BackgroundCVD in obesity and T2DM are associated with endothelial activation, elevated plasma vascular inflammation markers and a prothrombotic state. We examined the contribution of FFA to these abnormalities following a 48-hour physiological increase in plasma FFA to levels of obesity and diabetes in a group of healthy subjects.Methods40 non-diabetic subjects (age = 38 ± 3 yr, BMI = 28 ± 1 kg/m2, FPG = 95 ± 1 mg/dl, HbA1c = 5.3 ± 0.1%) were admitted twice and received a 48-hour infusion of normal saline or low-dose lipid. Plasma was drawn for intracellular (ICAM-1) and vascular (VCAM-1) adhesion molecules-1, E-selectin (sE-S), myeloperoxidase (MPO) and total plasminogen inhibitor-1 (tPAI-1). Insulin sensitivity was measured by a hyperglycemic clamp (M/I).ResultsLipid infusion increased plasma FFA to levels observed in obesity and T2DM and reduced insulin sensitivity by 27% (p = 0.01). Elevated plasma FFA increased plasma markers of endothelial activation ICAM-1 (138 ± 10 vs. 186 ± 25 ng/ml), VCAM-1 (1066 ± 67 vs. 1204 ± 65 ng/ml) and sE-S (20 ± 1 vs. 24 ± 1 ng/ml) between 13-35% and by ≥ 2-fold plasma levels of myeloperoxidase (7.5 ± 0.9 to 15 ± 25 ng/ml), an inflammatory marker of future CVD, and tPAI-1 (9.7 ± 0.6 to 22.5 ± 1.5 ng/ml), an indicator of a prothrombotic state (all p ≤ 0.01). The FFA-induced increase was independent from the degree of adiposity, being of similar magnitude in lean, overweight and obese subjects.ConclusionsAn increase in plasma FFA within the physiological range observed in obesity and T2DM induces markers of endothelial activation, vascular inflammation and thrombosis in healthy subjects. This suggests that even transient (48-hour) and modest increases in plasma FFA may initiate early vascular abnormalities that promote atherosclerosis and CVD.
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increased risk for developing LCH. We presented 3 cases, 2 of whom aged 6 months and below. Objectives To provide a wider perspective in diagnosing LCH. Methods We are presenting 3 case reports, 2 of whom aged 6 months and below. Results 1st case: Inguinal swelling mimicking inguinal abscess This was a case report of a 6-month-old girl who presented with multiple lymphadenopathies over the right inguinal, axillary and cervical region. She was otherwise asymptomatic. A detailed history revealed presence of the right inguinal swelling noted since 2 weeks old and progressively increasing in size. Detailed investigation for infection were all normal. She received few courses of antibiotics but symptoms persisted. The father works in road construction industry. Excision biopsy of the right inguinal lymph node showed positive staining of CD1a, confirming the diagnosis of LCH.2nd case: Skin rashes mimicking eczematous rashes This was a 5-month-old girl who was admitted for fever with petechiae rashes, while the blood investigations revealed pancytopenia. 3 weeks prior to admission, she developed skin rashes mimicking eczema over the genitalia and bilateral inguinal. Systemic examinations showed hepatosplenomegaly, ascites with multiple petechiae rashes over the groin and neck region. Full blood picture reported pancytopenia with leucoerythroblastic blood film and circulating blasts. Her mother works in company selling household cleaning detergent. Skin biopsy of the inguinal region confirmed the diagnosis of LCH.3rd case: Scalp swelling mimicking scalp abscess This was a 2-year-5-month old 'Orang Asli' (native people), whose stays in rubber estate in a remote area (regular exposure to pesticides), presented with multiple scalp swellings. Other systemic examination was unremarkable. Blood investigations and septic parameters were normal. Computed tomography (CT) brain showed multiple soft tissue mass with osteolytic bony destruction, involving outer and inner table of occipital, left parietal and left frontal bone. Excision biopsy of the scalp confirmed the diagnosis of LCH. Conclusions LCH has a wide spectrum of clinical manifestations. Although it is a very rare disease, LCH should always be considered as differential diagnosis in children with generalised lymphadenopathy, scalp swelling or any disorder with multisystemic organs involvement. A thorough history to identify risk, physical examination and laboratory investigation are vital to aid in diagnosing patient.
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