United States Public Health Service

In the past few years several methods have been developed for the analysis of serum lipoproteins. Lindgren, Elliott, and Gofman (1) have utilized the relatively low density of the lipoproteins to separate them from the other serum proteins by ultracentrifugal flotation. Quantitation was sub- sequently performed by refractometric methods in the analytical ultracentrifuge. Separations of lipoproteins have also been made by Cohn frac- tionation in cold ethanol, and the quantities of lipoprotein have been estimated from the lipid. content of the fractions (2, 3). Widely used at the present time is the method of zone electrophoresis with quantitation either by staining (4) or by chemical analysis of eluates from the support- ing medium (5, 6).

IMPORTANCE: More than one-third of adults and 17% of youth in the United States are obese, although the prevalence remained stable between 2003-2004 and 2009-2010. OBJECTIVE: To provide the most recent national estimates of childhood obesity, analyze trends in childhood obesity between 2003 and 2012, and provide detailed obesity trend analyses among adults. DESIGN, SETTING, AND PARTICIPANTS: Weight and height or recumbent length were measured in 9120 participants in the 2011-2012 nationally representative National Health and Nutrition Examination Survey. MAIN OUTCOMES AND MEASURES: In infants and toddlers from birth to 2 years, high weight for recumbent length was defined as weight for length at or above the 95th percentile of the sex-specific Centers for Disease Control and Prevention (CDC) growth charts. In children and adolescents aged 2 to 19 years, obesity was defined as a body mass index (BMI) at or above the 95th percentile of the sex-specific CDC BMI-for-age growth charts. In adults, obesity was defined as a BMI greater than or equal to 30. Analyses of trends in high weight for recumbent length or obesity prevalence were conducted overall and separately by age across 5 periods (2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012). RESULTS: In 2011-2012, 8.1% (95% CI, 5.8%-11.1%) of infants and toddlers had high weight for recumbent length, and 16.9% (95% CI, 14.9%-19.2%) of 2- to 19-year-olds and 34.9% (95% CI, 32.0%-37.9%) of adults (age-adjusted) aged 20 years or older were obese. Overall, there was no significant change from 2003-2004 through 2011-2012 in high weight for recumbent length among infants and toddlers, obesity in 2- to 19-year-olds, or obesity in adults. Tests for an interaction between survey period and age found an interaction in children (P = .03) and women (P = .02). There was a significant decrease in obesity among 2- to 5-year-old children (from 13.9% to 8.4%; P = .03) and a significant increase in obesity among women aged 60 years and older (from 31.5% to 38.1%; P = .006). CONCLUSIONS AND RELEVANCE: Overall, there have been no significant changes in obesity prevalence in youth or adults between 2003-2004 and 2011-2012. Obesity prevalence remains high and thus it is important to continue surveillance.

Publisher Summary This chapter discusses the different aspects of thiobarbituric acid assay of sialic acid. Periodate oxidation of the neuraminic acid backbone of sialic acids results in the formation of β -formylpyruvic acid from carbon atoms 1 to 4. The N -acetyl or N -glycolyl group of sialic acids apparently does not interfere with periodate oxidation. β -Formylpyruvic acid is coupled with 2-thiobarbituric acid to form a red chromophore with a maximum absorption at 549 mμ. It is found that as only free sialic acids are reactive in the assay, hydrolysis of sialic acid-containing material must be carried out for the measurement of total sialic acids. The assay is suitable for measuring the release of bound sialic acid by sialidase. A series of 2-keto, 3-deoxy sugar acids, found in bacteria, also react in the thiobarbituric acid assay. These produce a chromogen with a peak at 549 mμ. They can be readily distinguished from sialic acids because they are not reactive in the orcinol or direct Ehrlich assays for sialic acids. The hydrolysis frees all the sialic acids from several mucoproteins that have been tested except for brain tissue where release of sialic acids takes place for several hours.

