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Background: Fasting levels of glucagon are known to be elevated in youth and adults with type 2 diabetes mellitus (T2D). Children and adolescents with obesity were previously reported to show increasing fasting and post-glucose-challenge hyperglucagonemia across the spectrum of glucose tolerance, while no data are available in those with impaired fasting glucose (IFG). Materials and methods: Individuals from the Beta-JUDO study population (Uppsala and Salzburg 2010-2016) (n=101, age 13.3 ± 2.8, m/f=50/51) were included (90 with overweight or obesity, 11 with normal weight). Standardized OGTT were performed and plasma glucose, glucagon and insulin concentrations assessed at baseline, 5, 10, 15, 30, 60, 90 and 120 minutes. Patients were grouped according to their glycemic state in six groups with normal glucose metabolism (NGM) and normal weight (NG-NW), NGM with obesity or overweight (NG-O), impaired glucose tolerance (IGT), impaired fasting glucose (IFG), IGT+IFG and T2D, and in two groups with NGM and impaired glucose metabolism (IGM), for statistical analysis. Results and conclusion: Glucagon concentrations were elevated in young normoglycemic individuals with overweight or obesity (NG-O) compared to normoglycemic individuals with normal weight. Glucagon levels, fasting and dynamic, increased with progressing glycemic deterioration, except in IFG, where levels were comparable to those in NG-O. All glycemic groups showed an overall suppression of glucagon during OGTT. An initial increase of glucagon could be observed in T2D. In T2D, glucagon showed a strong direct linear correlation with plasma glucose levels during OGTT. Glucagon in adolescents, as in adults, may play a role in the disease progression of T2D. [ABSTRACT FROM AUTHOR]

The article focuses on the roles and responsibilities of nursing assistant professions in Austria, specifically detailing the tasks delegated to them within the healthcare framework. Topics include the scope of nursing assistant professions, encompassing activities in the nursing process such as assessment, observation, and execution of nursing measures. It also covers their involvement in medical diagnostics and therapy under delegation.

The article "Legal Innovations" provides information on various changes in the field of medical law and professional law. In medical law, changes have been made to the Narcotic Drug Quantity Regulation and the Psychotropic Substance Quantity Regulation. In professional law, changes have been made to the Occupational Diseases Modernization Act, the Health Reform Measures Financing Act, the Dental Practitioners Act Amendment 2023, and the Nursing Act Amendment 2023. Other changes concern the collective agreement of the Vorarlberg Social and Health Care Sector, the OTA-AV Amendment 2024, the Physicians Act 1998, the Federal Act on Hospitals and Health Resorts, the Pharmacopoeia, the Medical Device Reporting Regulation 2024, and the Health Target Control Act. Changes have also been made to the Pharmacy Act, the Pharmacy Chamber Act 2001, and the Salary Fund Act 2002, which aim to improve pharmaceutical supply. Pharmacies are now also allowed to conduct health tests and operate dispensing points in areas without their own pharmacies. [Extracted from the article]

The article "Legal Innovations" in the Journal for Medical and Health Law reports on various legislative changes in the field of healthcare in Austria. Changes in professional law, medical products, social law, and sanitary law are presented. Among other things, new framework conditions for the competencies and qualification certificates of healthcare and nursing professionals are created, an apprenticeship for nursing assistance and nursing specialist assistance is introduced, and a federal law on the establishment of a federal crisis camp for the healthcare sector is enacted. Further changes concern the pharmacy and pharmaceutical law, primary care law, and the parent-child passport law. [Extracted from the article]

The article provides information on various legal innovations in social and labor law, as well as in COVID-19 and health law in Austria. Changes in various laws and regulations are listed, such as the General Social Security Act, the War Victims' Compensation Act, and the Federal Care Allowance Act. In COVID-19 and health law, extensions of provisions for the provision of antigen tests, vaccination against SARS-CoV-2, and the implementation of screening programs are mentioned. There are also changes in the field of health law, professional law, and medical products. Vietnam has withdrawn reservations to international agreements, and Greece has ratified the Convention on the International Protection of Adults. There is a revision of the International Private Law in the field of adult representation. [Extracted from the article]

The article deals with the tension between the duty of confidentiality of medical institutions and practitioners on one hand, and the right to information of the legal guardians on the other hand, in the treatment of minors. It is pointed out that the duty of confidentiality towards legal representatives of incapacitated minors may be breached and must be breached due to obligations to provide information. Capable minors have the right to keep sensitive information confidential, while legal guardians have the right to determine the whereabouts of minors, unless this contradicts the best interests of the child. Practitioners must inform the legal guardians of the whereabouts of minors and breach their duty of confidentiality in this case. [Extracted from the article]

