Carrie C. Coughlin

Effect of Marked Weight Loss on Adiponectin Gene Expression and Plasma Concentrations

Objective: Adiponectin is the most abundant protein secreted by adipose tissue and is inversely associated with adiposity and insulin resistance. The aim of this study was to evaluate the hypothesis that marked weight loss, induced by gastric bypass surgery (GBS), would increase adiponectin gene expression in both upper and lower subcutaneous body fat and increase plasma adiponectin concentration.

Insulin sensitivity is not associated with palmitoleate availability in obese humans

We evaluated whether insulin resistance in obese people is associated with decreased plasma palmitoleate availability. Palmitoleate content (percentage and absolute concentrations) in FFA and VLDL was measured in obese subjects who were either insulin resistant (IR) or insulin sensitive (IS), based on assessment of multiorgan (skeletal muscle, liver, and adipose tissue) insulin sensitivity by using the hyperinsulinemic-euglycemic clamp procedure in conjunction with infusion of stable isotopically labeled tracers. Plasma palmitoleate concentration and the relative contribution of palmitoleate to total plasma FFA concentration in the IS group (0.018 ± 0.002 mmol/l and 4.4% ± 0.2%, respectively) were not significantly different than values in the IR group (0.023 ± 0.003 mmol/l and 4.4% ± 0.4%, respectively). Plasma VLDL-triglyceride palmitoleate concentration and the proportion of VLDL fatty acids as palmitoleate in the IS group (0.09 ± 0.02 mmol/l and 5.7 ± 0.3%, respectively) were also not significantly different than those in the IR group (0.16 ± 0.04 mmol/l and 5.0% ± 0.4%, respectively). These data demonstrate that decreased palmitoleate in plasma and in VLDL is not associated with insulin resistance in skeletal muscle, liver, or adipose tissue in obese people.

Deletion of Tis7 Protects Mice from High-Fat Diet-Induced Weight Gain and Blunts the Intestinal Adaptive Response Postresection

After loss of intestinal surface area, the remaining bowel undergoes a morphometric and functional adaptive response. Enterocytic expression of the transcriptional coregulator tetradecanoyl phorbol acetate induced sequence 7 (Tis7) is markedly increased in a murine model of intestinal adaptation. Mice overexpressing Tis7 in intestine have greater triglyceride absorption and weight gain when fed a high-fat diet (42% energy) than their wild-type (WT) littermates fed the same diet. These and other data suggest that Tis7 has a unique role in nutrient absorptive and metabolic adaptation. Herein, male Tis7(-/-) and WT mice were fed a high-fat diet (42% energy) for 8 wk. Weight was monitored and metabolic analyses and hepatic and intestinal lipid concentrations were compared after 8 wk. Intestinal lipid absorption and metabolism studies and intestinal resection surgeries were performed in separate groups of Tis7(-/-) and WT mice. At 8 wk, weight gain was less and jejunal mucosal and hepatic triglyceride and cholesterol concentrations were lower in Tis7(-/-) mice than in the WT controls. Following corn oil gavage, serum cholesterol, triglyceride, and FFA concentrations were lower in the Tis7(-/-) mice than in the WT mice. Incorporation of oral (3)[H] triolein into intestinal mucosal cholesterol ester and FFA was less in Tis7(-/-) compared with WT mice. Following resection, crypt cell proliferation rates and villus heights were lower in Tis7(-/-) than in WT mice, indicating a blunted adaptive response. Our results suggest a novel physiologic function for Tis7 in the gut as a global regulator of lipid absorption and metabolism and epithelial cell proliferation.

Malignant melanoma arising at the site of a previously excised giant congenital melanocytic nevus.

Malignant Melanoma Arising at the Site of a Previously Excised Giant Congenital Melanocytic Nevus Patients with giant congenital nevi are at increased risk for malignant melanoma. Most reported cases involve development of melanoma during childhood, usually before age 6 years.1-3 Herein, we report a case of a man with a giant congenital nevus and satellite nevi who underwent multiple excisions and grafting procedures as a child and developed malignant melanoma more than 30 years later.

