Teses / dissertações sobre o tema "Complications"

The main body of the work is a study of the rates of obstetric complications in 492 patients meeting ICD-9 criteria for schizophrenia, affective disorder and other functional psychosis, compared to their 797 non-psychotic siblings and to 2,460 normal controls. The main results, for each of the three diagnostic groups, indicate significant confounding between obstetric complications, maternal marital status and social class. No single obstetric complication remained associated with schizophrenia once these factors had been controlled for. Bleeding in pregnancy was associated with an increased risk of affective disorder compared to controls. A low Apgar score at 5 minutes was associated with an increased risk of affective disorder compared to controls. Low social class and maternal marital status were also associated with the risk of affective disorder. Induction of labour or elective caesarean section was associated with an increased risk of other functional psychosis compared to their non-psychotic siblings. Secondary analyses of the effect of season of birth, age of onset of illness and family history are presented. Schizophrenic patients were more likely to have been born in winter than their siblings but winter-born schizophrenics had similar rates of OCs to those born at other times.  An induced labour or elective caesarean section was associated with an increased risk of affective disorder of early onset and of non-familial affective disorder. Bleeding in pregnancy was also associated with an increased risk of non-familial affective disorder. The findings are compared to those of other studies and conclusions are drawn about the importance of obstetric complications in the aetiology of psychotic disorders, with particular emphasis on schizophrenia, and suggestions are made for further research.

In 1980, Christ and Lee wrote a paper titled 'Operator ordering and Feynman rules in gauge theories'. In this paper they showed that the Hamiltonian formulation of a non-abelian gauge theory in a general non-covariant gauge is complicated by problems of operator ordering, leading to new nonlocal interactions they call V₁ + V₂. In particular this applies to the familiar Coulomb gauge. More recently, Cheng and Tsai have arrived at the same ordering by careful attention to the fact that the Gauss-law constraint is not an operator equation. On the other hand, it is known that the naive Coulomb gauge Feynman rules in non-abelian gauge theory give rise to ambiguous integrals, in addition to the usual ultraviolet divergences. This thesis shows how these ambiguities can be resolved to all orders in perturbation theory. This is done by defining a gauge that interpolates smoothly between the Feynman gauge and the Coulomb gauge, and then using a diagrammatic method to combine the different contributions that arise. The extra terms V₁ + V₂ of Christ and Lee are then identified with certain two loop ambiguous terms. The only remaining question is whether the method of resolving the ambiguities is compatible with renormalisation. An investigation into the extra complications that renormalisation introduces is carried out.

Obesity is a major public health problem. Bariatric surgery is currently the only available treatment that offers sufficient weight-loss and metabolic benefits over time. Although bariatric surgery is considered safe now, serious complications still occur. The aim of this thesis was to identify factors associated with an increased risk for postoperative complication after laparoscopic gastric bypass surgery. Study I included patients operated with laparoscopic gastric bypass surgery in Sweden from May 2007 until September 2012. The risk for serious complication was low (3.4%). Suffering an intraoperative adverse event or conversion of the operation to open surgery were the strongest risk factors for postoperative complication. The annual operative volume and experience of the procedure at the institution were also important risk factors. Patient-specific risk factors appeared to be less important although age was associated with an increased risk. In Study II, a raised glycated haemoglobin A1c (HbA1c) was evaluated as a risk factor for serious postoperative complications in non-diabetics. A higher incidence of serious postoperative complications was seen with elevated HbA1c values, even at levels classified as ‘‘pre-diabetic’’. Study III was a multicentre, randomised clinical trial (RCT). 2507 patients planned for laparoscopic gastric bypass surgery were randomised to either mesenteric defects closure or non-closure. Closure of the mesenteric defects reduced the rate of reoperation for small bowel obstruction from 10.2% to 5.5% at 3 years after surgery. A small increase in the rate of serious postoperative complication within the first 30 days was seen with mesenteric defects closure. This relatively small increase in risk was however outweighed by the marked reduction of later reoperations for small bowel obstruction. Study IV was a comparison between study III and an observational study on the same population under the same period of time. Although the observational study reached the same conlusion as the RCT, the efficacy of mesenteric defects closure was less pronounced. Observational studies may thus be an alternative to RCTs under situations when RCTs are not feasible. The efficacy may however be underestimated.

