Medicine and Health Sciences Commons^™

Associations Of Adipose Tissue Architecture, Adipokines And Inflammatory Markers With Body Mass Index And Gestational Weight Gain In Non-Diabetic Pregnancies, Tiffany A. Moore Simas, Crina Boeras, Ningning Zhang, Olga Gaelikman, Katherine G. Leung, Nicole M. Wedick, Laura Robidoux, Jodi Adams Puleo, Mary M. Lee, Silvia Corvera, Milagros C. Rosal

Mary M. Lee

Background: Some pregnancy weight gain is stored as adipose tissue (AT). Human AT depots vary in their capacity for expansion. Data suggests that subcutaneous (SQ) is adapted for healthy lipid storage. Conversely visceral (V) accumulation is associated with inflammation, obesity-related co-morbidities and Type 2 diabetes (T2DM) risk. We investigated SQ and VAT histologic architecture along with insulin, adipokines and inflammatory markers in relationship to prepregnancy BMI and gestational weight gain (GWG). Methods: Subset of non-diabetic singleton gravidas from the Pregnancy & Postpartum Observational Dietary Study (PPODS), undergoing Cesareans and consenting to SQ & VAT biopsies were included. Average adipocyte size …

Evaluation Of Short And Tall Stature In Children, Benjamin Nwosu, Mary Lee

Mary M. Lee

Children and adolescents whose heights and growth velocities deviate from the normal percentiles on standard growth charts present a special challenge to physicians. Height that is less than the 3rd percentile or greater than the 97th percentile is deemed short or tall stature, respectively. A growth velocity outside the 25th to 75th percentile range may be considered abnormal. Serial height measurements over time documented on a growth chart are key in identifying abnormal growth. Short or tall stature is usually caused by variants of a normal growth pattern, although some patients may have serious underlying pathologies. A comprehensive history and …

Hepatic Dysfunction Is Associated With Vitamin D Deficiency And Poor Glycemic Control In Diabetes Mellitus, Benjamin Nwosu, Zheni Stavre, Louise Maranda, Karen Cullen, Mary Lee

Mary M. Lee

Background/Aims: The effect of the rising prevalence of nonalcoholic fatty liver disease on the 25-hydroxylation of pre-vitamin D in the liver, and consequent glycemic control in children with diabetes mellitus is not known. Our aim was to determine whether mild hepatic dysfunction was associated with impaired 25-hydroxylation of pre-vitamin D, and if this vitamin D deficiency was associated with impaired glycemic control in children and adolescents with type 1 diabetes (TIDM) and type 2 diabetes (T2DM).

Methods: We analyzed simultaneously measured HbA1c, ALT, AST, and 25OHD levels and clinical parameters in 121 children and adolescents with T1DM (n=81) and T2DM …

Temporal Trends In Serum Concentrations Of Polychlorinated Dioxins, Furans, And Pcbs Among Adult Women Living In Chapaevsk, Russia: A Longitudinal Study From 2000 To 2009, Olivier Humblet, Oleg Sergeyev, Larisa Altshul, Susan A. Korrick, Paige L. Williams, Claude Emond, Linda S. Birnbaum, Jane S. Burns, Mary M. Lee, Boris Revich, Andrey Shelepchikov, Denis Feshin, Russ Hauser

Mary M. Lee

BACKGROUND: The present study assessed the temporal trend in serum concentrations of polychlorinated dibenzo-p-dioxins, dibenzofurans, and biphenyls (PCBs) among residents of a Russian town where levels of these chemicals are elevated due to prior industrial activity.

METHODS: Two serum samples were collected from eight adult women (in 2000 and 2009), and analyzed with gas chromatography-high-resolution mass spectrometry.

RESULTS: The average total toxic equivalency (TEQ) decreased by 30% (from 36 to 25 pg/g lipid), and the average sum of PCB congeners decreased by 19% (from 291 to 211 ng/g lipid). Total TEQs decreased for seven of the eight women, and the …

Social Support To Empower Parents (Step): An Intervention For Parents Of Young Children Newly Diagnosed With Type 1 Diabetes, Susan Sullivan-Bolyai, Carol Bova, Katherine Leung, Allison Trudeau, Mary Lee, Philip Gruppuso

Mary M. Lee

PURPOSE: The purpose of this study was to test the efficacy of a social support intervention with parents of children <13 years old newly diagnosed with type 1 diabetes mellitus>(T1DM).

