Evidence That the Length of Bile Loop Determines Serum Bile Acid Concentration and Glycemic Control After Bariatric Surgery

Background

Bariatric surgery contributes to the improvement in glucose metabolism that may be related to a postoperative increase in serum bile acids (BAs). Three commonly used types of bariatric procedures, laparoscopic sleeve gastrectomy (LSG) (without creation of a bile loop), Roux-en-Y gastric bypass (RYGB), and omega-loop gastric bypass (OLGB) (with creation of shorter 100–150 cm and longer 200–280 cm bile loops, respectively), differ in their effects on glycemic control. The aim of the study was to compare the effects of various bariatric procedures on serum BA concentration and glucose homeostasis.

Methods

Serum BAs in 26 obese patients were determined by liquid chromatography-mass spectrometry prior to bariatric surgery, as well as 4 days and 3 months thereafter.

Results

Four days after the surgery, serum concentrations of BAs in LSG and OLGB groups were similar as prior to the procedure, and a slight decrease in serum BAs was observed in the RYGB group. Serum BA level in the LSG group remained unchanged also at 3 months after the surgery, whereas a significant 0.5- and 3-fold increase in this parameter was noted in the RYGB and OLGB groups, respectively. Serum concentration of BAs correlated positively with the length of the bile loop (R?=?0.47, p?<?0.05).

Conclusion

The evident improvement of glycemic control observed 3 months after OLGB might be associated with a postoperative increase in serum BAs, resulting from their better absorption from the longer bile loop. However, the changes in serum BAs probably had little or no impact on insulin sensitivity improvement at 4 days post-surgery.

     

Pelvic floor muscle activity during impact activities in continent and incontinent women: a systematic review

Introduction and hypothesis

Investigating the activity of the pelvic floor muscles (PFMs) in women during impact activities such as jumping, running or coughing may elucidate different aspects of PFM activation and therefore clarify the pathophysiology of stress urinary incontinence (SUI). A systematic review (PROSPERO 2016:CRD42016035624) was conducted to summarize current evidence on PFM activity during impact activities in both continent and incontinent women.

Methods

PubMed, EMBASE, Cochrane, and SPORTDiscus databases were systematically searched for studies published up to December 2016. The PICO approach (patient, intervention, comparison, outcome) was used to construct the search queries. Original studies were included that investigated PFM activity during impact activities if they included terms related to muscle activity and measurement methods, test positions, activities performed and continence status. Two reviewers screened titles and abstracts independently to ascertain if the included studies fulfilled the inclusion criteria, and extracted data on outcome parameters.

Results

The search revealed 28 studies that fulfilled the inclusion criteria, of which 26 were cross-sectional studies. They used different electromyography measurement methods, test activities, test positions, and comparisons with other structures. Ten studies compared continent and incontinent women. The timing of PFM activity in relation to the activity of other trunk muscles seems to be a crucial factor in maintaining continence. Women with SUI have delayed PFM activity.

Conclusions

The findings of this systematic review suggest that impact activities causing involuntary and reflex PFM activity should be the subject of further study. This may help guide clinical studies to improve our understanding of how the PFMs react during impact activities and to determine best practices that can be included in rehabilitation programmes.

     

Sex‐based disparities in delisting for being “too sick” for liver transplantation

Women with cirrhosis awaiting liver transplantation (LT) experience higher rates of waitlist mortality than men; it is unknown whether practices surrounding delisting for being “too sick” for LT contribute to this disparity beyond death alone. We conducted an analysis of patients listed for LT in the United Network for Organ Sharing/Organ Procurement and Transplantation Network not receiving exception points from May 1, 2007 to July 1, 2014 with a primary outcome of delisting with removal codes of “too sick” or “medically unsuitable.” A total of 44 388 patients were included; 4458 were delisted for being “too sick” for LT. Delisting was more frequent in women (11% vs 9%, P < .001). Compared to delisted men, delisted women differed in age (58 vs 57), non–hepatitis C virus listing diagnoses (69% vs 56%), hepatic encephalopathy (36% vs 31%), height (161.9 vs 177.0 cm), private insurance (47% vs 52%), and Karnofsky performance status (60 vs 70) (P < .001 for all). There were no differences in Model for End‐Stage Liver Disease including serum sodium and Child Pugh Scores. A competing risk analysis demonstrated that female sex was independently associated with a 10% (confidence interval 2%‐18%) higher risk of delisting when accounting for rates of death and transplantation and adjusting for confounders. This study demonstrates a significant disparity in delisting practices by sex, highlighting the need for better assessments of sickness, particularly in women.     