SHS vs. Gamma Nail Using FE analysis, the behaviour of the Gamma nail and the SHS was compared in an osteoporotic bone model for the fixation of three- and fourpart trochanteric fractures (31-A2 in the AO classification, types IV and V in Evans’ classification). The size of the medial fragment was varied based on clinical data and the case of a fractured greater trochanter was also considered. Results show that for Evans’ type V stabilized with a Gamma nail and for Evans’ types IV and V with the SHS, cancellous bone around the lag screw is susceptible to yielding, thus indicating a risk of cut-out. The volume of bone susceptible to yielding increases with an increase in size of the medial fragment. On the other hand, Evans’ type IV with a Gamma nail is not predicted to cut out. These findings suggest that future clinical trials investigating fixation of unstable proximal fractures should include the size of the medial fragment and the integrity of the greater trochanter as covariables and be powered to evaluate whether intramedullary devices are superior to SHSs for Evans’ type IV fractures and inferior/equivalent for type V. PFNA Because of the contradictory body of evidence related to the potential benefits of helical blades in trochanteric fracture fixation, the e↵ect of bone compaction resulting from the insertion of a PFNA was evaluated. A subject-specific computational model of a trochanteric fracture (31-A2 in the AO classification) was developed with lack of medial support and bone density was varied to account for variability in bone properties amongst hip fracture patients. Results show that for a bone density corresponding to 100% of the bone density of the cadaveric femur, there does not seem to be any advantage in using a PFNA with respect to the risk of blade cut-out. On the other hand, in a more osteoporotic femoral head characterized by a density corresponding to 75% of the initial bone density, local bone compaction around the helical blade provides additional bone purchase, thereby decreasing the risk of cut-out, as quantified by the volume of bone susceptible to yielding. These findings indicate benefits of using a PFNA over an intramedullary nail with a conventional lag screw and suggest that any clinical trial reporting surgical outcomes regarding the use of helical blades should include a measure of the femoral head bone density as a covariable. TAD and Screw Position Using a simple mathematical formulation, the relationship between the position of the lag screw tip (relevant to both intramedullary and extramedullary devices) and the concept of tip-apex distance (TAD) was derived. TAD is widely used in operating theaters as a surgical guideline in relation to the fixation of trochanteric fractures and in clinical studies as a predictor of lag screw cut-out. In order to visualize better this concept, the locus of points having the same TAD was plotted and TAD variations as the location of the lag screw tip was varied were described. Findings show that TAD should be adjusted for the size of the femoral head (a variable which varies a lot according to the sex of the patient) and that no correlation exists between TAD and bone morphometry indices obtained from μCT data (BV/TV and Tb.Th). Therefore, these results seem to suggest that TAD lacks mechanical justification and that predictors which are based on mechanical properties, such as bone density, should be investigated further. Cut-out and Screw Position The biomechanical performance of a CT scan-based three-part trochanteric fracture model (31-A2 in the AO classification) stabilized with a SHS was compared for nine di↵erent positions of the lag screw (3 x 3 arrangement, from anterior to posterior and from inferior to superior). Results show that the volume of bone susceptible to yielding in the head and neck region is the lowest for inferior positions and increases as the lag screw is moved superiorly. Overall, for this specific subject, the models less likely to lead to cut-out are the ones corresponding to inferior middle and inferior posterior positions of the lag screw. In this study, TAD was anti-correlated with the risk of cut-out, as quantified by the volume of bone susceptible to yielding, which suggests that a TAD > 25 mm cannot be considered to be an accurate predictor of lag screw cut-out. Further clinical studies investigating lag screw cut-out should attempt to find more reliable predictors of cut-out that should better reflect the biomechanics and subject-specificity of the femoral head. Plasticity Formulations Using an FE model of unstable trochanteric fracture stabilized with a SHS, the benefits of two plasticity-based formulations, Drucker-Prager and crushable foam, were evaluated and compared to the commonly used linear elastic model of trabecular bone in order to predict relative risk of lag screw cut-out for five distinct load cases. The crushable foam plasticity formulation leads to a much greater strain localization, in comparison to the other two models, with large plastic strains in a localized region. The plastic zone predicted with Drucker-Prager is relatively more di↵use. Linear elasticity associated with a minimum principal strain criterion provides the smallest volume of elements susceptible to yielding for all loading modes. The region likely to undergo plastic deformation, as predicted by the linear elastic model, is similar to that obtained from plasticity-based formulations, which indicates that this simple criterion provides an adequate estimate of the risk of cut-out.