METHODS: For this randomized, controlled clinical trial, 10 parent mentors of children diagnosed with T1DM >or=1 year and 60 parent participants were recruited from 2 pediatric diabetes centers. Mentors were trained to provide social support (home visits and phone calls) for 12 months to families in the experimental arm (32 mothers). Control group parents (28 mothers) received the phone number of an experienced parent (not trained to give social support) to call as needed.

FINDINGS: Mothers in the experimental …

A Potential Role For Adjunctive Vitamin D Therapy In The Management Of Weight Gain And Metabolic Side Effects Of Second-Generation Antipsychotics, Benjamin U. Nwosu, Bruce Meltzer, Louise Maranda, Carol A. Ciccarelli, Daniel Reynolds, Laura A. Curtis, Jean A. King, Jean A. Frazier, Mary M. Lee

Mary M. Lee

Second-generation antipsychotic (SGA) medications introduced about 20 years ago are increasingly used to treat psychiatric illnesses in children and adolescents. There has been a five-fold increase in the use of these medications in U.S. children and adolescents in the past decade. However, there has also been a parallel rise in the incidence of side effects associated with these medications, such as obesity, dyslipidemia, insulin resistance, and diabetes mellitus. Despite the severity of these complications and their financial impact on the national healthcare budget, there is neither a clear understanding of the mechanisms contributing to these side effects nor the best …

Mullerian Inhibiting Substance Recruits Alk3 To Regulate Leydig Cell Differentiation, Xiufeng Wu, Ningning Zhang, Mary Lee

Mary M. Lee

Mullerian inhibiting substance (MIS) not only induces Mullerian duct regression during male sexual differentiation but also modulates Leydig cell steroidogenic capacity and differentiation. MIS actions are mediated through a complex of homologous receptors: a type II ligand-binding receptor [MIS type II receptor (MISRII)] and a tissue-specific type I receptor that initiates downstream signaling. The putative MIS type I receptors responsible for Mullerian duct regression are activin A type II receptor, type I [Acvr1/activin receptor-like kinase 2 (ALK2)], ALK3, and ALK6, but the one recruited by MIS in Leydig cells is unknown. To identify whether ALK3 is the specific type I …

Serum Concentrations Of Organochlorine Pesticides And Growth Among Russian Boys, Jane S. Burns, Paige L. Williams, Oleg Sergeyev, Susan A. Korrick, Mary M. Lee, Boris Revich, Larisa Altshul, Julie T. Del Prato, Olivier Humblet, Donald G. Patterson, Wayman E. Turner, Mikhail Starovoytov, Russ Hauser

Mary M. Lee

Background: Limited human data suggest an association of organochlorine pesticides (OCPs) with adverse effects on children's growth.Objective: We evaluated the associations of OCPs with longitudinally assessed growth among peripubertal boys from a Russian cohort with high environmental OCP levels. Methods: A cohort of 499 boys enrolled in the Russian Children's Study between 2003 and 2005 at 8-9 years of age were followed prospectively for 4 years. At study entry, 350 boys had serum OCPs measured. Physical examinations were conducted at entry and annually. The longitudinal associations of serum OCPs with annual measurements of body mass index (BMI), height, and height …

Parent Mentor Perspectives On Providing Social Support To Empower Parents, Susan Sullivan-Bolyai, Mary Lee

Mary M. Lee

PURPOSE: To describe the experience of parent mentors providing a social support intervention to parents of children < 13 years old newly diagnosed with type 1 diabetes mellitus.

METHODS: Qualitative descriptive interviews were conducted with 6 parent mentors (all mothers) who provided social support to 34 mothers and 19 fathers of children newly diagnosed with type 1 diabetes mellitus over a 12-month period. The mentors were trained to provide informational, affirmational, and emotional social support through home visits, phone calls, and/or e-mail. Qualitative content analysis was used to identify themes guided by the Ireys social support framework.

FINDINGS: The parent mentors described support activities that could be categorized into the 3 …

Infant Formula, Autoimmune Triggers, And Type 1 Diabetes, David Harlan, Mary Lee

Mary M. Lee

No abstract provided.

