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Nine-year experience with insertion of vena cava filters in the intensive care unit.

BACKGROUND: Vena cava filter insertion (VCF) is traditionally performed in a radiology suite or in the operating room. We reviewed our experience of bedside VCF insertion in the intensive care unit (ICU) performed by general surgeons. METHODS: A prospective, observational study of bedside VCF insertion in the ICU was performed by general surgeons between February 1996 and June 2005. Demographic data and procedural complications were recorded. RESULTS: Four hundred three patients underwent bedside VCF insertion. Complications included 1 groin hematoma, 2 misplacements, and a right ventricular perforation from a dilator requiring surgical repair. DVT occurred in 38 patients (8.5%); 14 occurred at the insertion site. There were 2 pulmonary embolisms (<1%) after VCF. Contrast-related renal failure occurred in 2 of the first 35 patients; carbon dioxide gas is now used for contrast in high-risk patients. CONCLUSIONS: Bedside insertion of VCF in the ICU by surgeons is safe and effective.

Adult↗

Early insertion of a pulmonary valve for chronic regurgitation helps restoration of ventricular dimensions.

BACKGROUND: This study assesses the results of early insertion of a pulmonary valve for chronic pulmonary regurgitation based on right ventricular volume measurements. METHODS: Valved conduits were prospectively inserted in 39 patients (aged 14 to 39 years) when the right ventricular (RV) end-diastolic volume index on magnetic resonance imaging (MRI) exceeded 150 mL/m2. Changes in morphology and function of the RV were prospectively analyzed by an MRI at 6 months postoperatively (available in 21 patients). RESULTS: There were no early or late deaths. All conduits showed good function at a median 15 month follow-up. Postoperative RV end-systolic and end-diastolic volumes showed a significant positive correlation (p = 0.005 and p < 0.0001), while postoperative left ventricular (LV) ejection fraction showed a significant negative correlation (p = 0.03) with preoperative RV end-diastolic volume index. Seven patients who achieved normal RV end-diastolic volume index (< or = 100 mL/m2) (group 1) when compared with 14 remaining patients (group 2) showed that they differed significantly with respect to their preoperative RV end-diastolic volume index (170.3 +/- 21.1 vs 203.6 +/- 35.6; p = 0.02) and postoperative LV ejection fraction (59.9 +/- 4.2 vs 54 +/- 7%, p = 0.03). CONCLUSIONS: Our results show that the improvement in ventricular dimensions and functions directly correlates with the timing of pulmonary valve insertion. Early insertion leads to normalization and late insertion leads only to improvement. These observations, along with a low morbidity for these reoperations, justify earlier reintervention in cases of chronic pulmonary regurgitation. A RV end-diastolic volume index of 150 mL/m2 seems to be a practical cutoff value to prescribe pulmonary valve insertion.

Adolescent↗

Clinical outcomes of early postplacental insertion of intrauterine contraceptive devices.

OBJECTIVES: To assess the efficacy, safety and, thus, advantages and disadvantages, of early postplacental intrauterine device (IUD) insertion. METHODS: IUDs were inserted within 10 min after postplacental expulsion in term pregnancy both in vaginal and cesarean deliveries via a ring forceps. Of the 276 patients enrolled, 235 were included in the study. Recipients were scheduled for examination before hospital discharge and at 6 weeks, 6 months and 12 months after postplacental insertion. RESULTS: The percentages of women returning for a follow-up visit were 221 (94%), 210 (89%) and 183 (78%) at 6 weeks, 6 months and 12 months, respectively. Among IUD acceptors, 74% of the cases had vaginal deliveries and 26% had cesarean deliveries. Continuation rates were relatively high, 87.6% and 76.3%, at 6 and 12 months, respectively, after postplacental insertion of IUD. In this study, the 1-year cumulative expulsion rate with TCu 380A device was 12.3%, which may be regarded as a standard expulsion rate for immediate postplacental insertion of similar models of IUDs. CONCLUSION: The evidence from this study suggests that immediate postplacental insertion of CuT 380 models is an effective, useful, safe, convenient and low-cost procedure for early postpartum contraception.