Sixty-one evaluable patients, 19 with advanced aplastic anemia and 42 with end stage hematological malignancies, were conditioned for marrow grafting with total body irradiation or cyclophosphamide, or a combination of both. Marrow graft donors were siblings matched at the HL-A region and nonreactive in mixed leukocyte culture. All patients received methotrexate postgrafting to modify anticipated graft-versus-host disease (GVHD). Forty-three of the 61 patients developed clinically recognizable GVHD. In seven GVHD was limited to the skin. In the remaining patients, skin involvement was more severe and was followed by gastrointestinal involvement manifested by anorexia, nausea, diarrhea, abdominal pain, and malabsorption and/or liver involvement manifested by hepatomegaly, rises in serum glutamic oxaloacetic acid transaminase, and bilirubin. The severity of GVHD showed no correlation with the underlying disease, the conditioning regimen, or the day of onset after grafting. Fourteen of 25 patients without GVHD or with only skin involvement are alive. By contrast, only 5 of 36 with severe GVHD are alive. Twenty-six of the 36 patients with severe GVHD succumbed to infection, whereas only 4 of 25 without GVHD or with only skin involvement did so. The results show that despite histocompatibility matching and methotrexate therapy, GVHD remains a serious and often fatal complication of marrow transplantation.

BACKGROUND: Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome. METHODS: We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms. RESULTS: We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki's disease-like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%). CONCLUSIONS: Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.).

IMPORTANCE: Previous analyses of obesity trends among children and adolescents showed an increase between 1988-1994 and 1999-2000, but no change between 2003-2004 and 2011-2012, except for a significant decline among children aged 2 to 5 years. OBJECTIVES: To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011-2014 and investigate trends by age between 1988-1994 and 2013-2014. DESIGN, SETTING, AND PARTICIPANTS: Children and adolescents aged 2 to 19 years with measured weight and height in the 1988-1994 through 2013-2014 National Health and Nutrition Examination Surveys. EXPOSURES: Survey period. MAIN OUTCOMES AND MEASURES: Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011-2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005-2006 and 2013-2014 also were conducted. RESULTS: Measurements from 40,780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988-1994 and 2013-2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% (95% CI, 15.5%-18.6%) and extreme obesity was 5.8% (95% CI, 4.9%-6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%-8.8%) in 1988-1994 to 13.9% (95% CI, 10.7%-17.7%) (P < .001) in 2003-2004 and then decreased to 9.4% (95% CI, 6.8%-12.6%) (P = .03) in 2013-2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%-13.4%) in 1988-1994 to 19.6% (95% CI, 17.1%-22.4%) (P < .001) in 2007-2008, and then did not change (2013-2014: 17.4% [95% CI, 13.8%-21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988-1994 (10.5% [95% CI, 8.8%-12.5%]) and 2013-2014 (20.6% [95% CI, 16.2%-25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%-5.0%] in 1988-1994 to 4.3% [95% CI, 3.0%-6.1%] in 2013-2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI, 1.7%-3.9%] in 1988-1994 to 9.1% [95% CI, 7.0%-11.5%] in 2013-2014; P < .001). No significant trends were observed between 2005-2006 and 2013-2014 (P value range, .09-.87). CONCLUSIONS AND RELEVANCE: In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% and extreme obesity was 5.8%. Between 1988-1994 and 2013-2014, the prevalence of obesity increased until 2003-2004 and then decreased in children aged 2 to 5 years, increased until 2007-2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.

Summary A microtechnique (modified Takatsy) is described which can be applied to complement fixation, hemagglutination, hemagglutination inhibition and metabolic inhibition tests. The system permits an 8-fold saving of reagents and rapid performance of microdilutions. The specific methods and modifications of equipment necessary to obtain reliable results are presented in detail. Comparative data obtained with the micro- and standard systems establish the reliability and validity of the microsystem.

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Summary The antibody in agar plate test has proved valuable for the quantitative measurement of individual serum immunoglobulins. With this technique, specific antiserum is mixed uniformly in an agar gel plate. Antigen containing solutions are placed in small antigen wells cut in the agar. A concentric ring of antigen: antibody precipitate forms around the antigen well. By graphically comparing the ring diameters with those of appropriate standards, the protein concentration of the test sera can be determined. The probable error in measurement of normal serum immunoglobulins is ±10%. This procedure has been used to quantify protein concentrations as low as 0.003 mg/ml. Multiple samples can be easily tested and less than 0.1 ml of sample is required. The mean immunoglobulin levels in 20 normal human sera were found to be 12.4 mg/ml for IgG (7 S γ2-globulins); 2.8 mg/ml for IgA (γ1A or β2A-globulins) and 1.23 mg/ml for the IgM (18 S γ1M-globulins). Type K (I) and Type L (II) immunoglobulins were similarly determined. The results by the antibody-agar plate method are similar to those obtained by the isotopic immune inhibition technique, except for the serum IgA and Type K (I) and Type L (II) immunoglobulin levels. With each of these proteins the values obtained by the isotopic immune inhibition test are higher than those found by the antibody-agar plate test. The basis for this difference is discussed.

