Non-heart-beating donors

The widespread application of lung transplantation is limited by the shortage of suitable donor organs resulting in longer waiting times for listed patients with a substantial risk of dying before transplantation. To overcome this critical organ shortage, some transplant programs have now begun to explore the use of lungs from circulation-arrested donors, so called non-heart-beating donors (NHBDs). This review outlines the different categories of NHBDs, the relevant published experimental data that support the use of lungs coming from these donors and the clinical experience worldwide so far. Techniques for NHBD lung preservation and pretransplant functional assessment are reviewed. Ethical issues involved in transplanting lungs from asystolic donors are discussed.     

Secretion of Glucose-Dependent Insulinotropic Polypeptide in Patients With Type 2 Diabetes: Systematic review and meta-analysis of clinical studies

OBJECTIVE

To investigate glucose-dependent insulinotropic polypeptide (GIP) secretion in patients with type 2 diabetes and nondiabetic control subjects during oral glucose or meal tests.

RESEARCH DESIGN AND METHODS

Eligible trials were identified by The Cochrane Library, MEDLINE, Embase, and Web of Science. Data were retrieved and random-effects models for the primary meta-analysis, random-effects meta-regression, and subgroup and regression analyses were applied.

RESULTS

Random-effects meta-analysis of GIP responses in 23 trials during 28 different stimulation tests showed that patients with type 2 diabetes (n = 363) exhibited no significant differences (P = not significant) in peak plasma GIP, total area under the curve (tAUC), time-corrected tAUC (tAUC × min⁻¹), and time-corrected incremental area under the curve (iAUC × min⁻¹) in comparison with nondiabetic control subjects (n = 325) but had lower GIP responses as evaluated from iAUC (weighted mean difference, −648 pmol/L × min; 95% CI, −1,276 to −21). Fixed-effects models meta-analyses confirmed most of the results of the primary meta-analysis but showed iAUC × min⁻¹ to be reduced and showed tAUC and tAUC × min⁻¹ to be higher in diabetic patients. Random-effects meta-regression of the primary meta-analysis showed that age (peak GIP, tAUC, iAUC, and iAUC × min⁻¹), BMI (tAUC, iAUC, and iAUC × min⁻¹), and HbA_1c (iAUC and iAUC × min⁻¹) predicted some of the GIP outcomes. Post hoc subgroup analysis showed a negative influence of age and of HbA_1c on GIP responses and showed a positive influence of BMI on GIP responses.

CONCLUSIONS

Our results suggest that patients with type 2 diabetes are characterized by preserved GIP secretion in response to oral glucose and meal tests. They also suggest that high BMI is associated with increased GIP responses but increasing age and HbA_1c are associated with reduced GIP secretion.Glucose-dependent insulinotropic polypeptide (GIP) is a 42-amino-acid hormone secreted by intestinal K cells, located predominantly in the proximal small intestine (duodenum and proximal jejunum), in response to luminal presence of nutrients (carbohydrate, protein, and fat) (1). After secretion, the two N-terminal amino acids of GIP are cleaved-off by the enzyme dipeptidyl peptidase 4 (DPP-4), and the hormone is then inactivated. DPP-4 is present in the intestinal and renal brush border membranes, in hepatocytes, in capillary endothelium, and it is also found in a soluble form in plasma. As a consequence of the ubiquity of DPP-4, only a small amount of the intestinally secreted GIP circulates in the systemic circulation as intact hormone (2). Intact 42-amino-acid peptide GIP [GIP (1–42)] is a potent stimulator of glucose-dependent insulin secretion in healthy humans (3,4). In contrast, in patients with type 2 diabetes the insulinotropic effect of GIP is severely impaired (5), presumably as a consequence of the diabetic state (6). Besides the renowned insulinotropic effect of GIP, the hormone also exerts glucagonotropic and adipogenic effects (7,8). Therefore, GIP could play a crucial role in determining some of the key pathophysiologic characteristics of the type 2 diabetic phenotype, e.g., impaired insulin secretion, hyperglucagonemia, and obesity. Moreover, changes in GIP secretion could contribute to the loss of incretin effect that invariably characterizes patients with type 2 diabetes (9). However, the vast amount of data regarding GIP secretion published during the past decades have been inconsistent and confusing, showing impaired, normal, or increased responses after oral glucose or mixed meals in patients with type 2 diabetes.The aim of this meta-analysis was to systematically compile human GIP secretory data to compare the secretion of GIP in patients with type 2 diabetes and matched control individuals without diabetes.     

Pattern description and reliability parameters of six force–time related indices measured with plantar pressure measurements

BackgroundFunctional interpretation of plantar pressure measurements is commonly done through the use of ratios and indices which are preceded by the strategic combination of a subsampling method and selection of physical quantities. However, errors which may arise throughout the determination of these temporal indices/ratio calculations (T-IRC) have not been quantified. The purpose of the current study was therefore to estimate the reliability of T-IRC following semi-automatic total mapping (SATM).MethodsUsing a repeated-measures design, two experienced therapists performed three subsampling sessions on three left and right pedobarographic footprints of ten healthy participants. Following the subsampling, six T-IRC were calculated: Rearfoot-Forefoot_fti, Rearfoot-Midfoot_fti, Forefoot medial/lateral_fti, First ray_fti, Metatarsal 1-Metatarsal 5_fti, Foot medial-lateral_fti.FindingsPatterns of the T-IRC were found to be consistent and in good agreement with corresponding knowledge from the literature. The inter-session errors of both therapists were similar in pattern and magnitude. The lowest peak inter-therapist error was found in the First ray_fti (6.5 a.u.) whereas the highest peak inter-therapist error was observed in the Forefoot medial/lateral_fti (27.0 a.u.) The magnitude of the inter-session and inter-therapist error varied over time, precluding the calculation of a simple numerical value for the error. The difference between both error parameters of all T-IRC was negligible which underscores the repeatability of the SATM protocol.ConclusionThe current study reports consistent patterns for six T-IRC and similar inter-session and inter-therapist error. The proposed SATM protocol and the T-IRC may therefore serve as basis for functional interpretation of footprint data.     