Until recently, glucagon was considered a mere antagonist to insulin, protecting the body from hypoglycemia. This notion changed with the discovery of the liver-alpha cell axis (LACA) as a feedback loop. The LACA describes how glucagon secretion and pancreatic alpha cell proliferation are stimulated by circulating amino acids. Glucagon in turn leads to an upregulation of amino acid metabolism and ureagenesis in the liver. Several increasingly common diseases (e.g., non-alcoholic fatty liver disease, type 2 diabetes, obesity) disrupt this feedback loop. It is important for clinicians and researchers alike to understand the liver-alpha cell axis and the metabolic sequelae of these diseases. While most of previous studies have focused on fasting concentrations of glucagon and amino acids, there is limited knowledge of their dynamics after glucose administration. The authors of this systematic review applied PRISMA guidelines and conducted PubMed searches to provide results of 8078 articles (screened and if relevant, studied in full). This systematic review aims to provide better insight into the LACA and its mediators (amino acids and glucagon), focusing on the relationship between glucose and the LACA in adult and pediatric subjects. [ABSTRACT FROM AUTHOR]

The article presents the discussion on modification aims to address physician shortages and ensure uninterrupted blood supply. Topics include authorized to assess the health suitability of blood donors, grant approval for whole blood donation, and perform blood collection in mobile blood donation facilities without the presence of a physician; and standardized health assessment questionnaires, and the availability of direct consultation with a physician.

The article "LVwG Tirol: Unauthorized practice of healthcare and nursing" deals with administrative offenses related to the exercise of the advanced service for healthcare and nursing. It is stated that an administrative offense occurs when someone carries out this activity without recognition of their foreign acquired education or when someone employs someone for this activity without recognition of their foreign acquired education. It is also pointed out that an administrative offense occurs when the reservation of operation form according to the ÄrzteG (Physicians Act) is violated. The decision of the LVwG Tirol from March 17, 2022 refers to the administrative offenses committed by the complainant and the complainant. The fines imposed on the complainants were considered appropriate to their guilt and the decision has a general preventive effect. [Extracted from the article]

Objective: Over the years, non-alcoholic fatty liver (NAFLD) disease has progressed to become the most frequent chronic liver disease in children and adolescents. The full pathology is not yet known, but disease progression leads to cirrhosis and hepatocellular carcinoma. Risk factors included hypercaloric diet, obesity, insulin resistance and genetics. Hyperglucagonemia appears to be a pathophysiological consequence of hepatic steatosis, thus, the hypothesis of the study is that hepatic fat accumulation leads to increased insulin resistance and impaired glucagon metabolism leading to hyperglucagonemia in pediatric NAFLD. Methods: 132 children and adolescents between 10 and 18 years, with varying degrees of obesity, were included in the study. Using Magnetic Resonance Imaging (MRI) average liver fat was determined, and patients were stratified as NAFLD (>5% liver fat content) and non-NAFLD (<5%). All patients underwent a standardized oral glucose tolerance test (OGTT). Additionally, anthropometric parameters (height, weight, BMI, waist circumference, hip circumference) such as lab data including lipid profile (triglycerides, HDL, LDL), liver function parameters (ALT, AST), uric acid, glucose metabolism (fasting insulin and glucagon, HbA1c, glucose 120 min) and indices evaluating insulin resistance (HIRI, SPISE, HOMA-IR, WBISI) were measured. Results: Children and adolescents with NAFLD had significantly higher fasting glucagon values compared to the non-NAFLD cohort (p=0.0079). In the NAFLD cohort univariate analysis of fasting glucagon was associated with BMI-SDS (p<0.01), visceral adipose tissue volume (VAT) (p<0.001), average liver fat content (p<0.001), fasting insulin concentration (p<0.001), triglycerides (p<0.001) and HDL (p=0.034). This correlation equally applied to all insulin indices HOMA-IR, WBISI, HIRI (all p<0.001) and SPISE (p<0.002). Multivariate analysis (R² adjusted 0.509) for the same subgroup identified HIRI (p=0.003) and VAT volume (p=0.017) as the best predictors for hyperglucagonemia. Average liver fat content is predictive in pediatric overweight and obesity but not NAFLD. Conclusions: Children and adolescents with NAFLD have significantly higher fasting plasma glucagon values, which were best predicted by hepatic insulin resistance and visceral adipose tissue, but not average liver fat content. [ABSTRACT FROM AUTHOR]

