Obesity in adulthood is combined with vascular endothelial cell and platelet activation. In this study we evaluated whether or not such activation is already present in obese children. Forty obese (10.3 +/- 2.5 yr) and 40 nonobese (10.3 +/- 2.3 yr) children were studied. Circulating levels of soluble (s) intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin, as indices of vascular endothelial cell activation, were assessed in both groups. Plasma concentrations of sP-selectin and sCD40 ligand, as indices of platelet activation, were also measured. Circulating levels of highly sensitive C-reactive protein (hs-CRP) and the lipid peroxidation product 8-iso-prostaglandin (PG)F(2alpha) were evaluated because of their ability to promote vascular endothelial cell and platelet activation. Circulating levels of all of the assessed markers were higher in obese than in nonobese children (sICAM-1, +38.8 +/- 13.3%; sVCAM-1, +26.5 +/- 13.7%; sE-selectin, +31.3 +/- 17.3%; sP-selectin, +31.7 +/- 16.9%; sCD40 ligand, +36.9 +/- 22.1%; total 8-iso-PGF(2alpha), +24.0 +/- 20.2%; hs-CRP, +76.6 +/- 12.9%; P < 0.0001). Significant correlations (P < 0.004) between plasma total 8-iso-PGF(2alpha) levels and circulating sICAM-1 (r = 0.485), sVCAM-1 (r = 0.506), sP-selectin (r = 0.449), sCD40 ligand (r = 0.498), and hs-CRP (r = 0.520) concentrations were found in obese children. In conclusion, an early activation of vascular endothelial cells and platelets was present in obese children. Increased lipid peroxidation was also present in these children and likely contributed to the observed proinflammatory phenotype.

The time pattern of intracranial pressure (ICP) in response to typical clinical tests (i.e., bolus injection and bolus withdrawal of 1 to 4 mL of saline in the craniospinal space) was studied in 18 patients with acute brain damage by means of a mathematical model. The model includes the main biomechanical factors assumed to affect intracranial pressure, particularly cerebrospinal fluid (CSF) dynamics, intracranial compliance, and cerebral hemodynamics. Best fitting between model simulation curves and clinical tracings was achieved using the Powell minimization algorithm and a least-square criterion function. The simulation results demonstrate that, in most patients, the ICP time pattern cannot be explained merely on the basis of CSF dynamics but also requires consideration of the contribution of cerebral hemodynamics and blood volume alterations. In particular, only in a few patients (about 40% of total) the ICP monotonically returns toward baseline following the clinical maneuver. In most of the examined cases (about 60%), ICP exhibits an anomalous response to the same maneuver, characterized by a delayed increase after bolus injection and a delayed decrease after withdrawal. The model is able to explain these responses, imputing them to active intracranial blood volume changes induced by mechanisms controlling cerebral blood flow. Finally, the role of the main intracranial biomechanical parameters in the genesis of the ICP time pattern is discussed and a comparison with previous theoretical studies performed.

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