Role of bariatric-metabolic surgery in the treatment of obese type 2 diabetes with body mass index <35 kg/m2: a literature review

Bariatric surgery has been used to treat type 2 diabetes mellitus (T2DM); however, its efficacy is still debatable. This literature review analyzed articles that evaluated the effects of bariatric surgery in treatment of T2DM in obese patients with a body mass index (BMI) of <35?kg/m(2). A paired t test was applied for the analysis of pre- and postintervention mean BMI, fasting plasma glucose (FPG), and glycosylated hemoglobin (A1c) values. A significant (P<0.001) reduction in BMI (from 29.95±0.51?kg/m(2) to 24.83±0.44?kg/m(2)), FPG (from 207.86±8.51?mg/dL to 113.54±4.93?mg/dL), and A1c (from 8.89±0.15% to 6.35±0.18%) was observed in 29 articles (n=675). T2DM resolution (A1c <7% without antidiabetes medication) was achieved in 84.0% (n=567) of the subjects. T2DM remission, control, and improvement were observed in 55.41%, 28.59%, and 14.37%, respectively. Only 1.63% (n=11) of the subjects presented similar or worse glycemic control after the surgery. T2DM remission (A1c <6% without antidiabetes medication) was higher after mini-gastric bypass (72.22%) and laparoscopic/Roux-en-Y gastric bypass (70.43%). According to the Foregut and Hindgut Hypotheses, T2DM results from the imbalance between the incretins and diabetogenic signals. The procedures that remove the proximal intestine and do ileal transposition contribute to the increase of glucagon-like peptide-1 levels and improvement of insulin sensitivity. These findings provide preliminary evidence of the benefits of bariatric-metabolic surgery on glycemic control of T2DM obese subjects with a BMI of <35?kg/m(2). However, more clinical trials are needed to investigate the metabolic effects of bariatric surgery in T2DM remission on pre-obese and obese class I patients.     

Addition of Algenpantucel-L Immunotherapy to Standard Adjuvant Therapy for Pancreatic Cancer: a Phase 2 Study

Background

Despite continued investigation, limited progress has been made in the adjuvant treatment of resected pancreatic cancer. Novel or targeted therapies are needed.

Methods

Multi-institutional, open-label, dose-finding, phase 2 trial evaluating the use of algenpantucel-L (NewLink Genetics Corporation, Ames, IA) immunotherapy in addition to chemotherapy and chemoradiotherapy in the adjuvant setting for resected pancreatic cancer (ClinicalTrials.gov identifier, NCT00569387). The primary outcome was 12-month disease-free survival. Secondary outcomes included overall survival and toxicity.

Results

Seventy patients were treated with gemcitabine and 5-fluorouracil-based chemoradiotherapy as well as algenpantucel-L (mean 12 doses, range 1–14). After a median follow-up of 21 months, the 12-month disease-free survival was 62 %, and the 12-month overall survival was 86 %. The most common adverse events were injection site pain and induration.

Conclusions

The addition of algenpantucel-L to standard adjuvant therapy for resected pancreatic cancer may improve survival. A multi-institutional, phase 3 study is ongoing (ClinicalTrials.gov identifier, NCT01072981).     

Proximal opening-wedge osteotomy of the first metatarsal for moderate and severe hallux valgus using low profile plates

BackgroundTo present the results of the treatment of hallux valgus with the proximal metatarsal opening wedge (PMOW) osteotomy using two different screw and plate systems.MethodsForty-one patients with moderate and severe hallux valgus were treated with the PMOW osteotomy between 2005 and 2009. The fixation was obtained by the Darco^® BOW or by the Arthrex^® LPS plate. Biplanar chevron and/or Akin osteotomy were associated according to the magnitude of distal angles. Each patient was evaluated with weight-bearing radiographs and AOFAS score.ResultsThe HV, IM, DMA and IP angles improved by a mean of 14°, 8°, 11°, 7° respectively. The sesamoid position improved in 79% of the feet. AOFAS score improved from a mean of 50 to 82.ConclusionThe PMOW osteotomy is effective to correct high-level hallux valgus deformities. Both systems guarantee the stability and correction of the osteotomy site. The combination with distal procedures is advisable to correct distal angles.     