The article deals with the sanctioning of professional misconduct in non-medical healthcare professions. Similarities and differences in the sanctioning system are highlighted, problems are identified, and suggestions for improvement are made. The professional duties are presented in a table, and it is pointed out that behavioral norms are reinforced by sanctioning norms in order to protect the rights of patients. It is also noted that simultaneous criminal liability cannot be disregarded. The article addresses the sanctioning of professional misconduct in the healthcare sector. It is pointed out that unauthorized medical treatments, violations of disclosure obligations, lack of expert assistance, violations of documentation obligations, violations of confidentiality obligations, violations of disclosure obligations, violations of reporting obligations, violations of the obligation to personally and directly practice the profession, violations of the obligation to report the professional address, violations of advertising restrictions, and the hygienic condition of the professional address can be sanctioned differently. It is noted that professional liability is structured differently in different professions. The article discusses the differences in the sanctioning of professional misconduct in the professional laws for medical-technical services (MTD-G), midwives (HebG), and healthcare and nursing professionals (GuKG) in Austria. While almost all professional misconduct is criminally sanctioned in MTD-G and HebG, this is the exception in GuKG. It is argued that there is no rational justification for these differences and that harmonization of the sanctioning is politically necessary. It is suggested to include certain professional misconduct, such as violations of the prohibition of discrimination and the obligation for further education, in the criminal offenses of GuKG. Furthermore, the importance of reporting obligations for healthcare professions in violence prevention is emphasized, and corresponding sanctions for violations of this obligation are recommended. [Extracted from the article]

Summary: Background: Relationships between movement‐related behaviours and metabolic health remain underexplored in adolescents with obesity. Objectives: To compare profiles of sedentary time (more sedentary, SED+ vs. less sedentary, SED−), moderate to vigorous physical activity (MVPA) time (more active, MVPA+ vs. less active, MVPA−) and combinations of behaviours (SED−/MVPA+, SED−/MVPA−, SED+/MVPA+, SED+/MVPA−) in regard to metabolic health. Methods: One hundred and thirty‐four subjects (mean age 13.4 ± 2.2 yrs, mean body mass index [BMI] 98.9 ± 0.7 percentile, 48.5% females) underwent 24 h/7 day accelerometry, anthropometric, body composition, blood pressure (BP), lipid profile and insulin resistance (IR) assessments. Results: Metabolic health was better in SED− [lower fat mass (FM) percentage (p < 0.05), blood pressure (BP) (p < 0.05), homeostasis model assessment of insulin resistance (HOMA‐IR) (p < 0.001) and metabolic syndrome risk score (MetScore) (p < 0.001), higher high‐density lipoprotein‐cholesterol (HDL‐c) (p = 0.001)] vs. SED+ group and in MVPA+ [lower triglyceridemia (TG), (p < 0.05), HOMA‐IR (p < 0.01) and MetScore (p < 0.001), higher HDL‐c (p < 0.01)] vs. MVPA− group after adjustment with age, gender, maturation and BMI. SED−/MVPA+ group had the best metabolic health. While sedentary (p < 0.001) but also MVPA times (p < 0.001) were lower in SED−/MVPA− vs. SED+/MVPA+, SED−/MVPA− had lower FM percentage (p < 0.05), HOMA‐IR (p < 0.01) and MetScore (p < 0.05) and higher HDL‐c (p < 0.05), independently of BMI. Sedentary time was positively correlated with HOMA‐IR and Metscore and negatively correlated with HDL‐c after adjustment with MVPA (p < 0.05). MVPA was negatively correlated with HOMA‐IR, BP and MetScore and positively correlated with HDL‐c after adjustment with sedentary time (p < 0.05). Conclusion: Lower sedentary time is associated with a better metabolic health independently of MVPA and might be a first step in the management of pediatric obesity when increasing MVPA is not possible. [ABSTRACT FROM AUTHOR]