Adult↗

Lateral gene transfer and the complex distribution of insertions in eukaryotic enolase.

Insertions and deletions in protein-coding genes are relatively rare events compared with sequence substitutions because they are more likely to alter the tertiary structure of the protein. For this reason, insertions and deletions which are clearly homologous are considered to be stable characteristics of the proteins where they are found, and their presence and absence has been used extensively to infer large-scale evolutionary relationships and events. Recently, however, it has been shown that the pattern of highly conserved, clearly homologous insertions at positions with no other detectable homoplasy can be incongruent with the phylogeny of the genes or organisms in which they are found. One case where this has been reported is in the enolase genes of apicomplexan parasites and ciliates, which share homologous insertions in a highly conserved region of the gene with the apparently distantly related enolases of plants. Here we explore the distribution of this character in enolase genes from the third major alveolate group, the dinoflagellates, as well as two groups considered to be closely related to alveolates, haptophytes and heterokonts. With these data, all major groups of the chromalveolates are represented, and the distribution of these insertions is shown to be far more complicated than previously believed. The incongruence between this pattern, the known evolutionary relationships between the organisms, and enolase phylogeny itself cannot be explained by any single event or type of event. Instead, the distribution of enolase insertions is more likely the product of several forces that may have included lateral gene transfer, paralogy, and/or recombination. Of these, lateral gene transfer is the easiest to detect and some well-supported cases of eukaryote-to-eukaryote lateral transfer are evident from the phylogeny.

Amino Acid Sequence↗

Identification and characterization of novel polymorphic LINE-1 insertions through comparison of two human genome sequence assemblies.

Mobile elements represent a relatively new class of markers for the study of human evolution. Long interspersed elements (LINEs) belong to a group of retrotransposons comprising approximately 21% of the human genome. Young LINE-1 (L1) elements that have integrated recently into the human genome can be polymorphic for insertion presence/absence in different human populations at particular chromosomal locations. To identify putative novel L1 insertion polymorphisms, we computationally compared two draft assemblies of the whole human genome (Public and Celera Human Genome assemblies). We identified a total of 148 potential polymorphic L1 insertion loci, among which 73 were candidates for novel polymorphic loci. Based on additional analyses we selected 34 loci for further experimental studies. PCR-based assays and DNA sequence analysis were performed for these 34 loci in 80 unrelated individuals from four diverse human populations: African-American, Asian, Caucasian, and South American. All but two of the selected loci were confirmed as polymorphic in our human population panel. Approximately 47% of the analyzed loci integrated into other repetitive elements, most commonly older L1s. One of the insertions was accompanied by a BC200 sequence. Collectively, these mobile elements represent a valuable source of genomic polymorphism for the study of human population genetics. Our results also suggest that the exhaustive identification of L1 insertion polymorphisms is far from complete, and new whole genome sequences are valuable sources for finding novel retrotransposon insertion polymorphisms.

Alleles↗

Undernutrition is predictive of early mortality after palliative self-expanding metal stent insertion in patients with inoperable or recurrent esophageal cancer.

