Hildegard Christ

Correlation between BMI, leisure habits and motor abilities in childhood (CHILT-Project)

INTRODUCTION: The prevalence of childhood obesity is increasing with its negative medical and psychosocial consequences. This paper examines the association between body mass index (BMI), motor abilities and leisure habits of 668 children within the CHILT (Childrens Health InterventionaL Trial) project.APPROACH: A total of 668 children (51.0% boys; 49.0% girls) and their parents were questioned on sport and leisure behaviour of the children. The anthropometric data were measured. Motor abilities were determined by a body gross motor development test for children (Köperkoordinationstest für Kinder; KTK) and a 6-min run.RESULTS: The children were 6.70±0.42 y old, 122.72±5.36 cm tall and weighed 24.47±4.59 kg, the average BMI was 16.17±2.27 kg/m2. KTK showed an average motor quotient (MQ) of 93.49±15.01, the 6-min run an average of 835.24±110.87 m. Both tests were inversely correlated with BMI (KTK and BMI r=−0.164 (P<0.001); 6-min run and BMI r=−0.201 (P<0.001)); the group of overweight/obese children showed poorer results than the normal/underweight ones, even after adjustment for gender and age (in each case P<0.001). Children with the greatest extent of exercise achieve the highest MQ (P=0.035).SUMMARY: Overweight/obesity is associated with a poorer body gross motor development and endurance performance. On the other hand, an active lifestyle is positively correlated with a better gross motor development in first-grade children. Therefore, to prevent the negative consequences of physical inactivity and overweight/obesity early intervention to support exercise and movement is recommended.

School-based prevention: Effects on obesity and physical performance after 4 years

Abstract Juvenile obesity is increasing worldwide. Preventive strategies are warranted. The school-based Childrens Health Interventional Trial (the CHILT Project) combines health education and physical activity for children. The effect on obesity and physical performance was studied after four years in 12 primary schools compared with five control schools. Anthropometric data were recorded. Physical performance was measured by a coordination test for children (balancing backwards, one-legged obstacle jumping, lateral jumping, sideways movements) and a 6-min run (endurance). No difference in the prevalence and incidence of overweight and obesity was found between the intervention and control schools before and after the intervention. Remission of overweight was higher in the intervention schools (23.2 vs. 19.2%), but not significant. An increase in coordination related to lateral jumping and balancing backwards was apparent in the intervention schools (30.6, s = 10.8 vs. 26.1, s = 10.8, P = 0.005; 21.8, s = 11.8 vs. 19.4, s = 11.7, P = 0.007), and the increase in endurance performance tended to be higher in intervention schools (100.8, s = 122.7 vs. 92.8, s = 126.0, P = 0.055), adjusted for age, sex, baseline test result, and body mass index at final examination. Therefore, preventive intervention in primary school offers the possibility to improve physical performance in children. The prevalence and incidence of obesity were not affected.

Data from the StEP TWO programme showing the effect on blood pressure and different parameters for obesity in overweight and obese primary school children

UNLABELLED Obesity in childhood, which is associated with cardiovascular risk factors such as hypertension, is on the increase. Countermeasures are necessary. In this paper, we present the baseline and final data from the StEP TWO programme, a prospective study to prevent overweight and obesity in primary schools. METHODS We recorded and calculated, from 1689 children, anthropometric data, including analyses of bioelectric impedance, waist and hip circumferences, body mass index and its standard deviation, and the ratio of waist to hip. Blood pressure was measured after 5 minutes at rest. From the three schools involved in a programme of intervention, 121 children were invited to take part, and 40 (33.1 per cent) completed the programme. The effect was compared with 155 overweight and obese children identified at the 4 control schools. RESULTS 830 (49.5 per cent) boys and 848 girls (50.5 per cent) took part. Their mean age was 8.2 plus or minus 1.3 years, their height was 1.31 plus or minus 0.09 metres, they weighed 30.0 plus or minus 8.2 kilograms, and their mean index of body mass was 17.1 plus or minus 2.9 kilograms per metre squared. Of the children, 7.3 per cent were obese, 10.4 per cent were overweight, 75.7 per cent had normal weights, and 6.6 per cent were underweight. Resting hypertension was observed in 2.3 per cent of the children. Increased blood pressure was associated with a higher body weight, body mass index, standard deviation score for body mass index, and waist and hip circumferences (each p < 0.001), but not with the ratio of waist to hip. Hypertension at rest was also found in 11.0 per cent of obese children, 4.4 per cent of those who were overweight, 1.2 per cent of those with normal weight, and 1.0 per cent of underweight children (p < 0.001). After the intervention, the increase of the body mass index tended to be lower in those in whom we had intervened (p = 0.069), and in these the decrease of the standard deviation score for body mass index was significantly higher (p = 0.028). Systolic blood pressure was reduced by about 10 millimetres of mercury in those in whom we had intervened (p = 0.002), while there were no changes in the control group. Diastolic blood pressure was lowered by 3 millimetres of mercury, but this was not significant. CONCLUSION Obese children had the highest values for systolic and diastolic blood pressure. Increased levels of blood pressure are associated with other parameters of obesity, such as the circumference of the waist and hip. Early preventive measurements in childhood are necessary, and appropriate intervention appears to be effective.

