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The genus Tuber comprises ectomycorrhizal fungal species producing belowground ascomata, including the gastronomically most prominent hypogeous fungi. Since the discovery and description of new species are ongoing, the proportion of undescribed species can be considerable and the taxonomy of the genus goes often through changes. The taxonomy of the genus Tuber would therefore benefit from a periodic review. Tuber species described in Europe in recent decades include Tuber regianum, T. bernardinii and T. magentipunctatum. The common characteristics of these three species are the relatively small-sized spores with alveolate-reticulate ornamentation, a high number of spores per ascus (most frequently 6–8 spores) and small-sized ascomata with a verrucose-papillate or smooth surface. The present study aimed at examining the morphology and ecology of the three species, and providing a detailed taxonomic description of the Regianum clade using a multilocus phylogenetic analysis. In addition to this, we examined whether the apparently plesiomorphic morphological character states of this phylogenetically basal clade are the result of the conservation of ancestral character states. Our results show that in the case of certain morphological traits of the Regianum clade, the apparently plesiomorphic character states are indeed retained ancestral states, while in others, they are convergently reappeared ones. Furthermore, taking an overlook at all Tuber clades, we found that some morphological characters, such as spore length, number of spores per ascus and ascus length, changed together in the same evolutionary patterns, while others transformed in different ways within the genus. [ABSTRACT FROM AUTHOR]

Impulsivity is an important determinant of human behaviour, affecting self-control, reasonable thinking and food choices. Recent evidence suggests a role for gut microbiota in human behaviour, but the relationship between gut microbiota and impulsive behaviours remains largely unexplored. To address this knowledge gap, the present study aims to explore the associations between faecal microbiota composition with trait and behavioural impulsivity, in a subcohort of the PREDIMED-Plus trial, including older adults presenting overweight/obesity. Fecal samples (n = 231) were profiled for their microbiota composition using 16 S rRNA amplicon sequencing and impulsivity was determined through four different assessments. Adherence to different dietary patterns was estimated through questionnaires. Beta diversity analyses showed a significant association with the Conner’s Performance Test (CPT) in multivariate-adjusted models, and, in total, 13 bacterial genera associated with CPT. Erysipelotrichaceae UCG 003 showed the highest association with CPT and known butyrate producers such as Butyricicoccus spp., Roseburia spp., and Eubacterium hallii were among the identified bacteria. The bacteria Lachnospiraceae UCG 001, Anaerostipes and Blautia were associated with CPT and also the adherence to healthy and unhealthy plant-based diets. In addition, functional analysis showed a significant negative association between the CPT and the glucuronate and galacturonate metabolic pathways. From the other impulsivity assessments, two more associations were identified, for the genus Phascolarctobacterium with the Stroop test, and the genus Lachnospiraceae GAG 54 with the positive urgency subscore of UPPS-P Impulsive Behaviour Scale. Overall, our findings suggest potential links between the faecal microbiota composition and function with behavioural impulsive inattention as determined by the CPT. [ABSTRACT FROM AUTHOR]

Obesity is a chronic disease that may require multiple interventions and escalation of therapy throughout the years. Until recently, no universal definition existed for recurrent weight gain and insufficient weight loss. Standardization of reporting is key so outcomes can be compared and data can be pooled. The recent IFSO consensus provided standard terminology and definitions that will likely resolve this in the future, and publishers will need to enforce for authors to use these definitions. This current IFSO position statement provides guidance for the management of recurrent weight gain after bariatric surgery. [ABSTRACT FROM AUTHOR]