Thesis (M.A.)--Boston University
Hallucinogens are drugs that alter consciousness by distorting primarily auditory and visual perception but they can affect any sensory system. Hallucinogens also affect judgment, orientation, memory, or emotion. Despite the profound alteration in perception, adverse effects are minimal and hallucinogens are not addictive. Hallucinogen use has its roots in shamanic practices of indigenous cultures and is even incorporated in today’s religions like the Native American Church. By putting a person in an altered state of consciousness, many religions believed that the user was able to see beyond the boundaries of reality and reach out to mythical beings. Hallucinogen use in scientific research was not popular until the 1950’s when Albert Hoffman discovered lysergic acid diethylamide (LSD). The discovery of drug encouraged further research into understanding its mechanisms and its relationship with mental diseases like schizophrenia. Unfortunately, the Comprehensive Drug Abuse Prevention and Control Act of 1970 significantly limited hallucinogenic research and human research for the last 42 years. However, animal research in the last 20 years has determined the importance of serotonergic mechanisms and more specifically the 5-HT2A receptors in mediating LSD’s hallucinogenic effects. Researchers continue to identify mechanisms of LSD action. In addition to serotonergic actions, LSD is active with dopaminergic and metabotropic glutamate receptors. PET scans and fMRI’s have also revealed the importance of the prefrontal cortical region and its interaction with other areas during a hallucinogenic state. The relationship between LSD and acute psychosis is also being explored via animal models. Although human clinical research is limited, recent research sees a much deeper relationship by linking LSD brain activity and neurotransmitter levels to psychotic behaviors. This further understanding of hallucinogens on a physiological and psychological level has led to possible psychotherapeutic areas of research in anxiety and substance abuse. This thesis describes a brief history of hallucinogenic research, the pharmacology and neuroanatomy of serotonergic hallucinogens, the acute and chronic adverse effects of serotonergic hallucinogens, the possible treatments for complications of hallucinogens, the epidemiology, the relationship between hallucinogens and schizophrenia, and possible therapeutic uses of serotonergic hallucinogens. With its minimal adverse effects in humans and its powerful influence on the human psyche, serotonergic hallucinogens are invaluable tools for understanding the human mind.

