Effets de différents types de chirurgie bariatrique sur les concentrations circulantes de ghréline

Obesity is a major risk factor of morbidity and mortality in human. Excessive accumulation of fat is intimately associated with the development of metabolic dysfunctions such as insulin resistance, type 2 diabetes, cardiovascular diseases, non-alcoholic fatty liver disease as well as certain types of cancers. Bariatric surgery is a necessary alternative for an increasing number of patients suffering from severe obesity with or without complications. Different types of interventions proved their efficiency in reducing excessive weight and improving metabolic function in obese patients. However, the mechanisms underlying these improvements remain largely uncharacterized. The neuroendocrine relevance of gastrointestinal (GI) peptides in the regulation of metabolic function has been abundantly reported in the literature. For instance, ghrelin, a GI hormone mainly derived from the stomach, was shown to exert both orexigenic and adipogenic effects in cellular, animal and clinical studies. The effects of specific bariatric surgery procedures on circulating ghrelin levels remain highly controversial. The present review first intends to classify published data in function of the type of bariatric intervention, patient types and conditions as well as the post-operative period at which ghrelin levels were measured. This allows proposing important factors that are likely to influence conclusions regarding the potential role of ghrelin as a mediator of metabolic improvements in obese patients who undergo bariatric surgery.     

Dietary Potassium Intake and Renal Handling,and Their Impact on the Cardiovascular Health of Normotensive Afro-Caribbeans

Objective:

Recent nutritional profiles of dietary intake have indicated a shift from the ancient diet to the Western diet. The ancient diet provided high potassium and low sodium intake, which in turn led to sodium conservation and potassium excretion. This change in the dietary intake is expected to affect potassium and sodium handling in the kidneys. Numerous studies have been done to emphasize the importance of sodium handling by the kidneys and its impact on cardiovascular health. This study will investigate potassium intake and handling, and its impact on the cardiovascular health of a sample of normotensive Afro-Caribbeans by the possible modulation of the renin angiotensin aldosterone system (RAAS).

Methods:

A sample of 51 normotensive Afro-Caribbean participants was recruited for the study. Participants were observed over a two-day period in which they were given a 24-hour ambulatory blood pressure monitor and a container to collect blood pressure data and a 24-hour urine sample. Anthropometric measurements were noted. Urinary electrolytes and supine plasma renin activity (PRA) were determined from the 24-hour urine collection and a blood sample. Dietary potassium intake was estimated based on dietary intake observations, and calculated based on the urinary potassium excretion. SPSS version 19 was used to analyse the data to make inferences.

Results:

The daily potassium intake was observed to be 2.95 g/day and measured intake from the urinary potassium was between 4.95 and 7.32 g/day. Urinary potassium excretion was 3.66 (± 1.40) g/day. The urinary potassium excretion in the Afro-Caribbean sample in Barbados was higher than the other population samples. The averaged PRA of the participants (supine) was 0.778 (± 1.072) ng/mL/hour. The averaged nocturnal systolic blood pressure dip of the participants was 5.97 (± 4.324) %. There was no significant correlation between urinary potassium excretion, blood pressure, nocturnal systolic blood pressure dip and PRA.

Conclusions:

The Afro-Caribbean sample has an inadequate daily potassium intake based on the observed intake and recommended values, with a high urinary excretion of the electrolyte compared to other values in the literature. This high potassium excretion could have been partly due to low plasma renin activity levels in the study participants. As a possible consequence, an increase in the nocturnal peripheral resistance is a likely cause for the diminished systolic dip. The lack of correlations between dietary potassium excretion and the blood pressure parameters does not allow any firm inference of the electrolyte''s handling and its impact on cardiovascular health in the normotensive Afro-Caribbean participants. However, further research is needed to get a more accurate daily potassium intake value, and a more statistically robust sample to assess whether potassium handling and blood pressure would be affected by a change in potassium intake.     

How nursing managers respond to intraprofessional aggression: novel strategies to an ongoing challenge

Nursing managers are identified as playing a central role in workplace aggression management. In effect, employees' decisions to report unacceptable behavior is said to be directly influenced by how a manager will respond to their claims. Using principles from critical nursing ethnography, data were collected from interviews, organizational documents, and observation of physical environment. Twenty-three semistructured interviews were conducted in both a university-affiliated psychiatric hospital and a community hospital located in a large metropolitan city in Ontario. The study aimed at broadening the understanding of how nurse managers respond to intraprofessional and interprofessional workplace aggression. Several strategies were described by managers including coaching individuals so they feel capable of addressing the issue themselves, acting as mediator to allow both sides to openly and respectfully talk about the issue, and disciplining employees whose actions warrant harsh consequences. As part of the study, managers reported that dealing with workplace aggression could be difficult and time consuming and admitted that they sometimes came to doubt their abilities to be able to positively resolve such a widespread problem. Conclusions drawn from the study suggest that aggression management is not solely the responsibility of managers but must involve several actors including the aggressive individual, peers, human resources department, and unions.     