The excessive accumulation and malfunctioning of visceral adipose tissue (VAT) is a major determinant of increased risk of obesity-related comorbidities. Thus, risk stratification of people living with obesity according to their amount of VAT is of clinical interest. Currently, the most common VAT measurement methods include mathematical formulae based on anthropometric dimensions, often biased by human measurement errors, bio-impedance, and image techniques such as X-ray absorptiometry (DXA) analysis, which requires specialized equipment. However, previous studies showed the possibility of classifying people living with obesity according to their VAT through blood chemical concentrations by applying machine learning techniques. In addition, most of the efforts were spent on men living with obesity while little was done for women. Therefore, this study aims to compare the performance of the multilinear regression model (MLR) in estimating VAT and six different supervised machine learning classifiers, including logistic regression (LR), support vector machine and decision tree-based models, to categorize 149 women living with obesity. For clustering, the study population was categorized into classes 0, 1, and 2 according to their VAT and the accuracy of each MLR and classification model was evaluated using DXA-data (DXAdata), blood chemical concentrations (BLDdata), and both DXAdata and BLDdata together (ALLdata). Estimation error and R 2 were computed for MLR, while receiver operating characteristic (ROC) and precision-recall curves (PR) area under the curve (AUC) were used to assess the performance of every classification model. MLR models showed a poor ability to estimate VAT with mean absolute error ≥ 401.40 and R 2 ≤ 0.62 in all the datasets. The highest accuracy was found for LR with values of 0.57, 0.63, and 0.53 for ALLdata, DXAdata, and BLDdata, respectively. The ROC AUC showed a poor ability of both ALLdata and DXAdata to distinguish class 1 from classes 0 and 2 (AUC = 0.31, 0.71, and 0.85, respectively) as also confirmed by PR (AUC = 0.24, 0.57, and 0.73, respectively). However, improved performances were obtained when applying LR model to BLDdata (ROC AUC ≥ 0.61 and PR AUC ≥ 0.42), especially for class 1. These results seem to suggest that, while a direct and reliable estimation of VAT was not possible in our cohort, blood sample-derived information can robustly classify women living with obesity by machine learning-based classifiers, a fact that could benefit the clinical practice, especially in those health centres where medical imaging devices are not available. Nonetheless, these promising findings should be further validated over a larger population. [ABSTRACT FROM AUTHOR]

Direct lineage reprogramming of one somatic cell into another without transitioning through a progenitor stage has emerged as a strategy to generate clinically relevant cell types. One cell type of interest is the pancreatic insulin-producing β cell whose loss and/or dysfunction leads to diabetes. To date it has been possible to create β-like cells from related endodermal cell types by forcing the expression of developmental transcription factors, but not from more distant cell lineages like fibroblasts. In light of the therapeutic benefits of choosing an accessible cell type as the cell of origin, in this study we set out to analyze the feasibility of transforming human skin fibroblasts into β-like cells. We describe how the timed-introduction of five developmental transcription factors (Neurog3, Pdx1, MafA, Pax4, and Nkx2-2) promotes conversion of fibroblasts toward a β-cell fate. Reprogrammed cells exhibit β-cell features including β-cell gene expression and glucose-responsive intracellular calcium mobilization. Moreover, reprogrammed cells display glucose-induced insulin secretion in vitro and in vivo. This work provides proof-of-concept of the capacity to make insulin-producing cells from human fibroblasts via transcription factor-mediated direct reprogramming. Human foreskin fibroblasts are directly reprogrammed into insulin-producing cells using 5 pancreatic transcription factors, without pluripotency induction. [ABSTRACT FROM AUTHOR]

Introduction: Novel glucagon-like peptide-1 (GLP-1) receptor agonist oral semaglutide has demonstrated greater improvements in glycated hemoglobin (HbA1c) and body weight versus oral medications empagliflozin and sitagliptin, and injectable GLP-1 analog liraglutide, in the PIONEER clinical trial program. Based on these data, the present analysis aimed to evaluate the long-term cost-effectiveness of oral semaglutide versus empagliflozin, sitagliptin and liraglutide in Spain. Methods: Outcomes were projected over patients' lifetimes using the IQVIA CORE Diabetes Model (v9.0), discounted at 3.0% annually. Cohort characteristics and treatment effects were sourced from PIONEER 2 and 4 for the comparisons of oral semaglutide 14 mg versus empagliflozin 25 mg and liraglutide 1.8 mg, respectively, and PIONEER 3 for oral semaglutide 7 and 14 mg versus sitagliptin 100 mg. Costs were accounted from a healthcare payer perspective in 2020 euros (EUR). Patients were assumed to receive initial therapies until HbA1c exceeded 7.5% and then treatment-intensified to basal insulin. Results: Oral semaglutide 14 mg was associated with improvements in quality-adjusted life expectancy of 0.13, 0.19 and 0.06 quality-adjusted life years (QALYs) versus empagliflozin 25 mg, sitagliptin 100 mg and liraglutide 1.8 mg, respectively, with direct costs EUR 168 higher versus empagliflozin and EUR 236 and 1415 lower versus sitagliptin and liraglutide, respectively. Oral semaglutide 14 mg was associated with an incremental cost-effectiveness ratio (ICER) of EUR 1339 per QALY gained versus empagliflozin and was considered dominant (clinically superior and cost saving) versus sitagliptin and liraglutide. Additional analyses demonstrated that oral semaglutide 7 mg was associated with improvements of 0.11 QALYs and increased costs of EUR 226 versus sitagliptin and was therefore associated with an ICER of EUR 2011 per QALY gained. Conclusion: Oral semaglutide 14 mg was dominant versus sitagliptin and liraglutide, and cost-effective versus empagliflozin, for the treatment of type 2 diabetes in Spain. [ABSTRACT FROM AUTHOR]

