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Background: Lifestyle changes are a cornerstone in the treatment of metabolic syndrome (MetS). However, evidence as to which components of the MetS and associated aspects of quality of life are driven by weight loss or improvements in exercise capacity are scarce. Methods: Company employees (n = 302, 48.2 ± 8.2 years, BMI 33.2 ± 5.4 kg/m2) with diagnosed MetS were evaluated after a 6-month telemonitoring-supported intervention (counselling in nutrition and physical activity) or wait-list control (delayed start of the same intervention). Results: Exercise capacity, body mass index (BMI), and MetS severity were improved after the intervention. Multivariable regression models revealed that changes in BMI were associated with changes in three components of MetS (waist circumference, triglycerides, blood glucose), whereas changes in exercise capacity only were associated to one MetS component change (systolic blood pressure) but also improvements in anxiety severity, aspects of quality of life, and work ability. Conclusions: Both physical activity promotion and diet should be part of a holistic treatment of patients with MetS. However, our data suggest that dietary-induced weight loss might be more successful when aiming at improving MetS risk factors, whereas focusing more on physical activity promotion might be preferred when targeting aspects in quality of life and mental health. [ABSTRACT FROM AUTHOR]

Background: Major depressive disorder and anxiety disorders are associated with less productivity, earlier retirement, and more sick-days at the workplace. These associations also exist for patients with metabolic syndrome. For both, exercise is a generally recommended part of multimodal treatments. However, for individuals with metabolic syndrome, in which depression and anxiety is more prevalent and severe, evidence for the efficacy of exercise interventions is limited. Methods: Company employees with diagnosed metabolic syndrome (n=314, age: 48 ± 8 yrs) were randomized to a 6-month exercise intervention (150 min per week) or wait-list control. Participants received individual recommendations for exercise activities by personal meetings, telephone, or via a smartphone app. Physical activities were supervised and adapted using activity monitor data transferred to a central database. Work ability (work ability index), depression severity and anxiety severity [hospital anxiety and depression scale (HADS)], and health-related quality of live [short form 36 (SF-36)] were assessed. Results: We included 314 subjects from which 287 finished the intervention. Total work ability, depression- and anxiety severity, and the mental component score of the SF-36 improved after 6 months exercise compared to controls. After baseline stratification for normal (HADS scores 0–7) and increased depression- and anxiety scores (HADS scores 8–21) individuals with increased severity scores had similar age, body composition, blood lipids, and cardiorespiratory fitness compared to those with normal scores, but lower total work ability and component sum scores of health-related quality of life. After 6 months total work ability increased in the exercise group compared to controls with the magnitude of the observed increase being significantly greater for subjects with increased depression- and anxiety severity at baseline compared to those with normal severity scores. Conclusions: A 6-month exercise intervention for company employees with metabolic syndrome showed strongest effects on self-perceived work ability in individuals with mild to severe depression- and anxiety severity. This suggests exercise programs offered to workers with metabolic syndrome not only reduces individual disease risk but may also reduce healthcare and employers costs arising from metabolic syndrome and mental disease conditions. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03293264. [ABSTRACT FROM AUTHOR]

CD4+ T (helper) cells migrate in huge numbers through lymphoid organs. However, little is known about traffic routes and kinetics of CD4+ T-cell subsets within different organ compartments. Such information is important because there are indications that CD4+ T cells may influence the function of microenvironments depending on their developmental stage. Therefore, we investigated the migration of resting (naïve), activated, and recently activated (memory) CD4+ T cells through the different compartments of the spleen. Resting and recently activated CD4+ T cells were separated from thoracic duct lymph and activated CD4+ T cells were generated in vitro by cross-linking the T-cell receptor and CD28. The present study shows that all three CD4+ T-cell subsets selectively accumulate in the T-cell zone of the spleen. However, only activated T cells induce the formation of germinal centers (GCs) and autoantibodies in rats and mice. Our results suggest that in a two-step process they first activate B cells independent of the T-cell receptor repertoire and CD40 ligand (CD154) expression. The activated B cells then form GCs whereby CD154-dependend T-cell help is needed. Thus, activated T cells may contribute to the development of autoimmune diseases by activating autoreactive B cells in an Ag-independent manner. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to prospectively evaluate a new high-power argon plasma coagulation system (hp-APC) in therapeutic gastrointestinal (GI) endoscopy. Material and methods. From February to June 2005, 216 patients (167 M (77.3%), mean age 66 years) underwent treatment with hp-APC in a total of 275 sessions. Main indications were additive ablation therapy in Barrett's esophagus, palliative treatment of esophageal cancer, gastric polyps/carcinomas, angiodysplasias, Zenker's diverticula, and duodenal adenomas. The new hp-APC device (VIO 300 D with APC 2) was used (15–120 W) in upper GI endoscopy, push-enteroscopy, and double-balloon enteroscopy. Results. The mean number of treatment sessions required was 1.7 (1–5). For palliative tumor ablation in the esophagus, the number of sessions was 2.3 (1–5). Minor complications (pain, dysphagia, neuromuscular irritation, asymptomatic gas accumulation in the intestinal wall) were observed in 29/216 patients (13.4%). Major complications (perforation, stenosis occured) in 2 patients (0.9%). Conclusions. Hp-APC appears to be safe and effective in the treatment of various GI condition using different types of endoscopes including double-balloon enteroscopy. Because of the low number of treatment sessions required, hp-APC could be used as an alternative to Nd:YAG laser treatment in tumor debulking. [ABSTRACT FROM AUTHOR]