The Increased Incidence Of Congenital Hypothyroidism: Fact Or Fancy?, Marvin Mitchell, Ho-Wen Hsu, Inderneel Sahai, Stuart Brink, Laurie Cohen, Rosalind Brown, Roger Eaton, Mary Lee, Lynne Levitsky, Edward Reiter, Abdollah Sadeghi-Nejad, Leslie Soyka, Joseph Wolfsdorf

Mary M. Lee

OBJECTIVE: The incidence of congenital hypothyroidism (CH) detected by newborn screening in the US has increased significantly since the early 1990s. We defined the characteristics associated with the increased incidence. PATIENTS: A cohort of children with CH born during an earlier period of low incidence (1991-94) was compared with a cohort born during a later period when the incidence of CH had doubled (2001-04). MEASUREMENTS: Screening was performed with T4 as the primary marker and thyroid stimulating hormone (TSH) on selected specimens. Follow-up on hypothyroid children determined whether they had permanent or transient hypothyroidism. Cases were classified based on laboratory …

Vitamin D Status Is Associated With Early Markers Of Cardiovascular Disease In Prepubertal Children, Benjamin U. Nwosu, Louise Maranda, Karen Cullen, Carol A. Ciccarelli, Mary M. Lee

Mary M. Lee

Background: The associations of 25-hydroxyvitamin D [25(OH)D], non-high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL), and related markers of early cardiovascular disease (CVD) are unclear in prepubertal children. Objective: To investigate the association of 25(OH)D with markers of CVD. The hypothesis was that 25(OH)D would vary inversely with non-HDL-C. Subjects and methods: A prospective cross-sectional study of children (n=45; 26 males, 19 females) of mean age 8.3 ± 2.5 years to investigate the relationships between 25(OH)D and glucose, insulin, high-sensitivity C-reactive protein, and lipids. Vitamin D deficiency was defined as 25(OH)D/mL; overweight as body mass index (BMI) ≥ 85 th but …

Parental Mastery Of Continuous Subcutaneous Insulin Infusion Skills And Glycemic Control In Youth With Type 1 Diabetes, Kathleen Mitchell, Kimberley Johnson, Karen Cullen, Mary M. Lee, Olga T. Hardy

Mary M. Lee

OBJECTIVE: The purpose of this study is to determine whether parental knowledge of the continuous subcutaneous insulin infusion (CSII) device affects glycemic control as measured by hemoglobin A1c (A1C) level. SUBJECTS AND METHODS: Parents of children with type 1 diabetes mellitus (T1DM) using CSII completed a 14-item questionnaire. Questions 1-10 were knowledge-based questions that required the parent to extract specific information from their child's CSII device. Questions 11-14 asked parents to provide a self-assessment of their CSII knowledge. RESULTS: Twenty-two parents of youth with T1DM participated in the study. Ten of the youth were in the Low-A1C group (A1C/=8%). Parents …

Educating Diabetes Camp Counselors With A Human Patient Simulator: A Pilot Study, Susan Sullivan-Bolyai, Sybil Crawford, Kimberley Johnson, Bonny Huston, Mary Lee

Mary M. Lee

Purpose.  The purpose of this study was to pilot test the feasibility and efficacy of a novel method of teaching camp counselors hypoglycemia management.

Design and Methods.  During orientation, counselors were assigned to the experimental (n= 21) or control (n= 15) group and received hypoglycemia education. The experimental group received supplemental education with a human patient simulator (HPS).

Results.  Baseline demographics, knowledge, and self-efficacy were similar between groups. The experimental group had a significantly larger gain in diabetes knowledge than the control group. Within-participant change in self-efficacy did not differ by group. We observed a significant effect modification, with larger …

Evidence Of Insulin-Like Growth Factor Binding Protein-3 Proteolysis During Growth Hormone Stimulation Testing, Benjamin Nwosu, Leslie Soyka, Amanda Angelescu, Mary Lee

Mary M. Lee

OBJECTIVES: The ternary complex is composed of insulin-like growth factor (IGF)-I, IGF binding protein (IGFBP)-3 and acid labile subunit (ALS). Growth hormone (GH) promotes IGFBP-3 proteolysis to release free IGF-I, ALS, and IGFBP-3 fragments. Our aim was to determine whether elevated GH levels during GH stimulation testing would trigger IGFBP-3 proteolysis. DESIGN: This prospective study of 10 short prepubertal children (height standard deviation score -2.37 +/- 0.31) used arginine and GH releasing hormone stimulation to study dynamic changes in the ternary complex moieties. IGFBP-3 was measured in two assays: a radioimmunoassay (RIA) that detects both cleaved and intact IGFBP-3; and …