Objectives: To determine how the COVID-19 lockdown influenced the lifestyle, eating behavior, use of substances, mental health, and weight in patients who had undergone bariatric surgery (BS) and explore the self-perception of one's own health and fears related to COVID-19. Methods: We performed a cross-sectional exploratory study in obesity patients who had undergone BS surgery > 1 year previously in a university hospital. Assessment was performed 40 days after initiating lockdown and included 2 periods: from April 24 until May 8 and during the initial de-escalation period: from May 9 until 22, 2020. A structured telephone interview and an online survey were administered. Results: One hundred eighty-eight patients were interviewed; 156 also responded to the online survey (77% females, mean age 53.46 ± 10.48 years, mean follow-up 5.71 ± 4.30 years). Dietary habits were affected in 72% of the participants, with 15% reporting better diet planning; 83.5% reported having more sedentary behaviors; 27% and 36% showed depression and anxiety, respectively; and 45% of participants reported bad sleep quality. In relation to changes in the use of any substance, the use increased in the majority of patients who were previously users. Self-perception of one's own health and fears related to COVID-19 were only moderate. Finally, emotional eating and time since BS were statistically significant risk factors for predicting weight gain. Conclusions: Lockdown during COVID-19 pandemic negatively influenced the lifestyle, mental health, substance use, and weight in BS patients. These alterations were somewhat similar to those observed in the general population but more severe and with important clinical implications. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence on the impact of bariatric surgery (BS) on reproductive outcomes in the general population and specifically in patients with polycystic ovarian syndrome (PCOS) or the effect of different BS techniques. Purpose: The study aims to investigate the impact of BS on fertility, pregnancy, and newborn outcomes in reproductive age women who have undergone BS and the outcomes according to surgical procedure and PCOS diagnosis. Materials and Methods: This was a retrospective, descriptive, cross-sectional study performed in women from 18–39 years undergoing BS in our centre from January 2005 to December 2010. We performed a telephone interview including a structured reproductive health survey on fertility, pregnancy, and offspring outcomes before and after BS. Results: Of the women, 872 underwent BS during the study period, 298 were 18–39 years old, and reproductive data was obtained from 217. Women with regular menstrual cycles increased from 52.9% before BS to 72.9% 1 year after surgery. The percentage of patients with a time-to-pregnancy longer than 12 months was higher after laparoscopic sleeve gastrectomy (LSG) (17.8%) compared to laparoscopic Roux-en-Y gastric bypass (7.1%; p = 0.02). Menstrual regularity was less frequent in PCOS (n = 43) (26.0%) compared to non-PCOS women before BS (60.1%; p = 0.01), with no differences after surgery. Several perinatal results showed an improvement after BS, with a reduction in macrosomia rate and birth weight. Conclusion: BS was associated with an improvement in several reproductive outcomes. Menstrual regularity was especially improved in PCOS women. Further research may clarify the impact of LSG on fertility. [ABSTRACT FROM AUTHOR]

Purpose: Home lockdown and isolation due to COVID-19 have been related to negative changes in mood, sleep, and eating behaviors. People with obesity are especially vulnerable to emotional eating and might be more prone to weight gain and negative outcomes during lockdown. Materials and Methods: Individuals scheduled for an appointment at the Obesity Unit of a Tertiary Hospital between March 16 and June 21 (n=1230). An online survey was distributed on May 11. Multivariable logistic regression models and general linear models were used to assess the relationship between perceived COVID-19 threat, BS status, and outcome variables. Results: Of the 603 (72.0% females, 39% aged >55 years) respondents, 223 (36.9%) were BS naïve (non-BS), 134 (22.2%) underwent BS within the two previous years (BS<2y), and 245 (40.6%) more than 2 years before (BS>2y). Participants worried about being infected by COVID-19 showed significantly larger changes in family contact (p=0.04), mood (p<0.01), sleep (p<0.01), dietary habits (p=0.05), purchases of unhealthy food (p=0.02), snacking (p=0.05), and physical activity (p=0.02). Non-BS and BS>2y participants reported greater impact of lockdown in mood (p<0.01), experienced more negative changes in dietary habits (p<0.01), and had a higher likelihood for weight gain (OR: 5.61, 95% CI: 3.0–10.46; OR: 5.45, 95% CI: 2.87–10.35, respectively) compared to BS<2y. Conclusions: COVID-19 pandemic is having a substantial negative impact in our population affected by obesity. During lockdown, people more than 2 years before BS behave like people without history of BS. Strategies addressed to prevent negative metabolic outcomes in this population are urgently needed. [ABSTRACT FROM AUTHOR]