[Truncated abstract] Introduction: Childhood obesity is currently a serious worldwide public health issue associated with many medical and psychosocial complications. The increasing disease burden with the potential for the development of medical co-morbidities has implications for future health care provision. This thesis adds to the understanding of the medical complications of overweight and obesity in childhood. Design and Aims: Two different, but related, research studies are reported. The first study is a cross-sectional study, designed to quantify the medical complications of childhood obesity in primary school-aged children in Western Australia. This study aims to identify the medical complications of primary school children with overweight/obesity. The study also aims to compare the medical complications of obesity in a community sample who have never sought treatment with a clinical sample who are actively seeking treatment for overweight/obesity. Finally, this study also aims to examine the relationship between the medical complications of childhood obesity and a continuum of children's Body Mass Index z-scores, including those in the normal range. The second study is an exercise intervention study to investigate the effect of exercise on one specific medical complication of obesity, namely insulin resistance. This study aims to determine if a structured eight-week exercise program significantly changes insulin resistance in obese children, and to determine if this decrease in insulin resistance is associated with changes in body composition and inflammatory markers. ... Conclusion: The prevalence of the medical complications of overweight and obesity in primary school children indicates that all children should have body mass index regularly checked from a young age. Children who are overweight/obese should be screened for the presence of co-morbidities despite a young age. Parents and health professionals needs to be educated that childhood obesity is associated with medical co-morbidities and is not simply a social or cosmetic concern. The continuous nature of the BMI z-score/co-morbidities relationship suggests that public health and health education strategies should include adopting a populationbased approach to weight management. This continuous relationship means that even in the normal BMI spectrum, the risk of developing co-morbidities rises with increasing BMI. Such an approach would encourage maintenance of normal weight for all children, rather than targeting overweight/obese children only. Increased activity and decreased sedentary behaviours should be recommended for all children in line with the population-based public health approach suggested above. However, exercise has a specific role in weight management strategies for overweight/obese children, and in management strategies for adiposityrelated co-morbidities. Significant metabolic benefits of exercise occur in the absence of changes in body shape and weight. After an exercise program, simple blood investigations (such as lipid profiles, fasting insulin and OGTTs) are likely to miss important metabolic improvements and anthropometry (BMI calculation, waist circumference) may be more indicative of potential metabolic improvement and decreased co-morbidity risk.

Obstructive sleep apnoea (OSA) is the third commonest respiratory condition after Asthma and COPD and has been increasingly linked to cardiovascular consequences. This thesis examines how OSA might affect different vascular beds; large (the aorta), medium (the carotid artery) and small (retinal and cerebral blood vessels) through five different studies. Each study will be reported as a separate chapter and a final discussion will assess the overall conclusions. Methodology Study one examines the prevalence of OSA in individuals with an abdominal aortic aneurysm and demonstrates the increased prevalence and rate of aneurysm expansion in those with severe OSA. Study two demonstrates the increased prevalence of OSA in individuals with type two diabetes and clinically significant diabetic macular oedema (CS MO). Study three examines the clinical benefit of continuous positive airway pressure (CPAP) in individuals with OSA and CS MO and demonstrates an improvement in visual acuity when CPAP is used for >2.5hrs per night. Study four is a retrospective examination of the effect of snoring on carotid vessel disease and shows no significant difference between the severity of snoring and degree of carotid artery stenosis. Study five describes the effect of minimally symptomatic obstructive sleep apnoea on cerebrovascular disease and shows no association between OSA and small white matter change but, does confirm the association of increasing age and hypertension. Discussion This thesis adds to our understanding of the association of OSA and vascular disease and the potential therapeutic benefits of CPAP in these individuals.

This thesis investigates complications of surgery in infants, particularly infections and liver disease in infants receiving parenteral nutrition (PN) following gastrointestinal surgery, and intraoperative hypercapnia and acidosis in surgery for congenital diaphragmatic hernia (CDH) and oesophageal atresia with tracheo-oesophageal fistula (OA/TOF), using a series of clinical studies. A pilot randomised controlled trial comparing open versus thoracoscopic surgery in neonates with CDH and OA/TOF showed that neonatal thoracoscopy resulted in more severe intraoperative hypercapnia and acidosis than open surgery, particularly in patients with CDH. This highlights a need for studies assessing neurodevelopmental outcomes following neonatal thoracoscopy. In surgical infants receiving PN, chlorhexidine antisepsis to clean central venous catheter connectors was associated with a significant reduction in the rate of septicaemia (particularly staphylococcal). In such infants, septicaemia due to bowel organisms occurred later than septicaemia due to coagulase-negative staphylococci. In congenital duodenal obstruction, while avoidance of initial PN was successful for two thirds of cases in which it was attempted, one third subsequently required PN, and this group showed poorer growth than children who commenced PN soon after surgery. One third of surgical infants with intestinal failure develop intestinal failure associated liver disease (IFALD), and 61% developed septicaemia. I found no association between septicaemia and IFALD. In a randomised controlled trial to investigate whether glutamine supplementation affects the incidence of microbial invasion in surgical infants receiving PN, microbial invasion was detected by blood cultures, broad-range and targeted PCR for bacterial DNA, and assays of endotoxin, and lipopolysaccharide binding protein. Monocyte HLA-DR expression was measured by flow cytometry. Glutamine had no effect on microbial invasion, which was detected in 60% of patients (half of which was detected by blood culture). Glutamine supplementation significantly enhanced recovery of monocyte function. Among patients with low monocyte function at enrolment, glutamine was protective against microbial invasion.

