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Giuseppe Plazzi - One of the best experts on this subject based on the ideXlab platform.
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in field Assessment of sodium oxybate effect in pediatric type 1 narcolepsy an actigraphic study
Sleep, 2018Co-Authors: Marco Filardi, Fabio Pizza, Elena Antelmi, Raffaele Ferri, Vincenzo Natale, Giuseppe PlazziAbstract:Study Objectives Sodium oxybate (SXB) is a GABAergic agent widely used as off-label treatment in pediatric type 1 narcolepsy (NT1). Here, we aimed at analyzing by wrist actigraphy the sleep/wake profile of NT1 children and adolescents in drug-naive condition and after 1 year of SXB treatment. As secondary aim, we investigated changes on sleepiness, cataplexy, and children's Anthropometric profile after 1 year of SXB treatment. Methods Twenty-four drug-naive NT1 children underwent 7 days of actigraphy during the school week. Information on sleepiness, narcolepsy symptoms, and Anthropometric features were collected during the same week with questionnaires and semistructured clinical interview. Children started SXB treatment and underwent a second evaluation encompassing actigraphy, clinical interview, questionnaires, and Anthropometric Assessment after 1 year of stable treatment. Results Actigraphy effectively documented an improvement of nocturnal sleep quality and duration coupled with a reduction of diurnal total sleep time, nap frequency, and duration at 1 year follow-up. Reduction of sleepiness, cataplexy frequency and severity, and weight loss, mainly in obese and overweight NT1 children, were also observed at the 1 year follow-up. Conclusions Actigraphy objectively documented changes in nocturnal sleep quality and diurnal napping behavior after 1 year of SXB treatment, thus representing a valid approach to ecologically assess SXB treatment effect on NT1 children's sleep/wake profile. NT1 symptoms severity and children's Anthropometric features also changed as expected. Actigraphy offers the possibility to longitudinally follow up children and has potential to become a key tool to tailor treatment in pediatric patients.
Donghee Kim - One of the best experts on this subject based on the ideXlab platform.
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subclinical hypothyroidism and low normal thyroid function are associated with nonalcoholic steatohepatitis and fibrosis
Clinical Gastroenterology and Hepatology, 2018Co-Authors: Donghee Kim, Won Kim, Sae Kyung Joo, Jeong Mo Bae, Jung Ho Kim, Aijaz AhmedAbstract:Background & Aims Variations in level of thyroid-stimulating hormone (TSH) within the reference range of thyroid hormone could have negative health effects. We evaluated the effect of plasma TSH levels within the euthyroid range on the severity of histological damage associated with nonalcoholic fatty liver disease (NAFLD). Methods We performed a cross-sectional study of 425 subjects with biopsy-proven NAFLD (mean age, 53 years; 52% male) who participated in the Boramae NAFLD study from January 2013 to January 2017. Each subject underwent an Anthropometric Assessment and laboratory and clinical evaluations. Of the subjects, 282 were assigned to a strict-normal thyroid function group (plasma level of TSH, 0.4 to 2.5 mIU/L). Patients with low thyroid function were assigned to groups of subclinical hypothyroidism (plasma level of TSH above 4.5 mIU/L with a normal thyroid hormone level; n=59) or low-normal thyroid function (higher plasma TSH level [2.5 to 4.5 mIU/L] with a normal thyroid hormone level; n=84). Multivariate logistic regression analysis was used to identify factors independently associated with nonalcoholic steatohepatitis (NASH) and advanced fibrosis. Results NASH and advanced fibrosis were found in higher percentages of subjects with low thyroid function vs strict-normal thyroid function (52.4% vs 37.2% for NASH and 21.0% vs 10.6% for advanced fibrosis; P P P = .035) and advanced fibrosis (odds ratio, 2.23; 95% CI, 1.18–4.23; P = .014). Risks of NASH and advanced fibrosis increased significantly with plasma concentration of TSH ( P trend Conclusions Subclinical hypothyroidism and low-normal thyroid function are independent predictors of NASH and advanced fibrosis, confirming the relationship between these diseases. ClinicalTrials.gov, Number: NCT02206841.
