Electrical Stimulation of the Gut for the Treatment of Type 2 Diabetes: The Role of Automatic Eating Detection

Background

Automatic eating detection (AED) can potentially support treatments that need to be synchronized with food intake. This article analyzes an implantable AED device working in conjunction with gastric stimulation intended to treat type 2 diabetes (T2DM). The device continuously senses for changes in tissue impedance and electrical activity induced by food intake and initiates treatment sessions upon detection. This article reviews AED performance as well as its relevance to treatment outcomes.

Methods

Obese T2DM (n = 12) were implanted with gastric leads and the TANTALUS^® device. An AED algorithm was embedded in the device and was used to initiate periods of electrical stimulation during food intake. AED performance was assessed using patients'' food diaries. The treatment outcome at 37 weeks postimplants was correlated with the rates of stimulation during large meals vs stimulation during periods of no caloric intake.

Results

The algorithm was able to detect 73% of meals consumed while sensing. The rate of false stimulations was 28%. Stimulation during meals was significantly correlated (R² = 0.45, p < 0.05) with hemoglobin A1c change (average drop in hemoglobin A1c was −1 ± 0.4%) but not with changes in body weight (average drop −4.7 ± 2.8 kg). Stimulation during periods with no caloric intake was negatively correlated with hemoglobin A1c reduction (R² = 0.27, p < 0.05).

Conclusions

Sensing of gastric activity can be used for detection of food intake. The synchronization of gastric stimulation to periods of food intake is correlated with metabolic outcomes. AED may also benefit other applications such as drug delivery and control of food restriction devices.     

Use of Amplatzer device for endobronchial closure of bronchopleural fistulas

Bronchopulmonary fistula (BPF) is associated with high morbidity and mortality. It occurs as an uncommon but often severe complication of pneumonectomy. BPF may be treated by a range of surgical and medical techniques, including chest drain, Eloesser muscle flap, omental flap, transsternal bronchial closure, thoracoplasty, and prolonged therapy with antibiotic regimens. The use of bronchoscopy has been reported for the delivery of biological glue, coils, covered stents, and sealants. In this work, we describe a novel method of BPF closure using the Amplatzer device, which is commonly used for transcatheter closure of atrial septal defects.     

Intact working memory in non‐manifesting LRRK2 carriers – an fMRI study

Cognitive impairments are prevalent in patients with Parkinson's disease. Mutations in the leucine‐rich repeat kinase 2 (LRRK2) gene are the most common cause of genetic Parkinsonism. Non‐manifesting carriers of the G2019S mutation in the LRRK2 gene were found to have lower executive functions as measured by the Stroop task. This exploratory study aimed to assess whether the cognitive impairment in non‐manifesting carriers is specific for executive functions or includes other cognitive domains such as working memory. We recruited 77 non‐manifesting first‐degree relatives of Parkinson's disease patients (38 carriers). A block‐design fMRI N‐back task, with 0‐back, 2‐back and 3‐back conditions, was used in order to assess working memory. Participants were well matched on the Montreal Cognitive Assessment, University of Pennsylvania Smell Identification Test, Unified Parkinson's Disease Rating Scale part III, digit span, age, gender and Beck Depression Inventory. The task achieved the overall expected effect in both groups with longer reaction times and lower accuracy rates with increasing task demands. However, no whole‐brain or region‐of‐interest between‐groups differences were found on any of the task conditions. These results indicate that non‐manifesting carriers of the G2019S mutation in the LRRK2 gene have a specific cognitive profile with executive functions, as assessed by the Stroop task, demonstrating significant impairment but with working memory, as assessed with the N‐back task, remaining relatively intact. These finding shed light on the pre‐motor cognitive changes in this unique ‘at risk’ population and should enable more focused cognitive assessments of these cohorts.     

Increased risk of venous thromboembolism among patients with familial Mediterranean fever

Journal of Thrombosis and Thrombolysis - Familial Mediterranean Fever (FMF) is an auto inflammatory disease characterized by acute febrile attacks, serositis, arthritis and skin rash. Previous...     

Pregnancy and non-pregnancy related immune thrombotic thrombocytopenic purpura in women of reproductive age

Journal of Thrombosis and Thrombolysis - Pregnancy is a precipitating factor for immune thrombotic thrombocytopenic purpura (iTTP). We compared the clinical course and outcomes of iTTP in women of...     

Functional adaptation of rat remnant colon after proximal hemicolectomy

Functional adaptation of the remnant intestine after extensive resection of small bowel is well documented. The effects of partial resection of large bowel on the remaining colon have not been characterized. Transepithelial potential (V_T),tissue resistance (R_T),and short-circuit current (I _sc) were measuredin vitro across distal colonic tissue of rats three weeks after proximal hemicolectomy with ileotransversotomy and compared to the same parameters measured in the distal colon of control animals. In a second series of experiments, anin vivo perfusion technique was used to measure changes in sodium, potassium, and water transport in distal colon following proximal hemicolectomy. A 2.5-fold increase inV _T (P<0.01), a 62% increase inR _T (P<0.001), and a 35% increase inI _sc (P<0.05) were observed three weeks following hemicolectomy when compared to control animals. A 64% increase in net sodium absorption (P<0.025), no significant change in net potassium transport, and a 115% increase in net water absorption (P<0.01) were demonstrated in hemicolectomized animals when compared to control. It is concluded that in the rat the distal colon is capable of functional adaptation to increase net sodium and water absorption within three weeks after proximal hemicolectomy. The mechanism responsible for this adaptive process has yet to be defined. Our findings may explain the lack of chronic diarrhea in patients undergoing right hemicolectomy.     

Examining differences in drinking patterns among Jewish and Arab university students in Israel

Objectives. Worldwide there is a dearth of studies examining drinking patterns in Arabs and how these compare to other populations. The few studies that exist have suggested distinct drinking patterns in Arabs, with not only high rates of abstinence but also high rates of heavy drinking among current drinkers. No studies have yet examined potential socio-cognitive mechanisms that may contribute to this distinct drinking pattern. Israel represents a unique and valuable resource for studying Arab population drinking patterns because Israeli Arabs are nonimmigrants living in areas where exposure to Western lifestyles, including alcohol consumption, is prevalent. The current study was set out to examine differences in alcohol consumption in a convenience sample of 1310 Jewish and Arab students from Israeli universities and colleges and to explore alcohol expectancies as potential mediators of ethno-religious differences.

Design. Logistic regressions were used to produce odds ratios and 95% confidence intervals to test differences between Jewish and Arab students on binary outcomes (lifetime, last month, and heavy drinking). Mediation of ethno-religious differences by alcohol expectancies was tested with bootstrapping procedures.

Results. Results show that while Israeli Arab students tend to be more likely to abstain from alcohol than Israeli Jewish students, among current drinkers, Israeli Arab students are at a particular high risk of heavy drinking. Results also show that this is partly mediated by the expectancy that alcohol only influences the drinker at high levels of intake.

Conclusion. The current study confirms distinct Arab drinking patterns found in previous studies. The present study is the first demonstration that drinking expectations mediate ethno-religious differences in heavy drinking among Israeli Arabs and Jews. This work contributes to the understanding of ethno-religious group differences in harmful drinking, potentially informing future etiologic research and public health interventions aimed at reducing alcohol-related harm.