Of the 800,000 suicides recorded globally every year, over a third are due to pesticide ingestion, the majority of which occur in rural Asia with organophosphorus (OP) compounds. These anticholinesterase pesticides cause an acute cholinergic syndrome characterised by decreased consciousness, excessive airway secretions and respiratory failure. A combination of these clinical features is the most common cause of death. Up to 30% of OP pesticide poisoned patients are admitted to the Intensive Care Unit (ICU) for tracheal intubation and lung ventilation, but up to half die. It is not understood why the case fatality for intubated poisoned patients is so high, but one hypothesis is that the patients, when unconscious, aspirate their stomach contents (including the OP and the solvent present in its agricultural formulation) causing a toxic lung injury which contributes to the observed high mortality. In this PhD, I aimed to characterise the lung injury caused by OP pesticide self-poisoning through both indirect (ingestion) and direct (aspiration) means. To achieve this, I analysed data from previous toxicological minipig work and designed and conducted a specific minipig pulmonary aspiration study which was complemented by an experimental OP poisoning ex vivo lung perfusion model and human data from pesticide poisoned patients in Sri Lanka. I first investigated the pulmonary pathophysiology resulting from orogastric administration of OP pesticide without aspiration. Analysis of my group’s Gottingen minipig in vivo work demonstrated that orogastric placement of agricultural OP (dimethoate EC40) produced lung injury via exposure to blood-borne pesticide. Pathological lung changes consisted of alveolar and interstitial oedema, pulmonary haemorrhage and modest neutrophilia with increased concentrations of protein, IL-6 and IL-8 when compared with controls, but with low concentrations of TNF-α and IL-10 in bronchoalveolar lavage fluid (BALF). In a second study, OP poisoned minipigs had increased concentrations of BALF protein, neutrophils, IL-8 and CRP six hours after orogastric poisoning when compared with their baseline values. Electron microscopy images of both studies demonstrated damage to the alveolar capillary membrane secondary to systemic OP poisoning. Prior to conducting the main pulmonary aspiration study in minipigs, there was considerable refinement of the processes involved through use of: (i) pilot aspiration and dose ranging studies; (ii) the development of a specific pulmonary histopathological scoring system; and (iii) employment of modern human anaesthetic equipment and intensive care patient management protocols. After this period of model development, an in vivo 48 hour study using Gottingen minipigs (n=26) was conducted to investigate the pulmonary pathophysiology in animals given either sham bronchoscopy (sham control) or 0.5 mL/kg of: saline (saline control), porcine gastric juice [GJ], OP (dimethoate EC40) + GJ [OP+GJ], or solvent (cyclohexanone) + GJ [Solv+GJ] into the right lung under bronchoscopic guidance. The results showed that in a minipig model OP and GJ placed into one lung created a direct (right) and indirect (left) lung injury significantly different to controls, and in some respects worse than GJ alone 48 hours after poisoning. The direct lung injury caused by OP+GJ was characterised by significantly worse pathology (p=0.0003) in terms of: pulmonary neutrophilia, alveolar haemorrhage, necrosis, oedema and fibrin deposition, when compared with sham controls at 48 hours. Lungs injured directly with OP+GJ also had significantly higher concentrations of BALF neutrophils (p≤0.01), protein (p≤0.05), IL-6 (p≤0.01), IL-8 (p≤0.01) and CRP (p≤0.05) at 24 hours, and BALF protein (p≤ 0.01), and CRP (p≤ 0.05) when compared with sham controls at 48 hours. The BALF from OP+GJ minipigs at 48 hours also had higher numbers of aerobic bacteria than other groups, suggesting the development of pneumonia could be a source of additional lung injury. Lung damage might also have resulted from a reduction in the surfactant component responsible for the lowering of alveolar surface tension. Direct lung injury with OP+GJ caused