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body fat distribution and risk of incident and regressed nonalcoholic fatty liver disease
Clinical Gastroenterology and Hepatology, 2016Co-Authors: Donghee Kim, Won Kim, Goh Eun Chung, Min Sun Kwak, Hyo Bin Seo, Jin Hwa Kang, Yoon Jun Kim, Junghwan Yoon, Hyo Suk LeeAbstract:Background & Aims Some studies have examined correlations between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) with nonalcoholic fatty liver disease (NAFLD) or between VAT and NAFLD. We investigated the longitudinal association between body fat distribution (VAT vs SAT) and incidence and regression of NAFLD, adjusting for risk factors, in a large population-based cohort. Methods We collected data from adults who underwent abdominal ultrasonography (to identify liver fat), abdominal fat computed tomography scan, and blood tests from March 2007 through December 2008. Each patient underwent an Anthropometric Assessment and completed a questionnaire about their medical history, physical activity, and diet. Our final analysis involved 2017 subjects from the initial cohort who participated in a voluntary follow-up health screen performed in 2011 and 2013. The median follow-up time was 4.43 years. Results We found 288 incident cases of NAFLD; 159 patients had NAFLD regression during the follow-up period. An increasing area of VAT was associated with higher incidence of NAFLD in the multivariable analysis (highest quintile vs lowest quintile of VAT hazard ratio [HR], 2.23; 95% confidence interval [CI], 1.28−3.89; P for trend = .002; HR, 1.36 [per 1 standard deviation]; 95% CI, 1.16−1.59). An increased area of SAT was significantly associated with regression of NAFLD (highest quintile vs lowest quintile of SAT HR, 2.30; 95% CI, 1.28–4.12; P for trend= .002; HR, 1.36 [per 1 standard deviation]; 95% CI, 1.08−1.72). Conclusions In a large cohort study, larger areas of VAT were longitudinally associated with higher risk of incident NAFLD (during a period of approximately 4 years). In contrast, larger areas of SAT were longitudinally associated with regression of NAFLD. These data indicate that certain types of body fat are risk factors for NAFLD, whereas other types could reduce risk for NAFLD.
Peter B Sullivan - One of the best experts on this subject based on the ideXlab platform.
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nutritional risk in hospitalised children an Assessment of two instruments
Archives of Disease in Childhood, 2010Co-Authors: Rebecca E Ling, Victoria Hedges, Peter B SullivanAbstract:Aims A child9s nutritional status often deteriorates over the course of a hospital admission. No universally accepted paediatric nutritional screening tool exists. This study aimed to evaluate validity and ease of use two new instruments, STAMP and STRONG, for the Assessment of nutritional risk of paediatric inpatients. Methods In a cross-sectional study two trained investigators applied STAMP and STRONG, respectively, to eligible inpatients. Demographic data, clinical information, dietetic input and measurements of weight and height were recorded. Statistical analysis used weight-for-height (height 120 cm) as proxies for acute undernutrition and height-for-age for chronic undernutrition. Correlation of assessed risk and two factors predictive of nutritional risk: Anthropometric nutritional status and presence of nutritional intervention were used to evaluate validity of the instruments. Results 43 children (mean age 6 years and 4 months) were assessed by STAMP and STRONG. Using STAMP the population was classified as 44% high risk, 28% medium risk and 28% low risk. Using STRONG, 25% were high risk, 46% were medium risk and 29% low risk. For validity, STAMP scores correlated to weight-for-height (p 0.05). STRONG correlated to all Anthropometric measures (p Conclusion In terms of validity; STAMP correlates less closely to Anthropometric Assessment of nutritional status and identifies considerably more children who receive no nutritional intervention as high risk than STRONG. This suggests STAMP over-diagnoses nutritional risk. In terms of ease of use STAMP involves measurement of each child9s weight and height. Only 12.5% of inpatients had heights recorded. STAMP takes approximately 10 min longer than STRONG. Both for validity and ease of use STRONG was superior to STAMP.
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nutritional risk in hospitalised children an Assessment of two instruments
Journal of Pediatric Gastroenterology and Nutrition, 2010Co-Authors: Rebecca E Ling, Victoria Hedges, Peter B SullivanAbstract:Summary Background & aims A child’s nutritional status may deteriorate over the course of a hospital admission. No universally accepted paediatric nutritional screening tool exists. This study aimed to evaluate validity and ease of use of two new instruments, STAMP and STRONGKIDS, for the Assessment of nutritional risk of paediatric inpatients. Methods In a cross-sectional study two trained investigators applied STAMP and STRONGKIDS to eligible inpatients. Demographic data, clinical information and Anthropometric measurements were recorded. Correlation of assessed risk and two factors predictive of nutritional risk, Anthropometric nutritional status and presence of nutritional intervention, were used to evaluate validity of the instruments. Results The 43 children assessed by STAMP and STRONGKIDS, were assessed as: STAMP: 44% high risk, 28% medium risk and 28% low risk and STRONGKIDS: 27% high risk, 49% medium risk and 24% low risk. STAMP scores correlated to Anthropometric measures of chronic undernutrition (height-for-age) but not measures of acute undernutrition (BMI). STRONGKIDS correlated to all Anthropometric measures. For STAMP and STRONGKIDS, 57% and 83% of high risk children respectively, received nutritional intervention. Conclusions In terms of validity, STAMP correlates less closely to Anthropometric Assessment of nutritional status and identifies considerably more children receiving no nutritional intervention as high risk than STRONGKIDS. Our results suggest that STRONGKIDS may be a more useful paediatric nutritional screening tool but further comparative studies are required.