Safety of ultra-rush titration of sublingual immunotherapy in asthmatic children with tree-pollen allergy.

Mösges R, Graute V, Christ H, Sieber H‐Jochen, Wahn U, Niggemann B. Safety of ultra‐rush titration of sublingual immunotherapy in asthmatic children with tree‐pollen allergy.
Pediatr Allergy Immunol 2010: 21: 1135–1138.
© 2010 John Wiley & Sons A/S

Impact of Pump Flow Rate During Selective Cerebral Perfusion on Cerebral Hemodynamics and Metabolism

BACKGROUND Although hypothermic selective cerebral perfusion (SCP) is widely used for cerebral protection during aortic surgery, little is known about the ideal pump-flow management during this procedure. This study explored cerebral hemodynamics and metabolism at two different flow rates. METHODS Fourteen pigs (33 to 38 kg) were cooled on cardiopulmonary bypass to 25°C. After 10 minutes of hypothermic circulatory arrest, the animals were randomly assigned to 60 minutes of SCP at two different pump flow rates: 8 mL·kg(-1)·min(-1) (n = 7) and 18 mL·kg(-1)·min(-1) (n = 7). Microspheres were injected at baseline, coolest temperature, and at 5, 15, 25, and 60 minutes of SCP to calculate cerebral blood flow, cerebral vascular resistance, metabolic rate, and intracranial pressure. RESULTS Cerebral blood flow decreased during cooling to 41% of the baseline value (from 57 ± 10 to 23 ± 4 mL·min(-1)·100 g(-1)). It recovered during the initial 15 minutes of SCP, showing a significantly higher increase (p = 0.017) at high-flow versus low-flow perfusion (139 ± 41 versus 75 ± 22 mL·min(-1)·100 g(-1)). After 60 minutes of SCP the cerebral blood flow almost returned to baseline values in the low-flow group (43 ± 25 mL·min(-1)·100 g(-1)), but showed an unexpected decrease (30 ± 7 mL·min(-1)·100 g(-1)) in the high-flow group. The highest regional cerebral blood flow was seen in the cortex (66 ± 12 mL·min(-1)·100 g(-1)), followed by the cerebellum (63 ± 12 mL·min(-1)·100 g(-1)), the pons (51 ± 17 mL·min(-1)·100 g(-1)), and the hippocampus (36 ± 9 mL·min(-1)·100 g(-1)). Intracranial pressure increased from 11 ± 3 to 13 ± 5 mm Hg during cooling on cardiopulmonary bypass. During low-flow SCP, it stayed stable at baseline values, whereas high-flow perfusion resulted in significantly higher intracranial pressures (17 ± 3 mm Hg; p = 0.001). Changes in cerebral vascular resistance and metabolic rate showed no significant differences between the groups. CONCLUSIONS High-flow SCP provides no benefit during long-term SCP at 25°C. Higher cerebral blood flow during the initial SCP period leads to cerebral edema, with no profit in metabolic rate.

Does the Tokyo guidelines predict the extent of gallbladder inflammation in patients with acute cholecystitis? A single center retrospective analysis