a proportional reduction of beneficial pulmonary surfactant phosphatidylcholine (PC) species 16:0/16:0 [29(±4) % vs. 38(±4) %] when compared with sham controls at 48 hours. Unlike the other groups, OP+GJ (direct and indirectly-injured) lungs had type 2 alveolar cell ultrastructural morphological differences in the lamellar bodies that stored the surfactant. The lamellar bodies were more numerous and more dense in the OP+GJ lungs compared with other groups and could signify a failure of surfactant release or some other pathology pertinent to OP aspiration lung injury. Computed tomography analysis showed that direct lung injury with OP+GJ caused significantly more lung tissue to be poorly or non-aerated [77 (±13) % ; p≤0.0001 when compared with sham] as opposed to 62 (±27) % in GJ, 53(±13)% in sham and 47(±0.2)% in saline control animals by 47.5 hours and was mainly due to pulmonary haemorrhage and oedema fluid. The key differences between aspiration of OP+GJ versus GJ alone was that the majority of inflammatory markers (e.g. BALF protein, IL-6 and CRP) appeared to increase from 24-48 hours in OP+GJ treated animals, but decreased in GJ pigs, possibly signifying resolution. Treatment with GJ alone produced less severe histopathological damage, bacterial BALF numbers and percentage of poorly and non-aerated lung tissue. Importantly, there was less evidence of indirect lung injury within the GJ pigs when compared with animals treated with OP+GJ. Solvent placed into the lung seemed to offer some form of protection from the effects of GJ aspiration. This was dramatically demonstrated by the histopathology scores, proportional percentage of beneficial phosphatidylcholine (PC) species 16:0/16:0 and the percentage of poorly and non-aerated lung tissue all approaching control animal levels by 48 hours in minipigs that had Solv+GJ placed in the directly-injured (right) lung. Further evidence of benefit was provided by statistically significant reductions (p≤ 0.05) in BALF concentrations of IL-8, IL-6 and CRP in minipigs which had aspirated Solv+GJ when compared with OP+GJ and/or GJ minipig groups at 24 hours. The pathophysiology of aspirated OP+GJ was also investigated in a pilot ovine ex vivo lung perfusion (EVLP) model (n=4). Lungs directly-injured with OP+GJ had higher concentrations of total protein (4300 mg/L vs. 350 mg/L) with a proportional reduction of beneficial pulmonary surfactant phosphatidylcholine species 16:0/16:0 (27% vs.34%) when compared with control lungs. Analysis of toll-like receptor (TLR) lung tissue expression in the OP+GJ directly and indirectly-injured lungs indicated that inflammatory mechanisms might also involve upregulation of TLR 3 and 5, unlike other lung injuries e.g. those induced with lipopolysaccharide, which typically upregulates TLR 2 and 4. To compare OP-induced lung injury in humans and the minipigs, a small feasibility study was conducted in the ICUs of the University of Peradeniya hospital, Sri Lanka. Unfortunately, ethics review and recruitment proved more difficult than expected and we failed to recruit to target. We did however find raised BALF concentrations of IL-6, IL-8 and CRP and low concentrations of TNF, IL-1β, IL-10 in intubated OP poisoned patients at 24 hours when compared with controls. We also found that two plasma micro-RNA biomarkers thought to be involved in inflammation and lung injury, MiR-21 and MiR-146a, had significantly reduced expression in OP-poisoned patients with aspiration compared to non-intubated control patients from the UK (p=0.008 and p=0.0083 respectively). The work from this thesis has allowed the characterisation of both indirect and direct lung injuries caused by OP pesticide ingestion and aspiration. The minipig model showed that at 48 hours the lung injury created by aspiration of OP+GJ appeared more severe than GJ alone, but the addition of the solvent cyclohexanone seemed protective and even beneficial in the context of GJ aspiration. The cytokine expression profiles from both the human and minipig work, combined with the preliminary TLR lung tissue analysis from the EVLP model, suggest that OP+GJ aspiration is unlike normal GJ aspiration and classic ARDS.
