GC. Minor anterior GH instability showed a diminished posterior translation of the center of the HH on the GC, as well as an accentuated external rotation. GH contact areal displacement in the normal throwing shoulders and the test case with internal impingement revealed roll behavior. The test cases with minor anterior GH instability featured a pivot. CONCLUSIONS: This research demonstrated the use of helical CT data reconstruction of joint structures with the implementation of an FHA approach to study the 6 degrees of freedom of intra-articular motion assessing a local articular embedded frame and contact areal displacements. The study provided insight in the arthrokinematics of functional instability of the GH joint at late cocking

Desmopressin lyophilisate for the treatment of central diabetes insipidus : first experience in very young infants

INTRODUCTION: In neonates and small infants, early diagnosis of central diabetes insipidus (CDI) and treatment with desmopressin in low doses (avoiding severe hypo- or hypernatremia) are important to prevent associated high morbidity and mortality in this particular age group. CASE PRESENTATION: We described pharmacokinetic and pharmacodynamic results of the use of recently launched oral desmopressin lyophilisate (Minirin Melt®) in two infants with CDI, diagnosed at the age of 12 and 62 days, respectively. We observed that a starting dose of 60 μg of Minirin Melt® in the first case resulted in a pharmacokinetic profile largely exceeding the reference frame observed in children with nocturnal enuresis, while a dose of 15 μg in the second case resulted in acceptable concentrations. After initial dose adjustments, administration of sublingual lyophilisate resulted in rather stable serum sodium concentrations. CONCLUSIONS: Using Minirin Melt® in infants with CDI appears to be effective, easy to use and well tolerated

A synchronous papillary and follicular thyroid carcinoma presenting as a large toxic nodule in a female adolescent

Case presentation We report for the first time a synchronous papillary and follicular thyroid carcinoma in a 12-year-old girl presenting with a large (5 cm diameter) left thyroid nodule, an increased left and right upper pole technetium tracer uptake at scintigraphy and hyperthyroidism. The uptake at the right lobe was explained by the crossing of the left nodule to the right site of the neck at Computed Tomography (CT) scanning. Background Although thyroid nodules are less common in children than in adults, there is more vigilance required in children because of the higher risk of malignancy. According to literature, about 5% of the thyroid nodules in adults are malignant versus 20-26% in children. The characteristics of 9 other pediatric cases with a differentiated thyroid carcinoma presenting with a toxic nodule, which have been reported during the last 20 years, are summarized. A nodular size of more than 3.5 cm and female predominance was a common finding. Conclusions The presence of hyperthyroidism in association with a hyperfunctioning thyroid nodule does not rule out thyroid cancer and warrants careful evaluation, even in the absence of cervical lymph node invasion