The peptide hormone leptin plays a major role in the regulation of energy intake and expenditure and is predominantly expressed in mature adipocytes but not in preadipocytes. Using bisulfite genomic sequencing, we found that 32 CpGs, distributed within a 317-bp sequence of the proximal leptin promoter, were highly methylated in human preadipocytes (73.4% ؎ 9.0%). During maturation toward terminally differentiated adipocytes, this promoter region was extremely demethylated (9.4% ؎ 4.4%). CpG methylation-dependent transcriptional activity of the promoter fragment was determined in transfection experiments using a set of 5-truncated mock-, HhaI-, and SssI-methylated promoter-reporter constructs. Whereas the methylated CpG within the CCAAT/enhancer-binding protein ␣ recognition site down-regulated reporter expression, methylated CpGs proximal to the TATA motif and/or in a further upstream region abrogated promoter activity completely. These distinct promoter CpG sequences were found unmethylated in leptin-expressing mature adipocytes. As evidenced by electrophoretic mobility shift assays, nuclear protein complexes were specifically formed on methylated oligonucleotide probes corresponding to the dedicated promoter sequences, indicating that methyl-CpG binding proteins participate in transcriptional repression and regulation of the human leptin gene.

Purpose To review our incidence of developmental dysplasia of the hip (DDH) in breech infants referred for ultrasound screening and to determine if subsequent follow-up radiographs are necessary in these patients with normal clinical and ultrasound examinations. Methods A review of the clinical data and imaging studies of all children with the risk factor of breech presentation that were referred for orthopedic evaluation over a 5-year period was conducted. All patients were examined by a fellowship-trained pediatric orthopedic surgeon and all ultrasounds were done at approximately 6 weeks of age by an experienced ultrasonographer. Ultrasounds were evaluated using the dynamic method as described by Harcke. As per our protocol, all patients with normal screening ultrasounds were brought back for a final clinical examination and radiographic check at 4-6 months. Acetabular dysplasia was indicated by radiographic parameters-if there was severe blunting of the sourcil, abnormal acetabular index for age, or if there was significant asymmetry of acetabular indices side-to-side-in the setting of clinical parametersif there was greater than 10°difference in side-to-side abduction or symmetric abduction of less than 60°. Results Three hundred patients with the risk factor of breech presentation were included. Thirty-four patients had clinically unstable hips; 266 had clinically stable hips and were screened by ultrasound. Sixty-four percent were female and 36% were male. Twenty-seven percent of these breech patients had abnormal screening ultrasounds and were subsequently treated. Of the remaining 73% with normal ultrasounds, who were returned per protocol at a mean of 5 months, 29% had evidence of dysplasia and underwent treatment. The diagnosis of dysplasia following a normal ultrasound was based on both radiographic and clinical parameters. Of the hips treated with a Pavlik harness, 62% had acetabular indices at least two standard deviations from the age-corrected average versus 26% of patients not treated. The average length of follow-up was 10 months. Conclusions Retrospectively, we found that, at approximately 6 weeks of age, ultrasound screening of breech patients with clinically stable hips produces an incidence of DDH of 27%. In those patients with a normal ultrasound, 29%, at 4-6 months radiographic follow-up, were found to have dysplasia requiring treatment. This data supports breech as the most important risk factor for hip dysplasia and we, therefore, recommend careful and longitudinal evaluation of these patients with: a careful newborn physical examination, an ultrasound at age 6 weeks, and an anteroposterior (AP) pelvis and frog lateral radiograph at 6 months, as the risk of subsequent dysplasia is too high to discharge patients after a normal ultrasound.Keywords Developmental dysplasia of the hip Á Ultrasound Á Breech presentation Study conducted at Rady Children's Hospital,

Vaccinations are an important and effective cornerstone of preventive medical care. Growing technologic capabilities and use by both patients and providers present critical opportunities to leverage these tools to improve vaccination rates and public health. We propose the Social Ecological Model as a useful theoretical framework to identify areas in which technology has been or may be leveraged to target undervaccination across the individual, interpersonal, organizational, community, and society levels and the ways in which these levels interact.

Introduction Although patients with end-stage organ failure are at high risk for vitamin D deficiency because of limited sunlight exposure and hepatic dysfunction, few studies have measured 25-hydroxy vitamin D (25OHD) at the time of transplantation. Methods We measured serum 25OHD immediately after transplantation in 69 heart and liver transplant recipients. Results Forty-six heart and 23 liver transplant recipients were evaluated (mean age 53 yr). Mean 25OHD was well below the lower limit of the normal range (43.2 ± 21.2 nmol/L). Ninety-one percent had levels below 75 nmol/L, the threshold commonly used to denote sufficiency, and 71% had levels below 50 nmol/L. Severe deficiency (25OHD <25 nmol/L) was found in 16%. Vitamin D levels did not differ by race, age, gender, or season. Mean 25OHD was lower among liver than heart transplant recipients (34.4 ± 17.5 vs. 47.7 ± 20.7 nmol/L; p < 0.03). Among liver transplant recipients, 22% had undetectable levels (<17 nmol/L). Conclusions Vitamin D deficiency is highly prevalent among heart and liver transplant recipients; those with liver failure are at greatest risk. As vitamin D deficiency has many serious skeletal and extra-skeletal sequelae, physicians who treat transplant patients should maintain a high degree of vigilance for this problem.