Kellogg, Douglas S., Jr. (Communicable Disease Center, Atlanta, Ga.), William L. Peacock, Jr., W. E. Deacon, L. Brown, and Carl I. Pirkle. Neisseria gonorrhoeae. I. Virulence genetically linked to clonal variation. J. Bacteriol. 85:1274-1279. 1963.-One type, obtained from the purulent exudate of acute gonorrhea was maintained by 69 selective in vitro passages, at which point the organisms produced infections in human volunteers. A predominance of clonal types found in laboratory strains and a lack of ability to infect human volunteers resulted from 69 nonselective in vitro passages. Physiological and serological characteristics of the clonal types are compared. We are now in a position to study Neisseria gonorrhoeae organisms in their virulent form.

AFTER a lethal dose of radiation in rodents,1 canines2 or primates,3 the destroyed bone marrow may be repopulated by intravenous infusion of cellular suspensions of marrow taken from healthy isologous, homologous4 and, in some cases, heterologous3 donors. Effective cells for these infusions may be stored by the Polge technic of freezing to -80°C. in glycerol.6 Hosts seeded with donor marrow have some of the immunologic characteristics of the donors, and in some circumstances will take and hold homografts of other organs from them.7 Since cases of radiation disaster may occur, and since bone-marrow deficiency from radiation or chemotherapy does occur . . .

An illness-induced taste aversion was conditioned in rats by pairing saccharin with cyclophosphamide, an immunosuppressive agent. Three days after conditioning, all animals were injected with sheep erythrocytes. Hemagglutinating antibody titers measured 6 days after antigen administration were high in placebo-treated rats. High titers were also observed in nonconditioned animals and in conditioned animals that were nor subsequently exposed to saccharin. No agglutinating antibody was detected in conditioned animals treated with cyclophosphamide at the time of antigen administration. Conditioned animals exposed to saccharin at the time of or following the injection of antigen were significantly immunosuppressed. An illness-induced taste aversion was also conditioned using LiCl, a nonimmunosuppressive agent. In this instance, however, there was no attenuation of hemagglutinating antibody titers in response to injection with antigen.

This DataWatch examines the potential impact of socioeconomic differences on rates of hospitalization, based on patterns of hospital use in New York City in 1988. The research suggests that lack of timely and effective outpatient care may lead to higher hospitalization rates in low-income areas. For certain conditions identified as ambulatory care sensitive, hospitalization rates were higher in low-income areas than they were in higher-income areas where appropriate outpatient care was more readily available. Further study is needed to determine the relative impact of various economic, structural, and cultural factors that affect access to care.

Journal Article Method for the Quantitative Morphologic Analysis of Tissues Get access H. W. Chalkley H. W. Chalkley senior physiologist National Cancer Institute, National Institute of Health, United States Public Health Service Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 4, Issue 1, August 1943, Pages 47–53, https://doi.org/10.1093/jnci/4.1.47 Published: 01 August 1943

Centers for Disease Control and Prevention data were used to describe 1980-2007 trends among children 0 to 17 years of age and recent patterns according to gender, race, and age. Asthma period prevalence increased by 4.6% per year from 1980 to 1996. New measures introduced in 1997 show a plateau at historically high levels; 9.1% of US children (6.7 million) currently had asthma in 2007. Ambulatory care visit rates fluctuated during the 1990 s, whereas emergency department visits and hospitalization rates decreased slightly. Asthma-related death rates increased through the middle 1990 s but decreased after 1999. Recent data showed higher prevalence among older children (11-17 years), but the highest rates of asthma-related health care use were among the youngest children (0-4 years). After controlling for racial differences in prevalence, disparities in adverse outcomes remained; among children with asthma, non-Hispanic black children had greater risks for emergency department visits and death, compared with non-Hispanic white children. For hospitalizations, for which Hispanic ethnicity data were not available, black children had greater risk than white children. However, nonemergency ambulatory care use was lower for non-Hispanic black children. Although the large increases in childhood asthma prevalence have abated, the burden remains large. Potentially avoidable adverse outcomes and racial disparities continue to present challenges. These findings suggest the need for sustained asthma prevention and control efforts for children.