Dioxin And Polychlorinated Biphenyl Concentrations In Mother's Serum And The Timing Of Pubertal Onset In Sons, Olivier Humblet, Paige Williams, Susan Korrick, Oleg Sergeyev, Claude Emond, Linda Birnbaum, Jane Burns, Larisa Altshul, Donald Patterson, Wayman Turner, Mary Lee, Boris Revich, Russ Hauser

Mary M. Lee

BACKGROUND: Animal studies have demonstrated that timing of pubertal onset can be altered by prenatal exposure to dioxins or polychlorinated biphenyls (PCBs), but studies of human populations have been quite limited.

METHODS: We assessed the association between maternal serum concentrations of dioxins and PCBs and the sons' age of pubertal onset in a prospective cohort of 489 mother-son pairs from Chapaevsk, Russia, a town contaminated with these chemicals during past industrial activity. The boys were recruited at ages 8 to 9 years, and 4 years of annual follow-up data were included in the analysis. Serum samples were collected at enrollment …

Genetic Modification Of The Association Between Peripubertal Dioxin Exposure And Pubertal Onset In A Cohort Of Russian Boys, Olivier Humblet, Susan A. Korrick, Paige L. Williams, Oleg Sergeyev, Claude Emond, Linda S. Birnbaum, Jane S. Burns, Larisa Altshul, Donald G. Patterson Jr., Wayman E. Turner, Mary M. Lee, Boris Revich, Russ Hauser

Mary M. Lee

BACKGROUND: Exposure to dioxins has been associated with delayed pubertal onset in both epidemiologic and animal studies. Whether genetic polymorphisms may modify this association is currently unknown. Identifying such genes could provide insight into mechanistic pathways. This is one of the first studies to assess genetic susceptibility to dioxins. OBJECTIVES: We evaluated whether common polymorphisms in genes affecting either molecular responses to dioxin exposure or pubertal onset influence the association between peripubertal serum dioxin concentration and male pubertal onset. METHODS: In this prospective cohort of Russian adolescent boys (n = 392), we assessed gene-environment interactions for 337 tagging single-nucleotide polymorphisms …

Farm Residence And Reproductive Health Among Boys In Rural South Africa, Rene English, Melissa Perry, Mary Lee, Elaine Hoffman, Steven Delport, Mohamed Dalvie

Mary M. Lee

BACKGROUND: Few studies have investigated reproductive health effects of contemporary agricultural pesticides in boys. OBJECTIVES: To determine the association between pesticide exposure and reproductive health of boys. METHODS: We conducted a cross-sectional study in rural South Africa of boys living on and off farms. The study included a questionnaire (demographics, general and reproductive health, phyto-estrogen intake, residential history, pesticide exposures, exposures during pregnancy); and a physical examination that included sexual maturity development ratings; testicular volume; height, weight, body mass index; and sex hormone concentrations. RESULTS: Among the 269 boys recruited into the study, 177 (65.8%) were categorized as farm (high …

Endocrine Disorders Of The Newborn, Mary Lee, Thomas Moshang

Mary M. Lee

Citation: Lee MM, Moshang T. “Endocrine Disorders of Newborn” In Avery GV, Flethcer MA and MadDonald MG, eds. Avery's Neonatology: Pathophysiology and Management of the Newborn, 6^th Edition. Philadelphia: Lippincott Williams & Wilkins, 2005, p.914-938.

A partial preview of this chapter is available via Google Books.

Neonatal Endocrinology, Elizabeth Catlin, Mary Lee

Mary M. Lee

Summary: This chapter covers common endocrine conditions and some of the more unusual endocrine disorders of newborns. Citation: Catlin EA and Lee MM. “Neonatal Endocrinology,” in McMillan JA (Ed-in-chief), DeAngelis CD, Feigin RD, and Jones MD, Jr, eds. Oski’s Pediatrics: Principles and Practice, 4th ed., Philadelphia: Lippincott, Williams & Wilkins, 2006, 411-423. A partial preview of this chapter is available via Google Books.