BACKGROUND: Self-expanding metallic stents (SEMS) are a first-line therapeutic procedure in the palliative treatment of dysphagia in patients with esophageal cancer. However, the impact of SEMS insertion on patient nutritional status has never been assessed. OBJECTIVE: To evaluate the nutritional status of patients after insertion of a SEMS and the impact of a preexisting undernutrition status on survival. DESIGN: Retrospective observational study. PATIENTS: A total of 120 patients treated in a single center by insertion of a SEMS for relief of dysphagia in the palliative treatment of esophageal cancer were retrospectively included. MAIN OUTCOME MEASUREMENTS: Efficacy of SEMS was assessed by the Ogilvie's dysphagia score. Patient nutritional and clinical statuses were evaluated at SEMS insertion, and patients were regularly followed until death. Independent predictive factors of early 30-day mortality were researched. RESULTS: Dysphagia scores decreased after SEMS insertion in 89.1% of patients, with median scores decreasing from 3.0 to 1.0 (P < .05). There was a significant decrease in body mass index (BMI) (P < .04), serum albumin level (P < .01), and World Health Organization (WHO) performance index (P < .02) at a 1-month evaluation. Serum albumin level, BMI <18 kg/m(2), and WHO performance index >2 at SEMS insertion were independent predictive factors of 30-day mortality. CONCLUSIONS: This study suggested that palliative stent placement in esophageal cancer was effective to relieve dysphagia but was not followed by an improvement of nutritional parameters. Moreover, it underlined the key role played by undernutrition on survival.

Adenocarcinoma↗

In vivo evaluation of nicotine lyophilised nasal insert in sheep.

The nasal route offers an attractive means of delivering a drug directly to the systemic circulation and avoiding hepatic first-pass metabolism, although rapid mucociliary clearance can be detrimental to nasal absorption. The in vitro and in vivo characteristics of a nasal insert formulation prepared by lyophilisation of a viscous HPMC gel solution designed to overcome this problem were studied. In vitro release of nicotine from the lyophilised insert was compared with powder and spray formulations. Stability and characterisation studies were carried out using dynamic vapour sorption, scanning electron microscopy and HPLC analysis. Nicotine formulations were administered to eight wether sheep in a randomised four-way cross-over study, and plasma nicotine assessed comparing the nasal insert formulation with conventional nasal powder, nasal spray and IV doses. In vitro release studies demonstrated prolonged nicotine release from the nasal insert formulation compared to a powder and liquid. In vivo plasma profiles appeared to show prolonged plasma nicotine levels compared to the conventional formulations, although T(max), C(max) and AUC parameters for the insert were not significantly different due to high variability in the pharmacokinetic data. In conclusion, the nasal insert displayed a promising prolonged plasma profile, which must be investigated further to provide statistical significance to prove the effect.

Administration, Intranasal↗

Propofol concentration requirement for laryngeal mask airway insertion was highest with the ProSeal, next highest with the Fastrach, and lowest with the Classic type, with target-controlled infusion.

STUDY OBJECTIVE: To determine propofol concentration of plasma 50% (Cp50, concentration at which there is a 50% chance that patients show no movement in response) for the Classic-, Fastrach-, and ProSeal-type laryngeal mask airway (LMA) insertion using target-controlled infusion (TCI) technique. DESIGN: Prospective, randomized, comparative study. SETTING: University-affiliated hospital. PATIENTS: Sixty American Society of Anesthesiologists physical status I and II women scheduled for minor gynecologic operations. INTERVENTIONS: Propofol TCI (Diprifusor pharmacokinetic model) was started at target concentration using an anesthesia pump. After reaching target effect-site concentration of propofol, 1 of the 3 types of LMA was inserted. We recorded patient responses to LMA insertion as "movement" or "no movement." Test propofol concentrations started from a dosage of 4 microg/mL. Concentrations were then predetermined by a modified Dixon's up-and-down method with 0.4 microg/mL step size. MEASUREMENTS: Patient response to LMA insertion was classified as either of "no movement" or "movement." The midpoint was defined as the average concentration value of crossover (movement/no movement) response. The Cp50 value was defined as the average of the crossover midpoints in each group, and it was estimated from calculating the midpoints. MAIN RESULTS: Cp50 of the Classic, Fastrach, and ProSeal LMA insertion were 3.2+/-0.34, 4.0+/-0.22, and 4.9+/-0.20 microg/mL (mean+/-SD), respectively. CONCLUSION: Required propofol TCI concentrations for LMA insertion were significantly highest for the ProSeal, second highest for the Fastrach, and lowest for the Classic LMA.