Increased concentrations of aerobic bacteria in the minipig OP+GJ lungs at 48 hours and evidence of suppression of plasma miR-21 and miR-146a in OP poisoned patients could be linked, and may involve cholinergic immune system modulation. These molecular mechanisms need to be investigated further in both in vitro and in vivo models. These discoveries indicate the complex nature of the pulmonary injury that occurs after OP pesticide poisoning, and suggests that damage is not caused by gastric contents alone. Preliminary findings indicate that aspiration of OP+GJ could create favourable conditions for the development of aspiration or ventilator-associated pneumonia but this would need confirmation in larger clinical studies. The potential roles of micro RNA as a biomarker of OP poisoning and lung injury, and solvent as a therapy for aspiration should be explored in further pre-clinical studies.

Introduction: The aim of this study was to determine the types and prevalence of complications following MARPE protocol at University of the Pacific and to investigate the complication of asymmetry using CBCT analysis. Methods: In the first portion of this study, 97 patients who started treatment prior to July 2020 and who had MARPE expander treatment at the University of the Pacific were included. Chart review and evaluation of progress clinical photographs were used to report the following complications: inflammation, pain, appliance malfunction, broken microscrew, and pulpitis. In the second portion of this study, 77 patients from a private practice orthodontist who started treatment prior to January 2021 were included in this study. The complication of asymmetry was measured using CBCT measurements from T1 (prior to treatment start) and T2 (immediately following MARPE expansion). The change in U6 molar angulation changes was also assessed. Results: It was determined in the first portion of this study that the most common complication was inflammation around the MARPE site, with 82% of the study population exhibiting any severity of inflammation. 3 patients exhibited severe inflammation requiring removal of MARPE. 18% reported pain in the MARPE area. 9 patients exhibited appliance malfunction, 1 patient exhibited broken microscrew, and 1 patient exhibited pulpitis. It was determined in the second portion of this study that 47% of patients exhibited asymmetry greater than 1 mm and the average asymmetry at ANS was 1.47 mm. No correlation was exhibited between amount of asymmetric expansion and the following measures: age, molar inclination, palatal thickness, posterior screw expansion and palatal vault height. 3 Conclusions: Inflammation of the MARPE is the most common complication that can result in early removal of the expander. Other complications such as asymmetry and pain are common as well.

Cystic fibrosis-related diabetes (CFRD) is a secondary form of diabetes, associated with increasing age in subjects with Cystic Fibrosis (CF). With improved life expectancy, CFRD is anticipated to increase in prevalence in addition to its complications. The aim of this study was to investigate the use of HbA1c as an early predictor of disease, as well as investigate microvascular and macrovascular complications in an adult CF cohort attending the All Wales Cystic Fibrosis Centre. The current method of using the conventional oral glucose tolerance test (OGTT) to diagnose CFRD was compared to using glycated haemoglobin (HbA1c). The findings demonstrated that a HbA1c value ≥ 5.5%/36mmol/mol was significantly predictive of the development of dysglycaemia over a 6-year period. The association between HbA1c and development of diabetic retinopathy (DR) was analysed. The study demonstrated 23% of CF patients with CFRD screened for DR had evidence of moderate to severe diabetic retinopathy. They had a higher HbAc1 and longer duration of CFRD compared to those without severe forms of DR. This suggests that microvascular complications are present in CFRD and to a similar extent as in type 1 diabetes mellitus. The prevalence of cardiac autonomic neuropathy (CAN) in CFRD was tested in 71 subjects with CF. CF subjects who were of an older age group demonstrated an inverse correlation with heart rate variability (HRV) during deep breathing (p < 0.05). CF dysglyaemic individuals with severe forms of diabetic retinopathy