Paediatric non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in childhood. Obesity is the main risk factor. Nutrition and lifestyle are the key elements in preventing and treating NAFLD in the absence of approved drug therapy. Whilst recommendations and studies on macronutrients (carbohydrates, fat and protein) in adult NAFLD exist, the discussion of this topic in paediatric NAFLD remains contradictory. The purpose of this review is to provide state-of-the-art knowledge on the role of macronutrients in paediatric NAFLD regarding quality and quantity. PubMed was searched and original studies and review articles were included in this review. Fructose, sucrose, saturated fatty acids, trans-fatty acids and ω-6-fatty-acids are strongly associated with paediatric NAFLD. High consumption of fibre, diets with a low glycaemic index, mono-unsaturated-fatty-acids and ω-3-fatty-acids reduce the risk of childhood-onset NAFLD. Data regarding the role of dietary protein in NAFLD are contradictory. No single diet is superior in treating paediatric NAFLD, although the composition of macronutrients in the Mediterranean Diet appears beneficial. Moreover, the optimal proportions of total macronutrients in the diet of paediatric NAFLD patients are unknown. Maintaining a eucaloric diet and avoiding saturated fatty acids, simple sugars (mainly fructose) and a high-caloric Western Diet are supported by literature. [ABSTRACT FROM AUTHOR]

The Journal for Medical and Health Law (JMG) presents interesting articles on the topic of health and medical law in its second issue of the year. One focus is on the decision of the Supreme Court regarding "wrongful birth" and "wrongful conception". Other articles address topics such as the recognition of foreign degrees in the healthcare sector, the recruitment of nursing staff from third countries, and the assumption of costs by the Austrian Integration Fund. In addition, the journal offers contributions on various legal aspects in the medical field. One article deals with the health function of forests. [Extracted from the article]

Background: Nonalcoholic fatty liver disease (NAFLD) is the leading hepatic disease in children, ranging from steatosis to steatohepatitis and fibrosis. Age, sex, hormonal levels, pubertal stages, genetic risk- and epigenetic factors are among the many influencing factors. Appearing predominantly in children with obesity, but not exclusively, it is the liver's manifestation of the metabolic syndrome but can also exist as an isolated entity. Summary: Pediatric NAFLD differs from the adult phenotype. This narrative review on NAFLD in children with obesity provides an overview of the current knowledge on risk factors, screening, and diagnostic methods, as well state-of-the-art treatment. The recent discussion on the proposition of a new nomenclature – Metabolic [Dysfunction-] Associated Liver Disease – is featured, and current gaps of knowledge are discussed. Key Messages: Currently, there is no international consensus on screening and monitoring of pediatric NAFLD. With lifestyle interventions being the cornerstone of treatment, no registered pharmacological treatment for pediatric NAFLD is available. Development and validation of additional noninvasive biomarkers, scores and imaging tools suitable to subcategorize, screen and monitor pediatric patients are necessary. With a variety of upcoming and promising agents, clear recommendations for pediatric nonalcoholic steatohepatitis trials are urgently needed. [ABSTRACT FROM AUTHOR]

The article "Legal Innovations" in the Journal for Medical and Health Law summarizes various legislative changes in the period from July 1 to August 31, 2022. Changes in the Health Target Control Act, the Drug Tax, the Cost Reimbursement for the Umbrella Organization of Social Insurance Institutions, and the Federal Care Allowance Act are mentioned. In connection with COVID-19, regulations on the dispensing of drugs and vaccines, as well as school organizational measures to prevent the spread of the virus, are implemented. Decisions of the Constitutional Court regarding the COVID-19 Protection Measures Ordinance and the COVID-19 Emergency Measures Ordinance are also mentioned. Furthermore, changes related to notifiable diseases, the COVID-19 Fund, the isolation of the sick and suspected cases, the entry regulation, recommended vaccinations, and the Health Telematics Act are described. [Extracted from the article]

In the editorial of the Journal for Medical and Health Law (JMG), reference is made to the upcoming regional, national, and European elections, which also have implications for the healthcare system. It is mentioned that the Austrian healthcare reform still requires many steps. Two articles in this issue address changes in pharmacy law and the benefits of the new electronic parent-child pass. Another article deals with the Supreme Court's case law on claims for damages in cases of unintended pregnancy despite the use of a spiral contraceptive. It also highlights the legal entitlement to an advance healthcare directive and other less dramatic topics in health law. [Extracted from the article]

The article presents the discussion on competence of physician assistants (PA) and nursing assistants (PFA) to perform peripheral venous catheter flushing. Topics include eliminate the competence for maintaining the patency of peripheral venous catheters and hinder the proper execution of connecting and disconnecting ongoing infusions by PAs and PFAs; and performing the connection and disconnection of ongoing infusions in accordance with professional standards.

