Baseline glycated hemoglobin levels are associated with duodenal-jejunal bypass liner-induced weight loss in obese patients

Introduction

Endoscopic treatment with the duodenal-jejunal bypass liner (DJBL) leads to significant weight loss in obese patients. We sought to identify clinical factors associated with weight loss in obese patients treated with the DJBL for 1 year.

Methods

Subjects with morbid obesity were enrolled in a single-arm, open-label, prospective trial and implanted with the DJBL. Patient demographics along with baseline comorbidities, anthropometrics, and biochemical variables were selected for univariate and multivariate analysis.

Results

The DJBL was implanted in 79 subjects and 61 completed 12 months of follow-up. There were 18 early removals. Baseline mean age and body mass index (BMI) were 35.4 ± 9.7 years and 43 ± 5.6 kg/m², respectively. Forty-four (72 %) were women. This population included 22 subjects with type 2 diabetes (T2DM). Twelve months after treatment, patients had a mean excess body weight loss (%EBWL) of 46 ± 18 %. Univariate analysis identified that fasting glycemia (r ² = ?0.303, p < 0.013), insulin-resistance determined by HOMA-IR (r ² = ?0.457, p < 0.019), and glycated hemoglobin (HbA1c) (r ² = ?0.471, p < 0.013) were associated inversely with %EBWL at 1 year. In this cohort of patients, the multivariate analysis indicated that only baseline HbA1c levels were associated inversely with %EBWL after 1 year of treatment (β adjusted coefficient ?0.758, p < 0.016). Importantly, no differences at 1 year in %EBWL were observed between patients with or without T2DM (%EBWL T2D 46.7 ± 20 % vs. non-T2DM 46.8 ± 18.6 %, p = 0.988).

Conclusions

This analysis indicates that higher baseline HbA1c levels are associated independently with diminished body weight loss in obese patients treated with the DJBL independent of their diabetic status. These results show that DJBL induces clinically significant weight loss in both T2DM and non-T2DM patients.     

Growth of children with end-stage renal disease undergoing daily hemodialysis

Background

The aim of this report is to describe the effect of daily hemodialysis on the growth of children with end-stage renal disease (ESRD).

Methods

We performed a prospective, observational study on 24 children with ESRD undergoing daily hemodialysis (DHD). The control group comprised 26 children on concurrent conventional hemodialysis (CHD), and the follow-up for both groups was 9.3?±?3.0 months. No patient received growth hormone (GH) therapy.

Results

At the onset of the study, the height-for-age Z-score was ?2.12?±?1.54 in the CHD group and ?2.84?±?2.27 in the DHD group (p?=?0.313). Assuming an increase of 0.5 standard deviation scores (SDS) of the height-for-age parameter as an improvement of growth, there were 33 % of patients in the DHD group and 8 % in the CHD group (p?=?0.035). The cumulative probability of gain in height for age at 12 months was 40 % in the DHD group versus 15 % in the CHD group (p?=?0.047). Also, 98 % of patients in the DHD group had an adequate total caloric intake, whereas 38 % in the CHD group reached this goal (p?<?0.001). No patient left the study due to intensification of the dialysis modality.

Conclusions

Our data show that the DHD favored a 0.5 SDS height gain in a third of patients without GH treatment. Dialysis intensification was not a cause for treatment dropouts, and DHD should be considered as a treatment for selected cases, especially small children.     

Evaluation of Cytotoxicity,Genotoxicity and Hematotoxicity of the Recombinant Spore-Crystal Complexes Cry1Ia,Cry10Aa and Cry1Ba6 from Bacillus thuringiensis in Swiss Mice

The insecticidal properties of Cry-endotoxins from Bacillus thuringiensis (Bt) have long been used as spore-crystals in commercial spray formulations for insect control. Recently, some Bt-endotoxin genes have been cloned in many different plants. Toxicological evaluations of three spore-crystal endotoxins, BtCry1Ia, BtCry10Aa and BtCry1Ba6 from B. thuringiensis, were carried out on mice to understand their adverse effects on hematological systems and on genetic material. These three spore-crystals have shown toxic activity to the boll weevil, which is one of the most aggressive pests of the cotton crop. Cry1Ia, Cry10Aa and Cry1Ba6 did not increase the micronucleus frequency in the peripheral erythrocytes of mice and did not cause changes in the frequency of polychromatic erythrocytes. However, some hematologic disburbances were observed, specifically related to Cry1Ia and Cry1Ba6, respectively, for the erythroid and lymphoid lineage. Thus, although the profile of such adverse side effects can be related to their high level of exposure, which is not commonly found in the environment, results showed that these Bt spore-crystals were not harmless to mice, indicating that each spore-crystal endotoxin presents a characteristic profile of toxicity and might be investigated individually.     