BackgroundThe Tokyo guidelines provide criteria for the diagnosis and classification of acute cholecystitis in three severity grades. However, no data exists on the predictive value of these guidelines. The aim of this study was to analyze the accuracy of the Tokyo guidelines as a predicting parameter for the severity of acute cholecystitis in patients undergoing laparoscopic cholecystectomy.MethodsA retrospective analysis of the charts of patients undergoing laparoscopic cholecystectomy for acute cholecystitis in a primary care hospital within a five-year period was performed. The preoperative severity grades were compared with the histological extent of inflammation.ResultsOne hundred thirty-eight patients; 79 with severity grade I, 33 with grade II and 26 with grade III were analyzed. The incidence of uncomplicated cholecystitis decreased with increasing severity grade, while the incidence of complicated cholecystitis increased with increasing severity. However, complicated cholecystitis was evident in an unexpectedly high number of cases with severity grade I. There was a significant correlation (χ2(1) = 10. 43, p = 0.01) between the preoperative severity grade and the extent of gallbladder inflammation on histopathology. Conversion to open surgery (14 vs. 5, p = 0.002) and complications (17 vs. 7, p = 0.001) were significantly higher in patients with preoperative severity grade II/III compared to patients with severity grade I.ConclusionWorsening clinical severity correlated significantly with worseing pathology, findings from blood test and clinical outcomes; rates of conversion and morbidity. However, the Tokyo guidelines may have a tendency to underestimate the extent of inflammation in male patients with severity grade I and over estimate the difficulty of dissection in severity grade II.

Ten year survivorship after cemented and uncemented medial Uniglide® unicompartmental knee arthroplasties.

BACKGROUND Results of knee replacement registries have shown that unicompartmental knee arthroplasty (UKA) has a significantly higher revision and failure rate than current state-of-the-art TKA. The aim of this prospective study is to evaluate the long-term outcomes and to calculate the 10 year survival of knees with medial osteoarthritis treated with Uniglide® UKA. METHODS Two hundred thirty-four patients were assessed by an independent clinical observer using the American Knee Society Clinical Rating System, a validated outcome measure. Kaplan-Meier analysis was used to calculate the 10 year survival rates using revision surgery for any cause as the end point. RESULTS There were no revisions due to progression of lateral osteoarthritis or polyethylene failure. There were one traumatic and three non-traumatic bearing dislocations and two revisions due to aseptic loosening of the tibial component. One joint was revised for traumatic ligament rupture, one for synovitis from bearing impingement, one due to femoral component mal-positioning and one for infection. A total of 10 cases were revised due to failures for any cause in the 61 patients withdrawn because they had died, thus giving a cumulative survival rate at 10 years of 95.57%. The knee (function) score showed an increase from 33.4 (54.7) pre-operatively to 94 (83.4) points post-operatively. The average range of motion increased from 107 to 122° (p<0.01). CONCLUSION Based on our findings we believe that the Uniglide® unicompartmental knee prosthesis offers a safe and effective solution for the treatment of medial compartment osteoarthritis.

Effect of pressure management during hypothermic selective cerebral perfusion on cerebral hemodynamics and metabolism in pigs

OBJECTIVE The effect of perfusion pressure on cerebral hemodynamics and metabolism during selective cerebral perfusion in patients undergoing aortic surgery is still unknown. This study explored cerebral blood flow, metabolic rate, and intracranial pressure at different pressure rates. METHODS Twenty-five pigs (32-38 kg) were cooled during cardiopulmonary bypass to 25 degrees C. After 10 minutes of hypothermic circulatory arrest, the animals were randomized to 60 minutes of selective cerebral perfusion at 3 different perfusion pressures: group I (n = 8), 40 mm Hg; group II (n = 9), 60 mm Hg; and group III (n = 8), 80 mm Hg. Microspheres were injected at baseline, the coolest temperature, and 5, 15, 25, and 60 minutes of selective cerebral perfusion, respectively, to calculate cerebral hemodynamics. RESULTS Cerebral blood flow decreased during cooling to 54% of baseline value (50 mL/min per 100 g) and recovered in all groups during the first 15 minutes of selective cerebral perfusion. In groups I and II it reached 110% to 113% of baseline values, whereas group III animals showed significantly higher values (P(25min) = .003) during the first 25 minutes of selective cerebral perfusion (360%; 153 mL/min per 100 g). Cerebral blood flow decreased in all groups over the following 35 minutes of selective cerebral perfusion to 57% of baseline value. Cooling to 25 degrees C decreased the intracranial pressure to 10 mm Hg (93%). During selective cerebral perfusion, groups I and II showed a further intracranial pressure decrease to 45% and 82%, respectively, whereas group III, with 15 mm Hg (128%), had significantly higher intracranial pressure values at the end of selective cerebral perfusion (P(25min) = .03 and P(60min) = .02). The metabolic rate decreased to 30% of the baseline value during cooling, reaching 34% to 38% after 60 minutes of selective cerebral perfusion, with no significant differences between groups. CONCLUSION High-pressure perfusion provides no benefit during long-term selective cerebral perfusion at 25 degrees C. Higher cerebral blood flow during the initial 25 minutes of selective cerebral perfusion leads to cerebral edema, with no alteration in metabolic rate.