had reduced HRV during deep breathing compared to subjects with mild or no DR (p < 0.05). The presence of arterial stiffness in CFRD was examined in 65 CF subjects and 31 healthy volunteers. Age, gender and mean arterial pressure were significant predictors of increased augmentation index (AIx) and pulse wave velocity (PWV). Glycaemic control did not influence the arterial stiffness measurement outcomes. The CF group demonstrated a greater Aix than healthy volunteers (HV) (P < 0.05) when other variables were controlled in the analysis, suggesting possible increased inflammatory mechanism leading to increased Aix accounting for these findings. CF dysglycaemic subjects had greater PWV than CFNGT subjects which was only significant at the 10% level. The study findings demonstrate HbA1c has a predictive value in the diagnosis of CFRD based on a positive OGTT. Severe DR is prevalent in CFRD and is associated with a reduction in HRV during deep breathing. Glycaemic control is not predictive of arterial stiffness, in contrast to age, gender and MAP. Thus future consideration of the use of HbA1c may help to predict individuals with underlying dysglycaemia and reduce the risk of the development of associated microvascular complications.

Les prévalences du surpoids et de l'obésité chez l'enfant ont largement augmenté ces 20 dernières années avec le risque de voir augmenter les complications métaboliques associées et donc à long terme la morbidité cardiovasculaire. Dans une étude portant sur 308 enfants en surpoids ou obèses, nous montrons que près d'1 enfant obèse sur 2 est affecté par un syndrome métabolique (SM) ou syndrome d'insulino-résistance, fréquence influencée par l'âge, le degré d'obésité et l'obésité de la mère. L'insulino-résistance (IR) joue un rôle majeur dans le développement des complications métaboliques et pourrait en être un marqueur précoce. La masse grasse totale et sa distribution chez l'enfant en surpoids ou obèse sont influencées par l'âge et les antécédents parentaux d'obésité. La masse grasse totale est associée au SM alors que la viscérale est associée à l'IR. Nos résultats suggèrent que la masse grasse viscérale s'accumule dès l'enfance, influencée par différents facteurs dont le sexe et l'ethnie, et semble déjà être métaboliquement active. Bien que la fréquence des troubles de la tolérance au glucose soit relativement faible chez l'enfant obèse, des cas de diabète de type 2 commencent à apparaître. Le diabète de type 2 chez l'enfant obèse se caractérise par une IR marquée, compensée par une hypersécrétion d'insuline, suivie par une détérioration rapide et sévère de la sécrétion d'insuline. La détérioration fonctionnelle des cellules B peut apparaître moins de 4 ans après le diagnostic de diabète et ferait jouer un rôle majeur à la sécrétion d'insuline dans les perspectives thérapeutiques
The prevalence of overweight and obesity in childhood has grown very rapidly over the past 20 years with the risk of an increasing prevalence of associated metabolic complications and cardiovascular morbidity. In a study including 308 overweight and obese children, we show that one out of two obese children presents with metabolic syndrome (MS) or insulin résistance syndrome which frequency increased with age, degree of adiposity and mother's obesity. Insulin résistance (IR) plays a major role in the development of the metabolic complications and could precede the other metabolic complications in obese children. Total fat mass and its distribution in overweight and obese children are influenced by age and parental history of obesity. Total fat mass is associated with MS whereas visceral fat mass is associated with IR. Our data suggest that visceral fat mass starts to accumulate in childhood influenced by several factors such as sex and ethnicity, and seems to be metabolically active even in childhood. Although we find a low frequency of glucose tolerance disorders, cases of type 2 diabetes occur in childhood. Type 2 diabetes in obese children is characterized by a marked IR compensated by an elevated insulin secretion able to maintain normal fasting plasma glucose levels, followed by a rapid and severe impairment of insulin secretion. Deterioration of B cell function appears less than 4 yr after diagnosis and insulin secretion could play a major role in therapeutic approaches