An antibacterial effect of myeloperoxidase, a halide, such as iodide, bromide, or chloride ion, and H(2)O(2) on Escherichia coli or Lactobacillus acidophilus is described. When L. acidophilus was employed, the addition of H(2)O(2) was not required; however, the protective effect of catalase suggested that, in this instance, H(2)O(2) was generated by the organisms. The antibacterial effect was largely prevented by preheating the myeloperoxidase at 80 C or greater for 10 min or by the addition of a number of inhibitors; it was most active at the most acid pH employed (5.0). Lactoperoxidase was considerably less effective than was myeloperoxidase when chloride was the halide employed. Myeloperoxidase, at high concentrations, exerted an antibacterial effect on L. acidophilus in the absence of added halide, which also was temperature- and catalase-sensitive. Peroxidase was extracted from intact guinea pig leukocytes by weak acid, and the extract with peroxidase activity had antibacterial properties which were similar, in many respects, to those of the purified preparation of myeloperoxidase. Under appropriate conditions, the antibacterial effect was increased by halides and by H(2)O(2) and was decreased by catalase, as well as by cyanide, azide, Tapazole, and thiosulfate. This suggests that, under the conditions employed, the antibacterial properties of a weak acid extract of guinea pig leukocytes is due, in part, to its peroxidase content, particularly if a halide is present in the reaction mixture. A heat-stable antibacterial agent or agents also appear to be present in the extract.

Journal of NeurochemistryVolume 29, Issue 1 p. 13-26 Free Access RELATION BETWEEN PHYSIOLOGICAL FUNCTION AND ENERGY METABOLISM IN THE CENTRAL NERVOUS SYSTEM Louis Sokoloff, Louis Sokoloff Laboratory of Cerebral Metabolism, U.S. Department of Health, Education, and Welfare, Public Health Service, Bethesda, MD 20014, U.S.A.Search for more papers by this author Louis Sokoloff, Louis Sokoloff Laboratory of Cerebral Metabolism, U.S. Department of Health, Education, and Welfare, Public Health Service, Bethesda, MD 20014, U.S.A.Search for more papers by this author First published: July 1977 https://doi.org/10.1111/j.1471-4159.1977.tb03919.xCitations: 629AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abbreviations used: DG 2-deoxy-d-glucose DG-6-P 2-deoxy-d-glucose-6-phosphate REFERENCES Bachelard H. S. (1971) J. Neurochem. 18: 213– 222. Bidder T. G. (1968) J. Neurochem. 15: 867– 874. Caveness W. F. (1969) in Basic Mechanisms of the Epilepsies ( H. H. Jasper, A. A. Ward & A. Pope, eds.) pp. 517– 534. Little, Brown, Boston . Collins R. C., Kennedy C., Sokoloff L. & Plum F. (1976) Arch Neurol. 33: 536– 542. Des Rosiers M. H., Kennedy C., Shinohara M. & Sokoloff L. (1976) Neurology 26, 346. Giarman N. J. & Roth R. H. (1964) Science 145: 583– 584. Hers H. G. (1957) Le Métabolisme du Fructose, p. 102. Editions Arscia, Bruxelles . Hubel D. H. & Wiesel T. N. (1968) J. Physiol. 195: 215– 243. Hubel D. H. & Wiesel T. N. (1972) J. comp. Neurol. 146: 421– 450. Kennedy C., Des Rosiers M. H., Reivich M., Sharp F., Jehle J. W. & Sokoloff L. (1975) Science 187: 850– 853. Kennedy C., Des Rosiers M. H., Sakurada O., Shinohara M., Reivich M., Jehle J. W. & Sokoloff L. (1976) Proc. natn. Acad. Sci., U.S.A. 73: 4230– 4234. Kety S. S. (1950) Am. J. Med. 8: 205– 217. Kety S. S. (1957) in The Metabolism of the Nervous System ( D. Richter, ed.) pp. 221– 237. Pergamon Press, London . Landau W. H., Freygang W. H., Rowland L. P., Sokoloff L. & Kety S. S. (1955) Trans. Am. Neurol. Ass. 80: 125– 129. Lashley K. S. (1934) J. comp. Neurol. 59: 341– 373. Lassen N. A. (1959) Physiol. Rev. 39: 183– 238. Montero V. M. & Guillery R. W. (1968) J. comp. Neurol. 134: 211– 242. Oldendorf W. H. (1971) Am. J. Physiol, 221: 1629– 1638. Plum F., Gjedde A. & Samson F. E. (1976) Neurosci. Res. Prog. Bull. 14: 457– 518. Rakic P. (1976) Nature 261: 467– 471. Reivich M., Jehle J. W., Sokoloff L. & Kety S. S. (1969) J. Appl. Physiol. 27: 296– 300. Roth R. H. (1976) Pharmac. Ther. 2: 71– 88. Sakurada O., Shinohara M., Klee W. A., Kennedy C. & Sokoloff L. (1976) Neurosci. Abstr. 2 (Part 1). 613. Schwartz W. J., Sharp F. R., Gunn R. H. & Evarts E. V. (1976) Nature 261: 155– 157. Shapiro H. M., Greenberg J. H., Reivich M., Shipko H., Van Horn K. & Sokoloff L. (1975) in Blood Flow and Metabolism in the Bruin ( A. M. Harper, W. B. Jennett, J. D. Miller & J. O. Rowan, eds.) pp. 9.42– 9.43. Churchill Livingstone, Edinburgh . Sharp F. R., Kauer J. S. & Shepherd G. M. (1975) Brain Res. 98: 596– 600. Shinohara M., Sakurada O., Jehle J. & Sokoloff L. (1976) Neurosci. Abstr. 2 (Part 1). 615. Sokoloff L. (1969) in Psychochemical Research in Man ( A. J. Mandell & M. P. Mandell, eds.) pp. 237– 252. Academic Press, New York . Sokoloff L. (1976) in Basic Neurochemistry ( G. J. Siegel, R. W. Albers, R. Katzman & B. W. Agranoff, eds.) 2nd ed, pp. 388– 413. Little, Brown, Boston . Sokoloff L., Reivich M., Kennedy C., Des Rosiers M. H., Patlak C. S., Pettigrew K. D., Sakurada O. & Shinohara M. (1977) J. Neurochem. 28: 897– 916. Sols A. & Crane R. K. (1954) J. biol. Chem. 210: 581– 595. Wiesel T. N., Hubel D. H. & Lam D. M. K. (1974) Brain Res. 79: 273– 279. Wolfson L. I. & Brown L. (1976) Neurosci. Abstr. 2 (Part 1), 510. Wolfson L. I., Sakurada O. & Sokoloff L. (1976) Trans. Am. Soc. Neurochem. 7, 165. Citing Literature Volume29, Issue1July 1977Pages 13-26 ReferencesRelatedInformation