Protection against avian necrotic enteritis after immunisation with NetB genetic or formaldehyde toxoids

NetB (necrotic enteritis toxin B) is a recently identified β-pore-forming toxin produced by Clostridium perfringens. This toxin has been shown to play a major role in avian necrotic enteritis. In recent years, a dramatic increase in necrotic enteritis has been observed, especially in countries where the use of antimicrobial growth promoters in animal feedstuffs has been banned. The aim of this work was to determine whether immunisation with a NetB toxoid would provide protection against necrotic enteritis. The immunisation of poultry with a formaldehyde NetB toxoid or with a NetB genetic toxoid (W262A) resulted in the induction of antibody responses against NetB and provided partial protection against disease.     

Liraglutide changes postprandial responses of gut hormones involved in the regulation of gallbladder motility

Aim

Liraglutide treatment is associated with gallbladder-related disorders and has been shown to delay postprandial gallbladder refilling. The gut hormones cholecystokinin (CCK), fibroblast growth factor 19 (FGF19) and glucagon-like peptide 2 (GLP-2), are known to regulate gallbladder motility and may be implicated in gallbladder-related disorders associated with liraglutide treatment.

Materials and Methods

In a double-blind, 12-week trial, 52 participants [50% male, age 47.6 ± 10.0 years, body mass index 32.6 ± 3.4 kg/m² (mean ± standard deviation)] with obesity were randomized 1:1 to once-daily subcutaneous liraglutide (escalated from 0.6 mg to 3.0 mg once-daily) or placebo. During liquid meal tests performed at baseline, after the first dose and following 12 weeks of treatment, we evaluated postprandial gallbladder dynamics and plasma responses of CCK, FGF19 and GLP-2.

Results

Liraglutide reduced postprandial FGF19 after the first dose [area under the curve (AUC)_{0-240 min} 24.8 vs. 48.0 min × ng/ml, treatment ratio (TR) (95% confidence interval) 0.52 (0.39; 0.69)] and following 12 weeks of treatment [AUC_{0-240 min} 33.7 vs. 48.5 ng/ml × min, TR 0.69 (0.52; 0.93)]. Liraglutide also reduced postprandial GLP-2 responses (AUC_{0-240 min} 3650 vs. 4894 min × pmol/L, TR 0.75 (0.62; 0.90)] following the first dose as well as after 12 weeks [AUC_{0-240 min} 3760 vs. 4882 min × pmol/L, TR 0.77 (0.60; 0.99)]. Liraglutide increased postprandial responses of CCK after the first dose [AUC_{0-240 min} 762 vs. 670 min × pmol/L; TR 1.14 (0.97; 1.33)] and following 12 weeks of treatment [AUC_{0-240 min} 873 vs. 628 min × pmol/L; TR 1.39 (1.12; 1.73)].

Conclusion

Compared with placebo, treatment with liraglutide decreased postprandial FGF19 and GLP-2 concentrations and increased postprandial CCK concentrations, which may explain the delayed postprandial gallbladder refilling observed in individuals with obesity treated with liraglutide.     

The variability of 2D and 3D transthoracic echocardiography applied in a general population

The International Journal of Cardiovascular Imaging - Assessment of the left ventricular (LV) function by three-dimensional echocardiography (3DE) is potentially superior to 2D echo...     

Conversion of Open Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass: a Single-Center,Single-Surgeon Experience with 6 Years of Follow-up

Background

The aim of this study is to assess feasibility, relief of complications and mid- and long-term weight loss results following the conversion of open vertical banded gastroplasty (VBG) to Roux-en-Y gastric bypass (RYGB).

Materials and Methods

Retrospective analysis of patients undergoing conversion of open VBG to RYGB (open and laparoscopic) between 1 April 2000 and 1 January 2015 was performed. (Post)operative complications were listed. Weight loss was assessed using excess weight (EW), percentage excess weight loss (%EWL) and body mass index (BMI) at 1-year intervals after surgery. Ideal weight was determined by recalculating individual lengths to a BMI of 25 kg/m². Application of polynomial regression models was used to quantify weight loss over time.

Results

Ninety patients were identified in the database. Mean time between bariatric interventions was 9.6 years. Reasons for conversion were insufficient weight loss (82.2 %) and outlet obstruction (17.8 %). Early complications were encountered in eight patients of which three were reoperated. Patients who underwent conversion for inadequate weight loss after VBG were retrospectively analyzed regarding weight loss: 78.0 % EWL after 1 year, 71.4 % after 2 years, 62.1 % after 3 years, 64.1 % after 4 years, 70.2 % after 5 years, and 68.9 % after 6 years. Outlet obstruction was relieved in 94 %. Patient satisfaction was assessed by telephone: 86.4 % would repeat the conversion.

Conclusions

Conversion of open VBG to RYGB is feasible and safe and can be performed with an acceptable complication rate. It gives excellent weight loss results and relief of outlet obstruction.