Graft-versus-myeloma effect: proof of principle

The presence of a graft-versus-tumor effect has been well established in leukemia but not in multiple myeloma. A 40-year-old patient with myeloma refractory to standard chemotherapy and autologous transplantation received a matched unrelated T-cell-depleted transplant after conditioning with fractionated total-body irradiation, thiotepa, and cyclophosphamide. This procedure resulted in a transient and incomplete response with evidence of rapidly progressive disease within 2.5 months posttransplantation. The patient then received a small number of donor peripheral blood (PB) mononuclear cells (CD3 cells 1.2 x 10(6)/kg) without any further cytotoxic therapy. A complete remission was attained, lasting now for more than 14 months. The procedure was associated with severe acute and subsequently limited chronic graft- versus-host disease (GVHD). This report provides the first direct evidence of a graft-versus-myeloma effect after allogenic transplantation.     

Comparative stimulation of motilin duodenal receptor by porcine or canine motilin

Motilins purified from porcine and canine intestine differ in their amino acid composition in positions 7-8-12-13-14. We studied in vitro the contractile response of longitudinal duodenal muscles from various animals (guinea pig, rabbit, dog) to porcine and canine synthetic motilins. Both substances failed to elicit contraction of the guinea pig duodenum but were active and equally potent on rabbit muscle. In dogs, porcine motilin was inactive at the concentrations tested (up to 10(-4) M) whereas canine motilin induced duodenal contractions in a dose-response fashion (mean dose required to induce half-maximal response: 4.82 +/- 0.25 X 10(-5) M). The contraction generated by synthetic canine motilin (10(-5) M) was not influenced by atropine, hexamethonium, tetrodotoxin, naloxone, or sodium nitroprusside (all used at 10(-4) M) but was blocked by verapamil (10(-4)). Our study shows that species-related structural alterations in motilin molecules generate different bioactive capacities in some animal species, suggests that the middle portion of the molecule is important for its bioactive expression, suggests the presence of motilin receptors on canine duodenal muscle, and suggests that an influx of extracellular calcium is involved in the canine duodenal muscle contraction elicited by canine motilin.     

Preferential expression of the neuropeptide Y Y1 over the Y2 receptor subtype in cultured hippocampal neurones and cloning of the rat Y2 receptor

1. Neuropeptide Y (NPY) and NPY receptors are most abundant in the hippocampal formation where they modulate cognitive functions. Expression of NPY receptors in rat cultured primary hippocampal cells was investigated in the present study by use of combined molecular, pharmacological and immunohistochemical approaches, including the cloning of the rat Y₂ receptor described here for the first time.
2. More than 70% of the hippocampal neurones were endowed with [¹²⁵I]-[Leu³¹,Pro³⁴]PYY Y₁-like receptor silver grain accumulations and Y₁ receptor immunostaining. These radio- and immuno-labelling signals were distributed over cell bodies and processes of bipolar, stellate and pyramidal-like neuronal cells, as confirmed by neurone-specific enolase and MAP-2 staining.
3. Competition binding profiles revealed that specific [¹²⁵I]-[Leu³¹,Pro³⁴]PYY binding was competitively displaced according to a ligand selectivity pattern prototypical of the Y₁ receptor sub-type with [Leu³¹,Pro³⁴]substituted NPY/PYY analogues>>C-terminal fragments=pancreatic polypeptides, with the non-peptide antagonist BIBP3226 being most potent. This profile excludes the possible labelling by [¹²⁵I]-[Leu³¹,Pro³⁴]PYY of the newly cloned Y₄, Y₅ and Y₆ receptors.
4. The expression of the genuine Y₁ receptor was confirmed by RT–PCR in hippocampal cultures. In contrast, negligible levels of Y₂-like/[¹²⁵I]-PYY_3–36 binding were detected in these cultures in spite of the presence of its mRNA, as characterized by RT–PCR. The expression of both the Y₁ and the Y₂ receptor mRNAs was also noted in normal embryonic hippocampal tissues showing that signals expressed in cultured neurones were also present in utero.
5. Taken together, these results suggest that the Y₁ receptor subtype may be of critical importance in the normal functioning of the rat hippocampus, especially during brain development and maturation.