Evaluation of the use of lower body perfusion at 28°C in aortic arch surgery

OBJECTIVES Although hypothermic circulatory arrest (HCA) and selective cerebral perfusion (SCP) are widely used for cerebral protection during aortic arch surgery, these strategies offer no protection for mesenteric ischaemia during prolonged circulatory arrest. This study explored mesenteric haemodynamics, metabolism, oxidative stress and inflammatory response levels during isolated SCP and combined cerebral and lower body perfusion (CLBP) in pigs. METHODS Fourteen pigs (35-45 kg) were cooled on CPB to 28°C. After 10 min of HCA, they were randomized to 60 min of isolated SCP (n = 7) and CLBP (n = 7) at low-flow pump rates: 10 ml/kg/min (SCP) and 20 ml/kg/min (LBP). Microspheres were injected at baseline, 5 and 60 min of SCP/CLBP and 5 and 60 min off CPB, to calculate mesenteric regional blood flow (RBF). Lactate levels and Oxy-DNA expression [fluorescence activated cell sorting (FACS)] in the portal venous blood were determined at the same time points. Semi-quantitative assessment of inflammatory cytokines was performed using real-time polymerase chain reaction (PCR) and immunhistochemical analyses. RESULTS At baseline mesenteric, RBF was 61 ± 31 ml/min/100 g in the jejunum and 78 ± 43 ml/min/100 g in the colon. Whereas SCP provided a residual mesenteric RBF of 5%, CLBP offered 47% of the baseline jejunal (34 ± 10 ml/min/100 g) and 68% of the colonic RBF (52 ± 34 ml/min/100 g; P = 0.001). Lactate levels were significantly higher in then SCP group (15 ± 2 vs. 11 ± 3 mmol/l; P = 0.01). Oxy-DNA increased, reaching 137% of baseline (SCP) and 129% (CLBP) at 60 min SCP/CLBP, but recovered promptly during reperfusion. Real-time PCR revealed a massive increase in early cytokine expression vs. baseline, showing significant higher interleukin (IL) -6 (29 vs.2; P = 0.027) and COX-relative expression (7 vs. 3, P = 0.016) in the SCP group. Immunhistochemical analysis confirmed a higher immunological activity in the SCP group, showing more intensive signal for tumour necrosis factor-α, IL-6 and p38 when compared with the CLBP group. CONCLUSIONS Low-flow CLBP provides a diminished but considerable mesenteric RBF, leading to lower lactate and oxidative stress levels and a diminished local inflammatory response reaction than isolated SCP.

Temperature Dependence of Cerebral Blood Flow for Isolated Regions of the Brain During Selective Cerebral Perfusion in Pigs

BACKGROUND Hypothermic circulatory arrest (HCA) and antegrade selective cerebral perfusion (ASCP) are utilized for cerebral protection during aortic surgery. However, no consensus exists regarding optimal ASCP-temperature showing a tendency toward higher values during the last years. This study investigates regional changes of cerebral blood flow (CBF) during ASCP at two temperatures. METHODS In this blinded study, 20 pigs (35 to 37 kg) were randomized to two groups. Animals were cooled to 10 minutes of HCA followed by 60 minutes of ASCP. Afterward the animals were perfused at 25 degrees C and 30 degrees C according to the study group. Fluorescent microspheres were injected at seven time points during the experiment to calculate total and regional CBF. Hemodynamics, cerebrovascular resistance (CVR) and cerebral metabolic rate of oxygen (CMRO(2)) were assessed. Tissue samples from the cortex, cerebellum, hippocampus, and pons were taken for microsphere count. RESULTS The CBF and CMRO(2) decreased significantly (p < 0.002) during cooling in both groups; it was significantly higher throughout ASCP in the 30 degrees C versus the 25 degrees C group (p = 0.0001). These findings were similar among all brain regions, certainly at different levels. The CBF increased significantly (p = 0.002) during the early period of ASCP for analyzed regions and decreased significantly (p = 0.034) below baseline after 60 minutes of ASCP, reaching critical levels in the hippocampus and neocortex. The hippocampus turned out to have the lowest CBF, while the pons showed the highest CBF. Thirty minutes and more ASCP provides less CBF compared with baseline values at both temperatures. CONCLUSIONS Antegrade selective cerebral perfusion improves CBF in all regions of the brain for a limited time. Our study characterizes the brain specific hierarchy of blood flow during ASCP. These dynamics are highly relevant for clinical strategies of perfusion.