The article offers information on Austrian legal situation regarding the SARS-CoV-2 pandemic. Topics discusses include segregation and traffic restrictions and legal protection against te pandemic; legal instruments for containing infectious diseases regulated by the Epidemic Act 1950; and critical care health and key personnel and management of contact persons diverges according to category such as isolation, traffic restriction, self-monitoring and registration.

The editorial of the Journal for Medical and Health Law (JMG) refers to various crises in the year 2023, including the Corona pandemic, Russia's attack on Ukraine, and the climate crisis. It also addresses the "personnel crisis" in the healthcare sector and discusses solutions such as the implementation of nursing education. Other topics of the editorial include decision-making capacity in mental illnesses, professional legal issues of first responders and medical disciplinary law, liability of medical device manufacturers and authorities, as well as the temporary employment directive in outsourced hospitals. Recommendations are also given for ethically responsible medical practice in the use of artificial intelligence and the efficiency of the Austrian healthcare system compared internationally. The editorial also includes glosses on various court decisions regarding topics such as the discriminatory exclusion from participating in an entrance examination for military doctors, the social security number as health data, the requirements for medical expert opinions, the limits of freedom of speech in relation to a doctor's statement, as well as loss of earnings under the Crime Victims Compensation Act and the right to a decision within reasonable time limits in proceedings for granting a pharmacy concession. The editorial concludes with Christmas and New Year's greetings from the editorial board. [Extracted from the article]

The article focuses on liability in relation to surgical robots. It mentions surgical robots is the cause of death in cases on the technique or the intervention and basically a costly treatment method acts whose justification is lower evidence seems questionable. It also mentions liability regime failure and therefore no adequate risk allocation through artificial intelligence with features assistant liability and strict liability.

The second issue of the Journal for Medical and Health Law in the year 2023 contains a mixture of current topics. It addresses, among other things, the reform of nursing and health insurance, cross-border treatments, and questions of product liability. It also discusses topics such as the collaboration between medical and non-medical health professions, the basis for consent in cross-border medical treatments, and the protective effects of nursing home contracts. Another focus is the introduction of e-prescriptions and the legal regulation of triage in Germany. The issue offers a variety of interesting articles for readers. [Extracted from the article]

The article criticizes a change in the University of Applied Sciences Act that makes it more difficult for qualified health and nursing professionals to upgrade to a bachelor's degree. According to the amendment, students who have obtained their professional qualification as qualified health and nursing professionals through a qualification according to the GuK-AV must complete at least 90 ECTS credits to obtain the academic degree of "Bachelor". Specializations and further education courses cannot be credited either. The article discusses the recognition of professional qualifications for qualified health and nursing professionals and suggests creating a special regulation to obtain the bachelor's degree. However, this regulation should be temporary. [Extracted from the article]

The fourth and final issue of the Journal for Medical and Health Law in the year 2022 contains an up-to-date overview article on the amendment of the Detention Act (Toyooka). Other articles deal with the mandatory vaccination against the Corona virus, assisted suicide in prison, and changes to pharmaceutical law due to EU legal developments. Topics such as patient rights and patient safety, telemedicine as telework, and the shortage of personnel in the healthcare sector are also addressed. The issue also provides information on current literature and wishes the readers a Merry Christmas and a Happy New Year 2023. [Extracted from the article]