Pediatric aleukemic leukemia cutis: report of 3 cases and review of the literature.

Leukemia cutis (LC) denotes a cutaneous infiltration of neoplastic myeloid cells or lymphoid blasts, which can present in the setting of acute myeloid leukemia, particularly in those cases with monocytic or myelomonocytic differentiation. Rarely, cutaneous involvement by a leukemic infiltrate can occur in the absence of bone marrow or peripheral blood involvement by acute leukemia; this then is referred to as aleukemic LC (ALC). Recognition of LC is important for further classification and early diagnosis of the disease, but the diagnosis is difficult in the absence of a systemic presentation of acute leukemia. Although the molecular and cytogenetic features of ALC are poorly characterized, some have shown specific molecular alterations in common with classic forms of acute leukemias. We present 3 cases of ALC in pediatric patients.

Skin cancer risk education in pediatric solid organ transplant patients: an evaluation of knowledge, behavior, and perceptions over time

Skin cancer risk is elevated in solid OTRs. Studies of skin cancer awareness and sun‐protection behaviors in pOTRs have not been reported. We measured effects over time of a multimodal educational intervention on knowledge of sun‐protection practices and skin cancer risk, engagement in sun‐protection behaviors, and self‐efficacy and perceived barriers to photoprotection in pOTRs, their guardians, and a comparison group of children and guardians. Knowledge about skin cancer risk increased in pOTRs and their guardians (P≤.01) and frequency of pOTRs’ sun‐protection behaviors reported by pOTRs and their guardians also improved.

The preadolescent acne microbiome: A prospective, randomized, pilot study investigating characterization and effects of acne therapy

Acne, a common pediatric disease, tends to be more comedonal in preadolescents, whereas older individuals are more likely to have inflammatory lesions in addition to comedones. Thus the microbiome of preadolescents may be different. In this pilot study we aimed to characterize the preadolescent acne microbiome, compare the microbiome in preadolescents with and without acne, and investigate changes in the microbiome after topical treatment with benzoyl peroxide or a retinoid in a small cohort of preadolescents.

Optimal time to provide skin cancer and photoprotection education to pediatric solid organ transplant recipients

REFERENCES 1. Bergfeld WF, Farris PK, Wyatt SW, et al. Executive summary of the national Partners in Prevention Skin Cancer Conference: American Academy of Dermatology and Centers for Disease Control and Prevention. J Am Acad Dermatol. 1997;36(5 pt 1): 798-801. 2. Centers for Disease Control and Prevention. Protect your visitors and staff from skin cancer. Available from: http:// www.cdc.gov/cancer/skin/pdf/skincancer_parks-recreation.pdf. Accessed August 9, 2016. 3. National Oceanic and Atmospheric Administration. Available from: http://www.cpc.ncep.noaa.gov/products/stratosphere/uv_ index/Bulletin/. Accessed September 15, 2016.

Drug Hypersensitivity Syndrome with Prolonged Course Complicated by Parvovirus Infection

Drug hypersensitivity syndrome (DHS) is a severe medication reaction involving multiple organ systems that is characterized by rash, lymphadenopathy, and laboratory aberrations, including hepatic enzyme changes. Viral reactivation in the setting of DHS can significantly affect the course of disease. We report two children in whom parvovirus infection prolonged and complicated their course of DHS. Most other DHS‐complicating viruses are herpesviruses; this report broadens the scope of DHS‐modifying infections to include activation of Parvoviridae.

Omenn Syndrome Presenting with Striking Erythroderma and Extreme Lymphocytosis in a Newborn.

Omenn syndrome is an autosomal recessive form of “leaky” severe combined immune deficiency resulting in distinct phenotypic features. The patient described herein had an atypical presentation of Omenn syndrome, with conspicuous erythroderma and extreme lymphocytosis at birth, in contrast to the typical evolution of rash seen during the first few weeks of life. In addition, the skin findings were secondary to infiltration of CD8+ (cytotoxic) T‐cells in contrast to the CD4+ (helper) T‐cells typically seen, which broadens the Omenn syndrome phenotype.