Adult↗

Comparison of butorphanol and thiopentone vs fentanyl and thiopentone for laryngeal mask airway insertion.

STUDY OBJECTIVE: To compare laryngeal mask airway (LMA) insertion conditions using a combination of butorphanol and thiopentone vs fentanyl and thiopentone. DESIGN: Prospective, randomized, and double-blind study. SETTING: Operating theater. PATIENTS: One hundred four females, with American Society of Anesthesiologists grades I and II, diagnosed with carcinoma cervix scheduled for intracavitary implant placement, were recruited into the study. The patients were randomly divided into 2 groups of 52 each. INTERVENTION: Anesthesia was induced with butorphanol (30 microg kg(-1)) and thiopentone in group B and fentanyl (1.5 microg kg(-1)) and thiopentone in group F, followed by LMA insertion. Anesthesia was maintained with O2, N2O, and isoflurane with spontaneous ventilation. MEASUREMENTS: Six variables were noted on a 3-point scale: jaw relaxation (nil/slight/gross), ease of insertion (easy/difficult/impossible), swallowing (nil/slight/gross), coughing/gagging (nil/slight/gross), limb/head movement (nil/slight/gross), and laryngospasm (nil/slight/gross). Postoperatively, sedation score was assessed on a 4-point scale at 1/2 hour, 1 hour, and 2 hours. MAIN RESULTS: The 2 groups were demographically similar. Incidence of full jaw relaxation at first attempt was significantly higher in group B vs F (48 vs 35 patients, P = 0.003). Insertion was easy in 48 vs 37 patients in group B and F, respectively (P = 0.017). The incidence of swallowing, patient movements, and laryngospasm was comparable among the groups. Coughing/gagging was significantly lower in group B (P = 0.008). Significantly more patients were sedated in group B at 1/2 hour (P = 0.010) and 1 hour (P = 0.000). None of the patients were deeply sedated at 1 hour. At 2 hours, all patients were awake. CONCLUSION: The use of butorphanol and thiopentone as induction agents produced excellent LMA insertion conditions compared to fentanyl and thiopentone (98% vs 86% success rate with 92% vs 71% easy insertion).

Adjuvants, Anesthesia↗

Insertion of the LMA-Unique with and without digital intraoral manipulation by inexperienced personnel after manikin-only training.

In a randomized, crossover study, we compared insertion of the LMA-Unique with and without digital intraoral manipulation by inexperienced personnel after manikin-only training. Ten registered nurses with no hands-on clinical experience of airway management and 100 anesthetized, paralyzed adults (ASA Status 1-2, aged 18-80 years) participated in the trial. Training comprised: 1) a 30-min didactic lecture; 2) a 3-min description of each of the insertion techniques; 3) a 3-min demonstration of each technique using a manikin; 4) 10 min of supervised training on the manikin with each technique. The time to achieve an effective airway (2 consecutive expired tidal volumes >/= 8 ml/kg; maximum 90 s or 3 attempts allowed) and the number of insertion attempts were determined by analysis of digital video recordings. Any blood staining on the first randomized device was noted at removal. The first attempt success rate (with digital intraoral manipulation, 84%; without digital intraoral manipulation, 87%) and overall success rate (with digital intraoral manipulation, 94%; without digital intraoral manipulation, 93%) were similar. Effective airway time was shorter without digital intraoral manipulation (43 +/- 17 vs. 33 +/- 15 s). Blood staining was detected in 12% (6/50) with and 16% (8/50) without digital intraoral manipulation (not significant). There were no differences in performance among nurses. We conclude that insertion of the LMA-Unique is equally successful with or without digital intraoral manipulation by inexperienced personnel in paralyzed adults after manikin-only training. Successful insertion of the LMA-Unique does not require insertion of the finger into the patient's mouth.