Metabolic syndrome (MetS) is highly prevalent in children and adolescents with obesity and places them at an increased risk of cardiovascular-related diseases. However, the associations between objectively measured movement-related behaviors and MetS diagnosis remain unexplored in youths with obesity. The aim was to compare profiles of sedentary (SED) time (more sedentary, SED+ vs. less sedentary, SED−), moderate to vigorous physical activity (MVPA) time (more active, MVPA+ vs. less active, MVPA−) and combinations of behaviors (SED−/MVPA+, SED−/MVPA−, SED+/MVPA+, SED+/MVPA−) regarding the MetS diagnosis. One hundred and thirty-four adolescents with obesity (13.4 ± 2.2 years) underwent 24 h/7 day accelerometry, waist circumference (WC), blood pressure (BP), high-density lipoprotein-cholesterol (HDL-c), triglycerides (TG) and insulin-resistance (IR) assessments. Cumulative cardiometabolic risk was assessed by using (i) MetS status (usual dichotomic definition) and (ii) cardiometabolic risk z-score (MetScore, mean of standardized WC, BP, IR, TG and inverted HDL-c). SED− vs. SED+ and MVPA+ vs. MVPA− had lower MetS (p < 0.01 and p < 0.001) and MetScore (p < 0.001). SED−/MVPA+ had the lowest risk. While SED and MVPA times were lower in SED−/MVPA− vs. SED+/MVPA+ (p < 0.001), MetScore was lower in SED−/MVPA− independently of body mass index (BMI) (p < 0.05). MVPA, but not SED, time was independently associated with MetS diagnosis (p < 0.05). Both MVPA (p < 0.01) and SED times (p < 0.05) were associated with MetScore independently of each other. A higher MVPA and lower SED time are associated with lower cumulative cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (<18 years old) and a mixed age population (paediatric and adult) with T1DM published in the last 10 years was performed. Conclusion: Only a small number of studies with a very low number of participants and high degree of heterogeneity was identified. While all studies concluded that additional bolus insulin for (high) fat and (high) protein is necessary, no consensus on when dietary fat and/or protein should be taken into calculation and no unified algorithm for insulin therapy in this context exists. A prolonged postprandial observation time is necessary to improve individual metabolic control. Further studies focusing on a stratified paediatric population to create a safe and effective algorithm, taking fat and protein into account, are necessary. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) is highly prevalent in children and adolescents with obesity and places them at an increased risk of cardiovascular-related diseases. However, the associations between objectively measured movement-related behaviors and MetS diagnosis remain unexplored in youths with obesity. The aim was to compare profiles of sedentary (SED) time (more sedentary, SED+ vs. less sedentary, SED-), moderate to vigorous physical activity (MVPA) time (more active, MVPA+ vs. less active, MVPA-) and combinations of behaviors (SED-/MVPA+, SED-/MVPA-, SED+/MVPA+, SED+/MVPA-) regarding the MetS diagnosis. One hundred and thirty-four adolescents with obesity (13.4 ± 2.2 years) underwent 24 h/7 day accelerometry, waist circumference (WC), blood pressure (BP), high-density lipoprotein-cholesterol (HDL-c), triglycerides (TG) and insulin-resistance (IR) assessments. Cumulative cardiometabolic risk was assessed by using (i) MetS status (usual dichotomic definition) and (ii) cardiometabolic risk z-score (MetScore, mean of standardized WC, BP, IR, TG and inverted HDL-c). SED- vs. SED+ and MVPA+ vs. MVPA- had lower MetS ( p < 0.01 and p < 0.001) and MetScore ( p < 0.001). SED-/MVPA+ had the lowest risk. While SED and MVPA times were lower in SED-/MVPA- vs. SED+/MVPA+ ( p < 0.001), MetScore was lower in SED-/MVPA- independently of body mass index (BMI) ( p < 0.05). MVPA, but not SED, time was independently associated with MetS diagnosis ( p < 0.05). Both MVPA ( p < 0.01) and SED times ( p < 0.05) were associated with MetScore independently of each other. A higher MVPA and lower SED time are associated with lower cumulative cardiometabolic risk.

Background: Elastofibroma dorsi is a benign soft tissue lesion composed of abnormal elastic fibers. Degenerated elastic fibers in skin and liver are associated with clusterin, an apoprotein that shares functional properties with small heat shock proteins. We evaluated the staining pattern and possible role of clusterin in elastofibroma dorsi., Material and Methods: Twenty-one subcutaneous elastofibromas from the scapular region were evaluated with Elastica van Gieson and Orcein stains, immunohistochemically with antibodies to clusterin, smooth muscle actin, S-100, vimentin and CD34 and correlated with clinical data with respect to physical trauma., Results: Clusterin correlated with the staining pattern of Elastica van Gieson and labelled abnormal broad coarse fibrillar and globular elastic fibers in all elastofibromas. Orcein stains additionally identified fine oxytalan fibers which were not stained by clusterin. Clusterin staining was observed only on the outside of the elastin fibers, while the cores of fibers and globules were unstained. 4/21 elastofibromas showed cellular nodules with a myxoid/collagenous stroma. The round to oval cells showed cytoplasmic staining with vimentin and clusterin; CD34 labelled mostly cell membranes. The cells lacked SMA and S-100 expression. The central areas of the nodules were devoid of elastic fibers, but the periphery contained coarse fibers and globules. 9/ 11 patients, for whom clinical data were available, reported trauma to the scapular region., Conclusion: Many investigated ED were associated with trauma, which supports a reactive/degenerative etiology of ED. The abnormal large elastic fibers in all ED were enveloped by clusterin. Clusterin deposition may protect elastic fibers from degradation and thus contribute indirectly to the tumor-like presentation of ED.