PIHLAJAMÄ KI, JUSSI, MARI YLINEN, PAULI KARHAPÄ Ä , ILKKA VAUHKONEN, AND MARKKU LAAKSO. The effect of the Ϫ308A allele of the TNF-␣ gene on insulin action is dependent on obesity. Obes Res. 2003;11:912-917. Objective: Promoter polymorphisms of the tumor necrosis factor alpha (TNF-␣) gene are associated with insulin sensitivity and BMI. We investigated whether the effect of the G-308A polymorphism of the TNF-␣ gene on insulin action depends on BMI. Research Methods and Procedures:The effects of the G-308A polymorphism on the rates of glucose and lipid oxidation and free fatty acid (FFA) levels were studied using the hyperinsulinemic euglycemic clamp combined with indirect calorimetry in 129 healthy subjects. Results: The Ϫ308A allele of the TNF-␣ gene was associated with high rates of glucose oxidation (p ϭ 0.008 adjusted for age, gender, and BMI) and lipid synthesis (p ϭ 0.037) and suppression of FFA levels (p ϭ 0.023) during hyperinsulinemia. In normal weight subjects (BMI Ͻ 26 kg/m 2 ), the Ϫ308 allele was associated with high rates of glucose oxidation (p ϭ 0.036) during the clamp but not with high rates of lipid synthesis (p ϭ 0.896) or FFA suppression (p ϭ 0.464). In overweight subjects (BMI Ն 26 kg/m 2 ), high rates of lipid synthesis and FFA suppression (p ϭ 0.010 and p ϭ 0.042, respectively) but not the rates of glucose oxidation during the clamp (p ϭ 0.193) were associated with the Ϫ308A allele. Discussion: The Ϫ308A allele of the promoter of the TNF-␣ gene is associated with high rates of glucose oxidation in normal weight subjects and with effective lipid storage in overweight subjects. These findings suggest an interaction of the polymorphism with obesity.

ICS use during childhood may be related to a decrease in BMD at late school age. It is important to use the lowest possible ICS dose that maintains adequate asthma control.

Reinterventions after surgery in neonates were relatively common. In older children, percutaneous treatment carried a higher risk of reinterventions, which were mainly related to residual coarctation after primary treatment.

Objectives To assess predictors of blood pressure and hypertension and relations between blood pressure and left ventricular mass in a population-based retrospective study of repaired isolated coarctation of aorta. Methods We collected follow-up data until 2018 of 284/304 (93%) patients with coarctation treated by surgery (n = 235) or balloon angioplasty/stent (n = 37/12) in our unit 2000–2012. Systolic hypertension was defined as systolic blood pressure z-score ≥ +2SD or regular use of blood pressure medication. Left ventricular hypertrophy was defined as left ventricular mass z-score ≥ +2SD or left ventricular mass index g/m 2.7 ≥ 95th percentile. Results The median (25-75th percentiles) follow-up time and age at follow-up were 9.7 years (6.9–13.2) and 11.8 years (7.9–16.0), respectively. Age at first procedure (p = 0.011) and systolic arm-leg-gradient (p = 0.007) were positively, and transverse arch (p = 0.007) and isthmus diameter (p = 0.001) z-scores at follow-up negatively associated with systolic blood pressure z-score adjusted for age at follow-up and need for reintervention for coarctation. Systolic hypertension was present in 53/284 (18.7%) and related with increasing age at first procedure (median 33.2 vs 0.6 months; p < 0.001) and arm-leg-gradient at follow-up (mean±SD, -0.3 ± 14.6 vs -6.4 ± 11.6 mmHg; p = 0.047) adjusted for reintervention for coarctation and age at follow-up. Left ventricular hypertrophy was present in 20/227 (9.3%) and related with systolic blood pressure z-score. Conclusions Higher systolic blood pressure and hypertension in repaired coarctation of aorta are related with increasing age at first procedure and arm-leg-gradient at follow-up. Transverse arch and isthmus diameters at follow-up are inversely related with systolic blood pressure.