Adolescent↗

Retrograde (volar) scaphoid screw insertion-a quantitative computed tomographic analysis.

PURPOSE: The benefit of placing the screw tip in the center of the proximal pole of the scaphoid is supported by clinical and biomechanical data. In this investigation we attempted to quantify guidelines for optimal screw insertion into the scaphoid through a volar percutaneous approach using measurements from computed tomography images. METHODS: The parameters of safe insertion of a 3.0-mm cannulated-headed screw (Synthes, Paoli, PA) using a volar (retrograde) insertion technique were measured using quantitative computer analysis of computed tomography images of 15 unfractured scaphoids. In the coronal plane the average screw length for the most radial, most ulnar, and intermediate paths for safe screw insertion and the radial clearance of the trapezium were measured. In the sagittal planes defined by these screw paths the length of the screw, the length and depth of the concavity on the volar surface of the scaphoid, and the distance between a line corresponding to the center of the screw path and the volar surface of the trapezium were measured. RESULTS: Significant differences (1-way analysis of variance) were measured for the average screw lengths for different screw insertion paths in both the coronal and sagittal planes (with the shortest screw lengths observed for the most ulnar starting points) and for the volar clearance of the trapezium, which was greater for a radial screw path. The intermediate screw path-a measure of optimal screw insertion-passed radial to the radial edge of the trapezium in 10 of 15 patients (67%) with an average clearance of 3.9 mm (range, 1.1-7.9 mm) in those patients. The depth of the concavity on the volar surface of the scaphoid averaged 1.6, 2.0, and 2.5 mm in the 3 sagittal planes. CONCLUSIONS: Screw fixation of the scaphoid through a volar approach is hindered by the trapezium, risks cutout through the concavity in the volar surface of the scaphoid, and is most likely to violate the dorsoulnar aspect of the radiocarpal articular surface of the scaphoid if the screw is too long. A relatively radial starting point facilitates placement of the screw tip in the center of the proximal pole and helps avoid the trapezium but drilling or partial excision of the trapezium often may be necessary for optimal screw placement.

Adolescent↗

Dynamic mechanism for the serpin loop insertion as revealed by quantitative kinetics.

The serpin conformational change by insertion of the reactive center loop into beta-sheet A plays a central role in multiple physiological consequences such as serine proteinase inhibition, latency and serpinopathic polymerization. To study the dynamic mechanism for the loop insertion, a novel kinetic method was established utilizing the ovalbumin mutant R339T/A352R; the loop insertion progressed after the cleavage of P1-P1' (Arg352-Ser353) by trypsin was quenched at pH 8 and 0.5 degrees C, and different conformers were quantified by separation using ion-exchange HPLC. The apparent first-order rate constant k(app) determined for various R339T/A352R derivatives differing in conformational stability was greatly increased by lowering the pH. The pH-dependence of k(app) indicated that the protonation of side-chain(s) with a pK(a) value of around 4.6 is a pre-requisite for the loop insertion. The theoretical rate constant k for the protonated form calculated from k(app) was highly variable, depending on the ovalbumin derivative; structural modifications that give increased mobility to helix F and the sheet-A half (s3A/s2A/s1A) resulted in a striking increase in the loop insertion rate constant k. The k values were determined at different temperatures for all the ovalbumin derivatives, and DeltaH(double dagger) and DeltaS(double dagger) values for the loop insertion reaction were determined according to the transition theory. The formation of the transition state was highly endothermic with minor entropy gain, requiring a DeltaG(double dagger) larger than 18 kcal/mol, which can offset the hydrogen-bond cleavages between s3A and s5A. These results are consistent with the transition state with an opened sheet A and altered orientation of helix F.

Animals↗

Structure and function of lineage-specific sequence insertions in the bacterial RNA polymerase beta' subunit.