12 weeks of Brazilian jiu-jitsu training improves functional fitness in elderly men

Worldwide, there are up to 900 million people over 60 years old, of which more than half are physically inactive. Low physical fitness seems to be the major risk factor for cardiovascular diseases and mortality in this population. Alternative methods of exercise, such as martial arts, may be an option to improve physical fitness in the elderly. This study aimed to verify the effects of Brazilian jiu-jitsu (BJJ) training on the functional fitness of elderly men. Sixty-two elderly men were divided in two groups (experimental and control). The experimental group was submitted to a 12-week intervention of BJJ (2 times week^?1; 90-min session^?1). Physical fitness tests and anthropometric measurements were performed before and after intervention in both groups. No statistical differences were found between groups before and after the intervention. The experimental group improved in all performed physical fitness tests. Effect size showed that intervention had a small effect on upper body flexibility; a moderate effect for upper body strength, lower body flexibility, and motor agility/dynamic balance; and a large effect on lower body strength and aerobic endurance. BJJ seems to improve functional fitness in elderly men and may be an alternative method to enhance this population’s health and quality of life.     

The role of macrophage migration inhibitory factor in the cascade of events leading to reperfusion-induced inflammatory injury and lethality

Ischemia and reperfusion (I/R) injury is associated with a systemic inflammatory response, characterized by intense tumor necrosis factor (TNF)-alpha production and TNF-alpha-dependent tissue injury. Macrophage migration inhibitory factor (MIF) is a potent proinflammatory cytokine that may induce TNF-alpha release and play an important role in innate immune and inflammatory responses. The aim of this work was to assess whether MIF was involved the inflammatory cascade and injury that follows intestinal I/R. To this end, wild-type (WT) and MIF-deficient (MIF(-/-)) mice underwent 60 minutes of ischemia followed by 60 minutes of reperfusion, after which they were culled for the assessment of inflammatory parameters. I/R was accompanied by an increase in circulating levels of MIF and an increase of vascular permeability, hemorrhage, and production of TNF-alpha in the intestine and lungs. The latter parameters were markedly suppressed in reperfused MIF(-/-) mice, and this was associated with decreased lethality (80% in WT versus 20% in MIF(-/-) mice). Interestingly, the reperfusion-associated neutrophil accumulation in the intestine and lungs was similar in WT and MIF(-/-) mice. Leukocytes isolated from lungs of MIF(-/-) mice were less activated, as assessed by their response to zymosan in a luminol-enhanced chemiluminescence assay. In conclusion, our results suggest that MIF plays an important role in the cascade of events leading to TNF-alpha production and reperfusion-induced tissue injury and lethality in mice.     

Anomalous coronary artery causing transmural ischaemia and ventricular tachycardia in a high school athlete

A previously asymptomatic 15-year-old boy was treated at our institution after an episode of chest pain, palpitation, and syncope while playing in a high school soccer game. The patient's resting electrocardiogram was normal. A transthoracic echocardiogram showed an anomalous left main coronary artery originating from the right sinus of Valsalva. Contrast-enhanced multidetector computed tomography demonstrated clearly that the anomalous vessel coursed between the aorta and the pulmonary trunk (interarterial subtype). Treadmill testing registered several nonsustained polymorphic ventricular tachycardias and transmural myocardial ischaemia in the early recovery phase (ST-elevation up to 5mm in CM5 and V2 leads). The patient underwent bypass grafting. One year later, he remains asymptomatic, and new treadmill tests have been normal. In this patient, severe transmural myocardial ischaemia was detected, possibly due to collapse or vasospasm of the anomalous vessel, triggering life-threatening ventricular arrhythmias.     