Zearalenone,an Estrogenic Mycotoxin,Is an Immunotoxic Compound

The aim of this study was to assess the toxic effects of zearalenone (ZEA) on the immune function. Ovariectomised rats were treated daily by gavage with 3.0 mg/kg of ZEA for 28 days. Body weight gain, food consumption, haemotological parameters, lymphoid organs, and their cellularities were evaluated. Moreover, acquired immune responses and macrophage activity were also assessed. ZEA promoted reduction in body weight gain, which is not fully explained by diminished food consumption. Despite no effect on haematological parameters, ZEA caused thymic atrophy with histological and thymocyte phenotype changes and decrease in the B cell percentage in the spleen. With respect to acquired and innate immune responses, no statistically significant differences in delayed-type hypersensitivity were noticed; however, in the ZEA-treated rats, antibody production and peroxide release by macrophages were impaired. The observed results could be related to ZEA activity on ERs; thus, ZEA is an immunotoxic compound similar to estrogen and some endocrine disruptors.     

Insulin-associated neuroinflammatory pathways as therapeutic targets for traumatic brain injury

Traumatic brain injury (TBI) is characterized by an abrupt blow or exchange of force against the head and can be categorized as mild, moderate, and severe. The secondary cell death after TBI displays ischemic-like patterns including neuroinflammation. The scavenger receptor cluster of differentiation (CD) 36 is a lipid-associated protein capable of transducing intracellular signals to promote inflammatory mechanisms within different cell types. Expression and activation of CD36 is closely related to dyslipidemia secondary to diabetes. Diabetes mellitus (DM) has been documented as a co-morbidity factor in TBI, in that patients with a history of diabetes present with more severe brain damage and slower recovery from TBI than non-diabetic patients. Indeed, a strict regulation of blood serum glucose by the use of insulin promotes a better outcome for TBI patients. Based on these recent findings, we now advance the hypothesis that CD36 via DM insulin-associated pathways is closely involved in TBI chronic pathology.     

Periradicular lesions in HIV-infected patients attending the faculty of dentistry: clinical findings,socio-demographics status,habits and laboratory data - seeking an association

OBJECTIVE:

The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status.

METHOD:

One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment.

RESULTS:

The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001).

CONCLUSIONS:

The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection.     

The combined use of Er,Cr:YSGG laser and fluoride to prevent root dentin demineralization

The use of erbium lasers to prevent caries in enamel has shown positive results. However, it is not known if Er,Cr:YSGG laser can also be used to increase acid resistance of root dentine, which is another dental tissue susceptible to the action of cariogenic bacteria.

Objective

To analyze the effects of the Er,Cr:YSGG laser (λ=2.78 μm, 20 Hz) irradiation associated with 2% neutral sodium fluoride (NaF) to prevent root dentin demineralization.

Material and Methods

One hundred human root dentin samples were divided into 10 groups (G) and treated as follows: G1: no treatment; G2: NaF; G3: laser (4.64 J/cm²) with water cooling (WC=5.4 mL/min); G4: laser (4.64 J/cm²) without WC; G5: laser (8.92 J/cm²) with WC; G6: laser (8.92 J/cm²) without WC; G7: laser (4.64 J/cm²) with WC and NaF; G8: laser (4.64 J/cm²) without WC and NaF; G9: laser (8.92 J/cm²) with WC and NaF; G10: laser (8.92 J/cm²) without WC and NaF. The NaF gel was applied alone or after 4 min of irradiation. After 14 days of acid challenge, the samples were sectioned and the Knoop microhardness (KHN) test was done at different depths (30, 60, 90 and 120 μm) from the outer dentin surface. Data were analyzed by one-way ANOVA and Fisher''s test (α=5%).

Results

The results showed that G8 and G10 presented higher KHN than the G1 for the depths of 30 and 60 μm, indicating an increase of the acid resistance of the dentin in up to 35% (p<0.05).

Conclusions

The use of Er,Cr:YSGG laser irradiation at 4.64 J/ cm² and 8.92 J/cm² without water cooling and associated with 2% NaF can increase the acid resistance of human root dentin.     

Gonadal function in adolescent patients submitted to chemotherapy during childhood or during the pubertal period

STUDY OBJECTIVE: To determine the presence of impaired gonadal function in adolescent patients submitted to chemotherapy during childhood or during the pubertal period. DESIGN: A case series study of 28 patients aged 12 to 19 years with menarche at least 2 years before the study. SETTING: Tertiary care public hospital. PARTICIPANTS: Group I: 14 adolescents previously submitted to chemotherapy during the prepubertal or peripubertal period and with remission of oncologic disease for at least 2 years; Group II: 14 normal adolescents with no previous oncologic disease and with regular menstrual cycles. INTERVENTIONS AND MAIN OUTCOME MEASURES: Pubertal development, menstrual cycles and serum levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were determined during the early follicular phase. RESULTS: There were no differences between the two groups in terms of age at appearance of secondary sexual characteristics or age at menarche. Menstrual irregularity was detected in 7 of the 14 patients in Group I, all 8 of whom presented oligomenorrhea. There were no differences in LH levels between the two groups (P = 0.55), although mean FSH levels were higher in Group I than in Group II (6.71 +/- 2.99 mIU/ml vs. 3.83 +/- 2.01 mIU/ml, P = 0.01). CONCLUSION: Although girls submitted to chemotherapy during the prepubertal or peripubertal period presented normal sexual development, the incidence of oligomenorrhea was higher than expected for their age, and FSH levels, although within normal limits, were higher than those seen in normally cycling girls.