Introduction: Metabolic syndrome (MetS) is a major health problem worldwide and the main risk factor for metabolic-associated fatty liver disease (MAFLD). Established treatment options are lifestyle interventions facilitating dietary change and increased physical activity. Here, we tested the effect of a telemonitoring-supported intervention on liver parameter of inflammation and fibrosis in individuals with MetS., Methods: This was a prospective, randomized, parallel-group, and assessor-blind study performed in workers of the main Volkswagen factory (Wolfsburg, Germany). Volunteers with diagnosed MetS were randomly assigned (1:1) to a 6-month lifestyle intervention focusing on supervised, activity-tracker-guided exercise or to a waiting-list control group. This secondary analysis assessed the effect of the intervention on liver enzymes and MAFLD-related parameters., Results: We screened 543 individuals between October 10, 2017, and February 27, 2018, of whom 314 were randomly assigned to the intervention group (n = 160) or control group (n = 154). Liver transaminases, alkaline phosphatase, and gamma-glutamyl transferase significantly decreased after 6 months in the intervention group compared with the CG. Furthermore, an aspartate aminotransferase-to-platelet ratio index score as a marker for liver fibrosis significantly decreased in the intervention group. These improvements were associated with changes in obesity and exercise capacity., Discussion: A 6-month lifestyle intervention based on exercise training with individualized telemonitoring-based supervision led to improvements of liver inflammation and fibrosis in employees with MetS. Therefore, this intervention shows therapeutic potential for individuals at high risk of MAFLD (ClinicalTrials.gov Identifier: NCT03293264)., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

CD4(+) T (helper) cells migrate in huge numbers through lymphoid organs. However, little is known about traffic routes and kinetics of CD4(+) T-cell subsets within different organ compartments. Such information is important because there are indications that CD4(+) T cells may influence the function of microenvironments depending on their developmental stage. Therefore, we investigated the migration of resting (naïve), activated, and recently activated (memory) CD4(+) T cells through the different compartments of the spleen. Resting and recently activated CD4(+) T cells were separated from thoracic duct lymph and activated CD4(+) T cells were generated in vitro by cross-linking the T-cell receptor and CD28. The present study shows that all three CD4(+) T-cell subsets selectively accumulate in the T-cell zone of the spleen. However, only activated T cells induce the formation of germinal centers (GCs) and autoantibodies in rats and mice. Our results suggest that in a two-step process they first activate B cells independent of the T-cell receptor repertoire and CD40 ligand (CD154) expression. The activated B cells then form GCs whereby CD154-dependent T-cell help is needed. Thus, activated T cells may contribute to the development of autoimmune diseases by activating autoreactive B cells in an Ag-independent manner., (© 2013 The Authors. European Journal of Immunology published by Wiley-VCH Verlag GmbH & Co. KGaA Weinheim.)

Objective: Crohn's disease is frequently complicated by obstructive symptoms secondary to small bowel strictures that cannot be accessed by conventional endoscopy. Push-and-pull enteroscopy is a new endoscopic tool that might allow not only diagnostic work-up but also therapeutic interventions of these strictures. The purpose of this study was to evaluate the feasibility and safety of push-and-pull enteroscopy in the treatment of symptomatic small bowel Crohn's disease strictures., Methods: Between September 2003 and May 2006, 19 consecutive patients with known or suspected Crohn's disease and symptomatic small bowel strictures were subjected to push-and-pull enteroscopy and included in our analysis., Results: With push-and-pull enteroscopy at least one small bowel stricture was accessed in each patient. On the basis of endoscopic assessment strictures in nine patients were not amenable to endoscopic therapy because of anatomical reasons (3/9) or severe inflammatory activity within the stenotic segment (6/9). They underwent direct surgery or intensified immunomodulatory treatment, respectively. In 10 patients with 13 strictures we performed 15 dilations in combination with push-and-pull enteroscopy under fluoroscopic guidance. Technical success was achieved in 8/10 patients, symptomatic relief with avoidance of surgery was achieved in 6/10 patients who remained symptom free during a mean follow-up period of 10 months (range, 4-16 months). No complications were encountered after dilation., Conclusions: Push-and-pull enteroscopy is very useful for diagnosis and directing therapy in patients with Crohn's disease-associated strictures within the small bowel. Balloon dilation with the push-and-pull enteroscopy device appears safe and effective and can be considered as an alternative to surgery in selected patients with medically refractory strictures.