AID Biology: A pathological and clinical perspective

Activation-induced cytidine deaminase (AID), primarily expressed in activated mature B lymphocytes in germinal centers, is the key factor in adaptive immune response against foreign antigens. AID is responsible for producing high-affinity and high-specificity antibodies against an infectious agent, through the physiological DNA alteration processes of antibody genes by somatic hypermutation (SHM) and class-switch recombination (CSR) and functions by deaminating deoxycytidines (dC) to deoxyuridines (dU), thereby introducing point mutations and double-stranded chromosomal breaks (DSBs). The beneficial physiological role of AID in antibody diversification is outweighed by its detrimental role in the genesis of several chronic immune diseases, under non-physiological conditions. This review offers a comprehensive and better understanding of AID biology and its pathological aspects, as well as addresses the challenges involved in AID-related cancer therapeutics, based on various recent advances and evidence available in the literature till date. In this article, we discuss ways through which our interpretation of AID biology may reflect upon novel clinical insights, which could be successfully translated into designing clinical trials and improving patient prognosis and disease management.     

Large variation in ESBL-producing <Emphasis Type="Italic">Escherichia coli</Emphasis> carriers in six European countries including Russia

We investigated the faecal carriage prevalence of extended-spectrum β-lactamase production in Escherichia coli (EP-EC) and/or Klebsiella pneumoniae (EP-KP) and risk factors associated with carriage among adult study subjects in Finland, Germany, Latvia, Poland, Russia and Sweden (partner countries). The aim was to get indicative data on the prevalence of ESBL-carriage in specific populations in the region. Faecal samples were collected from four study populations and screened on ChromID-ESBL and ChromID-OXA-48 plates. Positive isolates were further characterised phenotypically. Our results show a large variation in carrier prevalence ranging from 1.6% in Latvia to 23.2% in Russia for EP-EC. For the other partner countries, the prevalence of EP-EC were in increasing numbers, 2.3% for Germany, 4.7% for Finland, 6.6% for Sweden, 8.0% for Poland and 8.1% for all partner countries in total. Carriers of EP-KP were identified only in Finland, Russia and Sweden, and the prevalence was <?2% in each of these countries. No carriers of carbapenemase-producing isolates were identified. This is the first study reporting prevalence of carriers (excluding traveller studies) for Finland, Latvia, Poland and Russia. It contributes with important information regarding the prevalence of EP-EC and EP-KP carriage in regions where studies on carriers are limited.     

The long-term effect of a protein-deficient-diet enriched with vitamin B6 on the blood parameters in unexercised and exercised rats

Protein undernutrition affects inter alia blood parameters and immune system. These negative effects may be improved by the addition of vitamin B6 to the diet. Here, we evaluated the effect of vitamin B6 supplementation and physical exercise in rats fed a protein-deficient diet. Rats were divided into six groups: exercised or unexercised – control, protein deficient, protein deficient with vitamin B6 supplementation. Sixty days of protein malnutrition caused significant changes in the rat body weight, haematological parameters (mainly red blood cells parameters), immunological parameters (NK and NKT cells) and biochemical parameters (total protein and albumin concentration and activity of AST). The rat exercise did not intensify the negative effects of protein malnutrition. The vitamin B6 supplementation in protein-deficient groups significantly improved body weight and red blood cell parameters. These results indicate that vitamin B6 should be considered as a valuable supplement for individuals suffering from protein malnutrition.     

MAP2K2 mutation as a cause of cardio‐facio‐cutaneous syndrome in an infant with a severe and fatal course of the disease

Cardio‐facio‐cutaneous syndrome (CFCS), a rare congenital disorder of RASopathies, displays high phenotypic variability. Complications during pregnancy and in the perinatal period are commonly reported. Polyhydramnios is observed in over half of pregnancies and might occur with fetal macrocephaly, macrosomia, and/or heart defects. Premature birth is not uncommon and any complications like respiratory insufficiency, edema, and feeding difficulties are present and might delay accurate clinical diagnosis. Besides neonatal complications, CFCS newborns and later infants have distinctive dysmorphic features usually accompanied by neurological (hypotonia with motor delay, neurocognitive delay) findings. Also, heart defects usually present at birth. Herein, we present the case of a female baby born prematurely from a pregnancy complicated with polyhydramnios, presenting at birth with craniofacial features typical for RASopathies, heart defects, neurological abnormalities, and hyperkeratosis unusual for a neonatal period. Due to the presence of a heart defect and other complications related to premature birth, the course of the disease was severe with a fatal outcome at the age of 9 months. The RASopathy, particularly CFCS, clinical diagnosis was confirmed and de novo p.Phe57Ile mutation in MAP2K2 was identified.