Brain deviations in adult obese-hyperglycemic mice (ob/ob)

In the brain of adult obese-hyperglycemic mice (ob/ob) deviations, such as reduced brain weight, diminished myelination, and reduced amount of DNA were found. These findings cannot be explained by hypothyroidism in adults since above mentioned deviations could only have been caused by a reduced thyroidal activity in the first weeks of postnatal life. Therefore, our data are in support of the earlier hypothesis of congenital hypothyroidism.     

Systematic Review and Neural Network Analysis to Define Predictive Variables in Implantable Motor Cortex Stimulation to Treat Chronic Intractable Pain

Implantable motor cortex stimulation (iMCS) has been performed for >25 years to treat various intractable pain syndromes. Its effectiveness is highly variable and, although various studies revealed predictive variables, none of these were found repeatedly. This study uses neural network analysis (NNA) to identify predictive factors of iMCS treatment for intractable pain. A systematic review provided a database of patient data on an individual level of patients who underwent iMCS to treat refractory pain between 1991 and 2017. Responders were defined as patients with a pain relief of >40% as measured by a numerical rating scale (NRS) score. NNA was carried out to predict the outcome of iMCS and to identify predictive factors that impacted the outcome of iMCS. The outcome prediction value of the NNA was expressed as the mean accuracy, sensitivity, and specificity. The NNA furthermore provided the mean weight of predictive variables, which shows the impact of the predictive variable on the prediction. The mean weight was converted into the mean relative influence (M), a value that varies between 0 and 100%. A total of 358 patients were included (202 males [56.4%]; mean age, 54.2 ±13.3 years), 201 of whom were responders to iMCS. NNA had a mean accuracy of 66.3% and a sensitivity and specificity of 69.8% and 69.4%, respectively. NNA further identified 6 predictive variables that had a relatively high M: 1) the sex of the patient (M = 19.7%); 2) the origin of the lesion (M = 15.1%); 3) the preoperative numerical rating scale score (M = 9.2%); 4) preoperative use of repetitive transcranial magnetic stimulation (M = 7.3%); 5) preoperative intake of opioids (M = 7.1%); and 6) the follow-up period (M = 13.1%). The results from the present study show that these 6 predictive variables influence the outcome of iMCS and that, based on these variables, a fair prediction model can be built to predict outcome after iMCS surgery.PerspectiveThe presented NNA analyzed the functioning of computational models and modeled nonlinear statistical data. Based on this NNA, 6 predictive variables were identified that are suggested to be of importance in the improvement of future iMCS to treat chronic pain.     

法国、德国、荷兰卫生技术评估发展历程及思考

在法国,由政府财政支持的独立性全国性卫生技术评估机构进行药品、服务、仪器设备等各项卫生技术的评估工作,其研究结果是重要的决策工具。在德国,卫生技术评估被卫生体系中各方广泛利用,针对各种不同类型技术,从不同角度出发,为政府、立法、保险等提供服务,是门诊服务中重要的决策工具。荷兰卫生技术评估曾经对政策有较强影响,但随着医保组织的退出,评估向学术研究发展,对政策的影响有所削弱。     

Renal concentrating ability in obesity. Effect of modified fasting and the supplementation of T3, sodium chloride and carbohydrate

The renal concentrating ability (RCA) was studied in 30 obese subjects before and after modified fasting (MF) and T3 supplementation, and during hypocaloric-carbohydrate refeeding. We also studied the effect of sodium supplementation on the RCA during MF. Modified fasting induced a low T3-high rT3 state ("sick euthyroid"). During T3-supplementation plasma T3 levels increased but were in the normal range for normal weight controls. Plasma sodium, potassium, and calcium remained within the normal range during all study periods. After MF (14 days) the mean maximal urinary osmolality was significantly lower compared to prefast values both after dehydration alone (706 +/- 12 mosm/kg H2O v 975 +/- 14, P less than 0.001) and after dehydration plus sc vasopressin administration (676 +/- 19 v 899 +/- 17, P less than 0.001). After 14 days MF followed by 14 days MF + T3-supplementation plasma urea, urinary urea excretion, and the creatinine clearance were significantly greater than after MF alone as was the RCA (764 +/- 15 v 652 +/- 25, P less than 0.002). Sodium chloride supplementation increased RCA (P less than 0.02) but no additive effect of T3 and sodium chloride supplementation was observed. Severe dietary salt restriction induced a significant decline in RCA (P less than 0.005). Refeeding with carbohydrate increased plasma T3 from 79.9 +/- 7.7 to 97 +/- 7.5 ng/100 mL (NS) and decreased plasma rT3 from 0.33 +/- 0.02 to 0.27 +/- 0.02 ng/mL, (P less than 0.02); no significant change in RCA was observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impact of chemotherapy-associated liver injury on tumour regression grade and survival in patients with colorectal liver metastases

Background

An inverse relation between chemotherapy-associated liver injury (CALI) and tumour response to chemotherapy has been reported. The aim was to validate these findings, and further investigate the impact of CALI on survival in patients who underwent partial hepatectomy for colorectal liver metastases (CRLM).