The large beta and beta' subunits of the bacterial core RNA polymerase (RNAP) are highly conserved throughout evolution. Nevertheless, large sequence insertions in beta and beta' characterize specific evolutionary lineages of bacteria. The Thermus aquaticus RNAP beta' subunit contains a 283 residue insert between conserved regions A and B that is found in only four bacterial species. The Escherichia coli RNAP beta' subunit contains a 188 residue insert in the middle of conserved region G that is found in a wide range of bacterial species. Here, we present structural studies of these two beta' insertions. We show that the inserts comprise repeats of a previously characterized fold, the sandwich-barrel hybrid motif (as predicted from previous sequence analysis) and that the inserts serve significant roles in facilitating protein/protein and/or protein/nucleic acid interactions.

Amino Acid Sequence↗

A cadaveric study on the anatomy of the deltoid insertion and its relationship to the deltopectoral approach to the proximal humerus.

Elevation of the deltoid insertion (DI) has been recommended, but little is known about its anatomy or importance for deltoid function. The purpose of this study is to determine the dimensions of the DI with specific reference to the deltopectoral approach. The deltoid was exposed and detached at its origin in 36 cadaveric shoulders. The morphology of the DI was documented, and its relationship with the pectoralis major insertion and the axillary and radial nerves was recorded. The anterior, middle, and posterior deltoid muscle fibers entered into the DI in a V-shaped tendinous confluence with a broad posterior band and a narrow separate anterior band, which accounted for the anterior one fifth of the DI (0.44 cm). The deltoid insertion was separated from the pectoralis major insertion by as little as 2 mm in 31 of 36 specimens. The distance between the axillary nerve and the DI averaged 5.6 cm anteriorly and 4.5 cm posteriorly. The distance between the radial nerve and posterior deltoid insertion averaged 2.4 cm proximally and 1.6 cm distally. Exposure during the deltopectoral approach is most limited by the close proximity of the deltoid and pectoralis major insertions. Our study would suggest that partial anterior DI release (greater than one fifth) could compromise the anterior deltoid. The axillary and radial nerves are not at significant risk when operating in the region of the anterior DI.

Brachial Plexus↗

Pharmacokinetics of a controlled-release misoprostol vaginal insert at term.

OBJECTIVE: The objective of this investigation was to report the pharmacokinetic properties of misoprostol administered intravaginally to women at term via a controlled-release hydrogel polymer insert. METHODS: This open-label, dose escalation trial consisted of 31 nulliparous women at term who were treated intravaginally in cohorts of six with inserts containing reservoirs from 25 through 300 microg (7 at 200 microg) of misoprostol. Inserts remained intravaginally until the patient went into labor, developed adverse events, or completed 24 hours of treatment. Complete data about residual drug in the inserts and plasma concentrations of misoprostol acid were gathered for 27 and 25 patients, respectively. RESULTS: Misoprostol was released at a constant rate (5.1% total dose per hour) with the amount absorbed being directly proportional to the dose reservoir. For the 25-, 50-, 100-, 200-, and 300-microg reservoir doses, the maximum median plasma concentrations were 6.4, 11.3, 21.7, 40.8, and 74.2 pg/mL, respectively, and the area under the curve until drug removal was 39, 117, 223, 269, and 477 pg x h/mL. Regardless of dose, the peak plasma concentration occurred at approximately 7 hours after insertion and the elimination half-life of the misoprostol acid was 0.55 hours (95% confidence interval, 0.36 to 1.32 hours). CONCLUSIONS: Misoprostol is released from the vaginal insert in a controlled manner and is eliminated rapidly after removal. Pharmacokinetic parameters are proportional to the reservoir dose.

Administration, Intravaginal↗

Investigation of the alternatively spliced insert region of the D2L dopamine receptor by epitope substitution.