Epipericardial fat necrosis as cause of chest pain in patient after heart transplantation

Epipericardial fat necrosis is an uncommon clinical condition of unknown etiology. It typically presents as acute pleuritic chest pain and should be differentiated from acute pulmonary embolism and acute coronary syndrome. This condition is diagnosed by characteristic chest computed tomography findings of an ovoid mediastinal fatty lesion with intrinsic and surrounding soft‐tissue stranding. Treatment of epipericardial fat necrosis includes the administration of anti‐inflammatory agents, and symptoms usually resolve within a few days after treatment initiation. This disease entity has rarely been reported since it was first described in 1957. Most current knowledge of epipericardial fat necrosis is based on case reports that describe this condition in previously healthy individuals. We present the case of a 39‐year‐old woman with a history of heart transplant, who presented with chest pain secondary to epipericardial fat necrosis. Serial computed tomography revealed lesion resolution after appropriate treatment.     

NMR insights on nano silver post-surgical treatment of superficial caseous lymphadenitis in small ruminants

Caseous lymphadenitis (CL), caused by a pathogen of the second class of biosafety – Corynebacterium pseudotuberculosis, is a chronic and severe infectious disease that affects small ruminants and requires long, ineffective treatment which generally leads to animal sacrifice so as to stop the disease spreading. The infected animals suffer the excision of affected superficial lymph nodes and post-surgical treatment with iodine (10% solution in ethanol) and, sometimes, prolonged antibiotic use, but only if the sick animals are of great importance to breeding. Herein, we propose a cheap and easy to apply treatment of CL with excellent results using biogenic silver nanoparticles (AgNP) based technology. AgNP antibacterial properties were investigated in vitro against Corynebacterium pseudotuberculosis cells and in vivo on small ruminants with CL. Treatment of surgical wounds resulting from the excision of superficial CL lesions with a AgNP-based cream was compared to the standard post-surgical treatment method by iodine. Also, the effects of AgNP-based cream treatment were evaluated and compared with the effects of the iodine CL treatment by serum NMR-based metabolomics. Serum samples were collected from 29 animals, 9 sheep and 20 goats, during the treatments and analyzed. All animals showed stable serum metabolomes when iodine or AgNP-based cream effects were compared. The AgNP-based cream treatment showed excellent results, especially in accelerating the healing of wounds, which occurred two to three times faster in comparison with the iodine treatment. AgNP-based cream treatment also prevented CL reappearance and did not cause any side effects on animals. This is the first report on very effective post-surgical treatment of superficial CL in small ruminants based on biogenic silver nanoparticles, which might open up the possibility for a safe veterinary application of AgNP-based cream.

Biogenic nanosilver in a pharmaceutical cream for wound healing in animal and human healthcare.     

Sophrology versus resistance training for treatment of women with fibromyalgia: A randomized controlled trial

IntroductionPhysical training has been recommended to improve overall well-being in patients with fibromyalgia. Body relaxation exercises also seem to have some beneficial effect, however there is no consensus regarding this modality.ObjectiveComparing the effectiveness of sophrology and resistance training in improving the pain of women with fibromyalgia.MethodA randomized controlled clinical trial with a blind evaluator. Sixty (60) women with a medical diagnosis of fibromyalgia were randomized and included in two groups: sophrology group (SG) who participated in a relaxation program based on sophrology (n = 30), and resistance group (RG) (n = 30) who participated in a resistance training program for biceps, pectoral, triceps, knee extensors, trapezius, knee flexors, hip abductors. Both groups were treated twice a week for 12 weeks and reevaluated every 4 weeks. The assessment instruments used were the Visual Analog Scale for Pain (VAS), the one-repetition maximum test (1 RM), the overall quality of life (SF-36), the 6-min walk test (6MWT), the Timed Up and Go test (TUG) and the Fibromyalgia Impact Questionnaire (FIQ).ResultsWe found that the RG presented statistically significant decreases in pain (VAS) during the evaluations (p < 0.05) and increased strength of the evaluated muscles (p < 0.05). A statistically significant decrease in pain (p < 0.05) was observed in the SG compared to T0, with no significant differences in muscle strength. Differences between groups were observed, with better indices only for 6MWT and functional capacity domain of the SF36 for the RG (p < 0.05).ConclusionNo differences in pain were found between the groups. Resistance training was more effective than sophrology in improving strength and functional capacity of women with fibromyalgia.