Hyo Suk Lee - One of the best experts on this subject based on the ideXlab platform.
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body fat distribution and risk of incident and regressed nonalcoholic fatty liver disease
Clinical Gastroenterology and Hepatology, 2016Co-Authors: Donghee Kim, Won Kim, Goh Eun Chung, Min Sun Kwak, Hyo Bin Seo, Jin Hwa Kang, Yoon Jun Kim, Junghwan Yoon, Hyo Suk LeeAbstract:Background & Aims Some studies have examined correlations between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) with nonalcoholic fatty liver disease (NAFLD) or between VAT and NAFLD. We investigated the longitudinal association between body fat distribution (VAT vs SAT) and incidence and regression of NAFLD, adjusting for risk factors, in a large population-based cohort. Methods We collected data from adults who underwent abdominal ultrasonography (to identify liver fat), abdominal fat computed tomography scan, and blood tests from March 2007 through December 2008. Each patient underwent an Anthropometric Assessment and completed a questionnaire about their medical history, physical activity, and diet. Our final analysis involved 2017 subjects from the initial cohort who participated in a voluntary follow-up health screen performed in 2011 and 2013. The median follow-up time was 4.43 years. Results We found 288 incident cases of NAFLD; 159 patients had NAFLD regression during the follow-up period. An increasing area of VAT was associated with higher incidence of NAFLD in the multivariable analysis (highest quintile vs lowest quintile of VAT hazard ratio [HR], 2.23; 95% confidence interval [CI], 1.28−3.89; P for trend = .002; HR, 1.36 [per 1 standard deviation]; 95% CI, 1.16−1.59). An increased area of SAT was significantly associated with regression of NAFLD (highest quintile vs lowest quintile of SAT HR, 2.30; 95% CI, 1.28–4.12; P for trend= .002; HR, 1.36 [per 1 standard deviation]; 95% CI, 1.08−1.72). Conclusions In a large cohort study, larger areas of VAT were longitudinally associated with higher risk of incident NAFLD (during a period of approximately 4 years). In contrast, larger areas of SAT were longitudinally associated with regression of NAFLD. These data indicate that certain types of body fat are risk factors for NAFLD, whereas other types could reduce risk for NAFLD.
Kevin R Ford - One of the best experts on this subject based on the ideXlab platform.
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high knee abduction moments are common risk factors for patellofemoral pain pfp and anterior cruciate ligament acl injury in girls is pfp itself a predictor for subsequent acl injury
British Journal of Sports Medicine, 2015Co-Authors: Gregory D Myer, Kevin R Ford, Stephanie Di Stasi, Kim Barber D Foss, Lyle J Micheli, Timothy E HewettAbstract:Background Identifying risk factors for knee pain and anterior cruciate ligament (ACL) injury can be an important step in the injury prevention cycle. Objective We evaluated two unique prospective cohorts with similar populations and methodologies to compare the incidence rates and risk factors associated with patellofemoral pain (PFP) and ACL injury. Methods The ‘PFP cohort’ consisted of 240 middle and high school female athletes. They were evaluated by a physician and underwent Anthropometric Assessment, strength testing and three-dimensional landing biomechanical analyses prior to their basketball season. 145 of these athletes met inclusion for surveillance of incident (new) PFP by certified athletic trainers during their competitive season. The ‘ACL cohort’ included 205 high school female volleyball, soccer and basketball athletes who underwent the same Anthropometric, strength and biomechanical Assessment prior to their competitive season and were subsequently followed up for incidence of ACL injury. A one-way analysis of variance was used to evaluate potential group (incident PFP vs ACL injured) differences in Anthropometrics, strength and landing biomechanics. Knee abduction moment (KAM) cut-scores that provided the maximal sensitivity and specificity for prediction of PFP or ACL injury risk were also compared between the cohorts. Results KAM during landing above 15.4 Nm was associated with a 6.8% risk to develop PFP compared to a 2.9% risk if below the PFP risk threshold in our sample. Likewise, a KAM above 25.3 Nm was associated with a 6.8% risk for subsequent ACL injury compared to a 0.4% risk if below the established ACL risk threshold. The ACL-injured athletes initiated landing with a greater knee abduction angle and a reduced hamstrings-to-quadriceps strength ratio relative to the incident PFP group. Also, when comparing across cohorts, the athletes who suffered ACL injury also had lower hamstring/quadriceps ratio than the players in the PFP sample (p Conclusions In adolescent girls aged 13.3 years, >15 Nm of knee abduction load during landing is associated with greater likelihood of developing PFP. Also, in girls aged 16.1 years who land with >25 Nm of knee abduction load during landing are at increased risk for both PFP and ACL injury.