The triglyceride and glucose (TyG) index has been proposed as a simple surrogate of insulin resistance (IR) with high sensitivity as an IR index besides the well known homeostasis model assessment of IR (HOMA-IR). Limited data are reported in children. We investigated the sensitivity and specificity of TyG index in a pediatric Caucasian population, as a surrogate measure of IR and compared the results with HOMA-IR. Methods: We enrolled 541 children (11.7±2.71 yrs). According to body mass index (BMI) chart, the subjects were divided into three groups: normal weight BMI<75th percentile, overweight BMI 75th-95th percentile, and obese>95 th percentile. TyG index was calculated as (ln[fasting triglycerides(mg/dl)×fasting plasma glucose(mg/dl)/2]) and considered pathological when exceeding 7.88. HOMA-IR was calculated as (insulin×glucose)/22.5 and defined pathological whenever exceeding 97.5th percentile for age and sex. Results: In children with overweight/obesity TyG index was higher compared to normal weight subjects (p<0.001). TyG index was correlated with BMI (p<0.001); WHtR (p<0.001), total and HDL cholesterol (p<0.001); ALT (p<0.001), blood pressure (p<0.001). A correlation between TyG index and HOMAIR (p<0.001) as well as high TyG index and pathological HOMA-IR (p<0.001) were noted. The optimal cutoff for IR was considered 7.98 (sensitivity 60%; specificity 78%; AUC 0.69). Conclusions: TyG index is a useful and cost-effective index of IR among children and adolescents. The cutoff 7.98 may be used for IR risk screening in childhood obesity, but we recommend caution when used in other populations.

Simultaneous measurements of pressure and flow waves were made in the course of 25 femoropopliteal bypass operations. From these measurements the the hydraulic impedance of the arterial system in the lower limb was calculated. The values obtained were correlated with the results of the operations. Although reconstruction reduced the impedance we were unable to predict accurately the probable result of the operation on the basis of these measurements. The results suggest that success is more closely related to a good collateral circulation than to "run off".

Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease characterized by itch and clinical heterogeneity regarding the age of onset, morphology, distribution, and severity of lesions. Severe AD has a significant impact on the quality of life of affected children and their caregivers. Children with moderate‐severe AD inadequately controlled with topical therapy have limited treatment options, such as systemic corticosteroids or phototherapy, often prescribed as off‐label treatments, often with unfavorable benefit‐to‐risk ratio adverse events. Dupilumab is a fully human monoclonal antibody with proven effectiveness and a relatively safe adverse effect profile in patients with type 2 inflammatory diseases, including AD. We report three pediatric cases of severe AD successfully treated with dupilumab.

A series of 29 femoropopliteal bypass operations is described. The patients were selected carefully to exclude those with clinical and aortographic evidence of aorto-iliac disease. A pulsatility index was calculated from the velocity waveforms recorded over the common femoral and popliteal arteries. The pulsatility index is the ratio of the amplitude of the waveform to its mean height over one cardiac cycle. There was a highly significant difference in the result of the operation between patients with a pulsatility index of 4 or more in the common femoral artery and patients with a pulsatility index of less than 4. We concluded that calculation of this pulsatility index provides useful additional evidence when selecting patients suitable for a femoropopliteal bypass.