Effects of dietary fat on pain threshold, thermoregulation and motor activity in rats

Groups of young male Sprague-Dawley (albino) or Long-Evans (hooded) rats were fed the same semi-purified diets containing 20% (w/w) fat in the form of soybean oil vs. lard, or a reference diet of standard Purina Chow (4.5% mixed fats) for 21 days. Behavioral testing after this time revealed that albino rats fed the diet containing soybean oil had increased paw-lick latencies on a 58 degrees C hot plate compared to chow-fed rats. In addition, both strains fed the diet containing soybean oil were protected from hypothermia induced by placing animals in a 4 degrees C cold room for 60 min following systemic injection of 10-15 mg/kg d-amphetamine. Rats of both strains fed the lard diet displayed paw-lick latencies similar to those shown by rats fed chow and hypothermic changes intermediary to those shown by rats fed soybean oil vs. chow diets. Horizontal crossings as well as rearings in a 15 min test of open field activity were the same for all diet groups within strains. No substantial differences were observed in the number of calories consumed, amount of body weight gained or basal colonic temperatures across diet conditions. The results suggest that a soybean oil-based diet can alter physiological mechanisms which mediate these indices of pain perception and thermoregulation. More generally, they indicate that qualitative changes in dietary fat content may be capable of altering certain behavioral states.     

Referral for a Bariatric Surgical Consultation: It is Time to Set a Standard of Care

Indications for bariatric surgery have been clear for some time and many would say that they are conservative. Unfortunately few eligible candidates seek or are referred for bariatric surgery, with less than 1% currently treated annually. In recent years, the evidence base supporting surgical therapy has strengthened with demonstrable improvements in both safety and efficacy. We now have evidence of remarkable improvements in health, quality of life, and increased life expectancy. There is continued frustration with the poor efficacy of non-surgical therapies and no indication that this is about to change. A caring physician should, as best care, refer the seriously ill morbidly obese patient for a surgical opinion. It is no different from their obligation to adequately manage type-2 diabetes, depression or unstable angina. Currently, even discussion of a surgical referral is optional. It is time we articulated and defined a group of patients where referral for a surgical opinion is no longer merely an option but a physician’s responsibility as best care for the patient. It is time to provide leadership towards the delivery of better care for these patients.     

Preoperative Endocrine Therapy: Preferred Therapy for Whom?

Neoadjuvant endocrine therapy is safe and can be effective in many postmenopausal women with estrogen receptor positive breast cancer. There are limited data available for premenopausal women taking aromatase inhibitors in combination with estrogen suppression. Letrozole, anastrozole, and exemestane have all been shown to be equivalent or superior to tamoxifen in relatively small neoadjuvant trials in postmenopausal women. Tumor factors that appear to have good response are estrogen receptor positivity, characteristics consistent with the so-called Luminal A subtype and lobular carcinomas. Response to neoadjuvant treatment may inform decision making regarding adjuvant treatment, which should include radiotherapy following breast-conserving surgery, or mastectomy, made feasible by neoadjuvant treatment to maintain low local recurrence rates. Chemotherapy may also be required in some cases based on the biological characteristics of the residual tumor and the extent of residual disease.     

Impact of laparoscopic adjustable gastric banding on type 2 diabetes

Bariatric surgery is becoming an accepted option for obese people with type 2 diabetes. Our aim was to assess the impact of laparoscopic adjustable gastric banding (LAGB) through a systematic review of the literature. Data was sourced from Scopus, MEDLINE and EMBASE published from 2000 through May 2011, and five unpublished studies that were performed by industry for regulatory approval were also included. Studies were selected on the basis that they provide some detail of diabetes status before and after LAGB. There were 35 studies meeting the inclusion criteria. There was considerable heterogeneity in study design, sample size, length of follow‐up, attrition rates and classification of diabetes status. Weight loss was progressive over the first 2 years with a weighted average of 47% excess weight loss at 2 years. Remission or improvement in diabetes varied from 53% to 70% over different time periods. Results were broadly consistent, demonstrating clinically relevant improvements in diabetes outcomes with sustained weight loss in obese people with type 2 diabetes following LAGB surgery. However, there were significant shortcomings in the reviewed literature with few high‐quality studies, inconsistent reporting of diabetes outcomes and high attrition rates. Long‐term studies that address these limitations are needed.     

Population-Level Administration of AlcoholEdu for College: An ARIMA Time-Series Analysis

Autoregressive integrated moving averages (ARIMA) is a powerful analytic tool for conducting interrupted time-series analysis, yet it is rarely used in studies of public health campaigns or programs. This study demonstrated the use of ARIMA to assess AlcoholEdu for College, an online alcohol education course for first-year students, and other health and safety programs introduced at a moderate-size public university in the South. From 1992 to 2009, the university administered annual Core Alcohol and Drug Surveys to samples of undergraduates (Ns = 498 to 1032). AlcoholEdu and other health and safety programs that began during the study period were assessed through a series of quasi-experimental ARIMA analyses. Implementation of AlcoholEdu in 2004 was significantly associated with substantial decreases in alcohol consumption and alcohol- or drug-related negative consequences. These improvements were sustained over time as succeeding first-year classes took the course. Previous studies have shown that AlcoholEdu has an initial positive effect on students' alcohol use and associated negative consequences. This investigation suggests that these positive changes may be sustainable over time through yearly implementation of the course with first-year students. ARIMA time-series analysis holds great promise for investigating the effect of program and policy interventions to address alcohol- and drug-related problems on campus.     

End-stage periventricular leukomalacia: MR evaluation

A prospective study was performed to assess the capabilities of magnetic resonance (MR) imaging in evaluation of end-stage periventricular leukomalacia (PVL) in six children, aged 31-54 months, in whom PVL had been documented by neurologic ultrasonography during the neonatal period. Eight children of similar age (four premature infants and four full-term infants) with normal neurologic development served as controls. A characteristic triad of PVL abnormalities was seen on MR images: (a) abnormally increased periventricular white-matter signal intensity on the first and second echo images of a T2-weighted sequence (repetition time = 2,000-2,400 msec, echo times = 20 or 30 and 80 msec), most commonly observed in the trigone regions of the lateral ventricles bilaterally; (b) marked loss of periventricular white matter in these regions of abnormal signal intensity, predominantly in the periatrial regions; and (c) compensatory focal ventricular enlargement adjacent to regions of abnormal signal intensity. In patients with the classic periatrial distribution of PVL lesions, general correlation between the degree of neurologic impairment and the severity of MR abnormalities was demonstrated. MR imaging was useful in detecting subtle forms of PVL in cases in which neurologic damage was subclinical.