The majority of influenza related deaths and hospitalizations occur among individuals ≥65 years, yet the national influenza vaccination rate for this group is 63% and is lower in the Hispanic population. Previous studies have described negative predictors of vaccination; however, there is a knowledge gap of how influenza vaccine-specific beliefs affect vaccination rates. We examined the relationship between influenza vaccine health beliefs and vaccination behaviors in a cross sectional sample of 200 primarily Hispanic patients aged ≥65 years in an academic general internal medicine clinic. Participants were asked about perceptions of influenza vaccine effectiveness and safety. Interview responses regarding influenza vaccine concerns were evaluated qualitatively with conventional content analysis. Logistic regression evaluated associations between beliefs and self-reported vaccination the previous year, adjusted for age, gender, and language. Of those approached to complete the questionnaire, 88% participated. Self-reported influenza vaccination rate during the study year was 75%. Only 46.5% endorsed the belief that influenza vaccine is very effective and 47% that it is very safe. Many stated specific concerns about flu vaccine including that it causes side effects/adverse outcomes, is not effective, vaccine components are harmful, and vaccination is not necessary. Belief that the flu shot causes the flu and concern for variability of the flu shot were associated with reduced odds of vaccination (aOR 0.19, 95% CI [0.05, 0.83] and 0.06 [0.006, 0.63] respectively). The patient-perceived distinction between cold, flu, and other symptoms warrants further exploration. This information can be used to develop targeted communication to promote vaccination.

PurposeFor correction of angular deformity, tension band plating has been proposed as a safe and minimally invasive technique. The purpose of this study was to assess the experiences and report the rate of correction obtained with this procedure in patients with idiopathic genu valgum.MethodsThis study was a retrospective review of 47 valgus deformities of the knee treated with medial hemiepiphysiodesis using a tension band plate. The tibiofemoral angle (TFA) and the anatomic lateral distal femoral angle (aLDFA) were assessed on anteroposterior (AP) radiographs of the lower extremity taken at multiple time intervals. The values were charted to determine the change in orientation of the joint surface over time. Pearson’s correlation was used to analyze the correction over time. A subanalysis was performed evaluating the effect of age and the number of plates utilized.ResultsA total of 47 deformities in 25 patients were reviewed. The average time of follow-up from index surgery was 12.7 months, with an average correction of 0.96° every 3 months or 3.8° per year. The aLDFA corrected at a faster rate in knees with two plates per hemiepiphysiodesis than those with one plate, 4.2° and 3.3° per year, respectively (P = 0.035). Girls <11 years of age and boys <13 years of age corrected at a rate of 4.5°, while older children corrected at a rate of 3.4° per year (P = 0.39). There were no complications or instrumentation breakages.ConclusionHemiepiphysiodesis with tension band plating provides an effective and predictable correction of idiopathic genu valgum. Two plates appear to provide a greater rate of correction. There is also a trend toward faster correction in younger patients as well.

OBJECTIVES: To assess the impact of a parent educational intervention about influenza disease on child vaccine receipt. METHODS: A convenience sample of parents of children $6 months old with a visit at 2 New York City pediatric clinics between August 2016 and March 2017 were randomly assigned (1:1:1) to receive either usual care, an educational handout about influenza disease that was based on local data, or an educational handout about influenza disease that was based on national data. Parents received the handout in the waiting room before their visit. Primary outcomes were child influenza vaccine receipt on the day of the clinic visit and by the end of the season. A multivariable logistic regression was used to assess associations between intervention and vaccination, with adjustment for variables that were significantly different between arms. RESULTS: Parents who received an intervention (versus usual care) had greater odds of child influenza vaccine receipt by the end of the season (74.9% vs 65.4%; adjusted odds ratio 1.68; 95% confidence interval: 1.06-2.67) but not on the day of the clinic visit. Parents who received the national data handout (versus usual care) had greater odds of child influenza vaccine receipt on the day of the clinic visit (59.0% vs 52.6%; adjusted odds ratio 1.79; 95% confidence interval: 1.04-3.08) but not by the end of the season. CONCLUSIONS: Providing an educational intervention in the waiting room before a pediatric provider visit may help increase child influenza vaccine receipt.

How can researchers best measure infants' motor experiences in the home? Body position—whether infants are held, supine, prone, sitting, or upright—is an important developmental experience. However, the standard way of measuring infant body position, video recording by an experimenter in the home, can only capture short instances, may bias measurements, and conflicts with physical distancing guidelines resulting from the COVID-19 pandemic. Here, we introduce and validate an alternative method that uses machine learning algorithms to classify infants' body position from a set of wearable inertial sensors. A laboratory study of 15 infants demonstrated that the method was sufficiently accurate to measure individual differences in the time that infants spent in each body position. Two case studies showed the feasibility of applying this method to testing infants in the home using a contactless equipment drop-off procedure.