The separation of peptides from controlled proteolytic digests by two-dimensional paper chromatography and electrophoresis is finding wide application to studies of protein structure. With this method it is possible to compare digestion mixtures from different proteins and to detect differences as slight as the replacement of a single amino acid. Such differences are of importance in the comparison of homologous proteins from different animal and plant species, and in the study of genetically determined changes in protein structure, such as those resulting from a single gene mutation.

THE &amp;quot;paucity of reliable epidemiological data&amp;quot;1 concerning periodontal dis-ease has been discussed by several commentators.2 3 Although field surveys of gingivitis prevalence have been carried out using the P. M. A. index of Massler and Schour,4-10 studies dealing with more advanced stages of tissue destruction have generally been based upon collections of case histories, with all of the drawbacks inherent in such data,&amp;quot;1 and have ordinarily been limited to estimates of the qualitative presence or absence of disease without regard to its severity,12 or of quantitative bone loss as determined by radiographs alone, without reference to clinical appearance.13 &amp;apos; 14 A committee of the University of Michigan Periodontal Workshop stated that &amp;quot;the lack of valid indexes for determining the prevalence and epidemiological characteristics of periodontal diseases has hindered seriously the development of more effective preventive and treatment procedures for these diseases. &amp;apos;1 The Council on Dental Health of the American Dental Association commented that, &amp;quot;The prevalence of the disease has not been measured, largely because of inadequate measuring devices.&amp;quot;&amp;apos;5

2This research was supported by U. S. Public Health Service research grants 5-MO1-FR00094 CLR from the Division of Research Facilities and Resources, and GRS-FR 5394 3Work done during the term of U. S. Public Health Service Postdoctoral Fellowship 5-F2-AM- 28,805. Current address: Metabolism Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 4From the Subdepartment of Endocrinology and Metabolism, Department of Medicine, and the Department of Surgery, Albany Medical College, and the Albany Medical Center Hospital, Albany, New York