Alternatively spliced variants of the D2 dopamine receptor have distinct neuronal function and localization. The long isoform (D2L) of this heptahelical transmembrane receptor differs from the short form only by the presence of a 29-amino acid insert in the third intracellular loop-a region known to be important for G protein coupling. Short and long isoforms have been shown to have distinct Galphai/o protein coupling specificities. However, the exact role of the alternatively spliced insert region in D2 dopamine receptor function needs a more comprehensive examination. One way to address this is to substitute the entire insert region with an equivalent length, yet nonhomologous protein sequence. This report demonstrates the feasibility of replacing the 29-amino acid insert with a hemagglutinin double epitope tag with no recognizable functional consequences. The D2L mutant is indistinguishable from the wild type D2L receptor in terms of its ligand binding characteristics, as well as two effector responses: the agonist-mediated inhibition of forskolin-stimulated cAMP production, and agonist-stimulated MAPK phosphorylation. These data demonstrate that the epitope substitution generates a functional receptor, and that the alternatively spliced insert region, itself, does not appear to play a direct role in signal transduction. The epitope substitution permits dissection of sequence-mediated effects from structural effects due to the presence of the alternatively spliced insert region. Thus, this new construct could be a valuable tool for the study of D2 receptor function.

Alternative Splicing↗

Regions of alpha-amino-5-methyl-3-hydroxy-4-isoxazole propionic acid receptor subunits that are permissive for the insertion of green fluorescent protein.

The green fluorescent protein can be fused to the ends of a mature glutamate receptor subunit to produce functional, fluorescent receptors. However, there are good reasons to search for internal regions of receptor subunits that can tolerate green fluorescent protein insertion. First, internal insertions of green fluorescent protein may produce functional, fluorescent subunits that traffic more correctly. Second, fluorescent proteins inserted near interacting surfaces of subunits could potentially create reagents suitable for fluorescence resonance energy transfer measurements. Finally, internal green fluorescent protein insertions could potentially produce subunits capable of signaling conformational changes through intrinsic changes in fluorescence intensity. To identify regions of receptor subunits that are permissive for green fluorescent protein insertion, we used a series of recombinant transposons to create fluorescent protein insertions in three alpha-amino-5-methyl-3-hydroxy-4-isoxazole propionic acid receptor subunits. A combined analysis of the relative fluorescence intensity and glutamate-gated ion channel function of 69 different green fluorescent protein fusion proteins identified permissive zones for the creation of bright and fully functional receptor subunits in the C-terminal portion of the amino terminal domain, the intracellular tail of the carboxy terminal domain, and within the pore-forming regions of the channel.

Amino Acid Sequence↗

Higher obesity risk associated with the exon-8 insertion of the UCP2 gene in a Spanish case-control study.

OBJECTIVE: We conducted a case-control study to examine the association between the risk of obesity and the exon-8 insertion allele in the UCP2 gene. METHODS: The case series included 157 subjects with a body mass index greater than 30 kg/m(2) (obesity) and no other major disease except for type 2 diabetes; the control series consisted of 150 healthy subjects with a body mass index less than 25 kg/m(2). In total, 307 subjects between ages 20 and 60 y were screened for the exon-8 insertion allele in the UCP2 gene. RESULTS: The association between risk of obesity and the UCP2 insertion allele was estimated using multivariate logistic regression. Obesity risk among carriers of the UCP2 insertion allele was slightly higher than among non-carriers (unadjusted odds ratio, 1.42; 95% confidence interval, 0.90 to 2.23); however, when the model was adjusted for sex, age, physical activity, and sedentary lifestyle (hours spent sitting down), a statistically significant odds ratio of obesity (1.94; 95% confidence interval, 1.14 to 3.30; P = 0.01) for carriers of the UCP2 insertion allele was found. CONCLUSIONS: We found a greater risk of developing obesity among individuals carrying the exon-8 insertion allele in the UCP2 gene, independent of sex, age, physical activity, and sedentary lifestyle, which may partly explain some discrepancies found in the literature.

Adult↗