Optical microscopy techniques for plant inspection benefit from the fact that at least one of the multiple properties of light (intensity, phase, wavelength, polarization) may be modified by vegetal tissues. Paradoxically, polarimetric microscopy although being a mature technique in biophotonics, is not so commonly used in botany. Importantly, only specific polarimetric observables, as birefringence or dichroism, have some presence in botany studies, and other relevant metrics, as those based on depolarization, are underused. We present a versatile method, based on a representative selection of polarimetric observables, to obtain and to analyse images of plants which bring significant information about their structure and/or the spatial organization of their constituents (cells, organelles, among other structures). We provide a thorough analysis of polarimetric microscopy images of sections of plant leaves which are compared with those obtained by other commonly used microscopy techniques in plant biology. Our results show the interest of polarimetric microscopy for plant inspection, as it is non-destructive technique, highly competitive in economical and time consumption, and providing advantages compared to standard non-polarizing techniques. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare systems aim to maximize the health of the population, but must work within constrained budgets. Therefore, choosing therapies that are both effective and cost-effective is paramount. The present analysis assessed the cost-effectiveness of once-weekly semaglutide 0.5 mg and 1 mg versus once-weekly dulaglutide 1.5 mg and versus once daily sitagliptin 100 mg for the treatment of patients with type 2 diabetes with inadequate glycemic control on oral anti-hyperglycemic medications over patient lifetimes from a healthcare payer perspective in the Spanish setting. Methods: Cost and clinical outcomes were projected over patient lifetimes using the IQVIA CORE Diabetes Model. Baseline cohort characteristics and treatment effects on initiation of semaglutide 0.5 mg and 1 mg, dulaglutide 1.5 mg and sitagliptin 100 mg were based on the once-weekly semaglutide clinical trial program (SUSTAIN 7 and 2). Captured costs included treatment costs and costs of diabetes-related complications. Projected outcomes were discounted at 3.0% annually. Results: Projections of long-term clinical outcomes indicated that once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in discounted life expectancy of 0.02 and 0.11 years, respectively, and discounted quality-adjusted life expectancy of 0.03 and 0.11 quality-adjusted life years (QALYs), respectively, versus dulaglutide 1.5 mg. Compared with sitagliptin, once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in discounted life expectancy of 0.17 and 0.24 years, respectively and discounted quality-adjusted life expectancy of 0.16 and 0.23 QALYs. The increased duration and quality of life with once-weekly semaglutide 0.5 mg and 1 mg resulted from a reduced cumulative incidence and delayed time to onset of diabetes-related complications. Avoided complications resulted in once-weekly semaglutide 0.5 mg and 1 mg being cost-saving versus dulaglutide 1.5 mg and versus sitagliptin 100 mg from a healthcare payer perspective. Conclusions: Once-weekly semaglutide 0.5 mg and 1 mg were considered dominant (more effective and less costly) versus sitagliptin 100 mg and dulaglutide 1.5 mg for the treatment of patients with type 2 diabetes with inadequate glycemic control on oral anti-hyperglycemic medications and are likely to be a good use of healthcare resources in the Spanish setting. Plain Language Summary: Since healthcare systems aim to maximize the health of the population but must work within constrained budgets, choosing therapies that are both effective and cost-effective is paramount. We assessed the cost-effectiveness, from a Spanish healthcare payer perspective, of the newly marketed once-weekly semaglutide 0.5 mg and 1 mg versus two established therapies (dulaglutide 1.5 mg and sitagliptin 100 mg) for the treatment of patients with type 2 diabetes with inadequate glycemic control on oral anti-hyperglycemic medications over patient lifetimes. Outcomes were projected using a computer simulation model, based on two trials conducted as part of the once-weekly semaglutide clinical trial program (SUSTAIN 2 and SUSTAIN 7). Captured costs included treatment costs and costs of diabetes-related complications. Projections of long-term clinical outcomes indicated that once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in quality-adjusted life expectancy of 0.03 and 0.11 quality-adjusted life years (QALYs), respectively, versus dulaglutide 1.5 mg, and 0.16 and 0.23 QALYs, respectively, versus sitagliptin 100 mg. The increased duration and quality of life with once-weekly semaglutide 0.5 mg and 1 mg resulted from a reduced cumulative incidence and delayed time to onset of diabetes-related complications. Avoided complications resulted in once-weekly semaglutide 0.5 mg and 1 mg being cost-saving versus dulaglutide 1.5 mg and versus sitagliptin 100 mg. Once-weekly semaglutide 0.5 mg and 1 mg were more effective and less costly and therefore were considered dominant in both comparisons, and are likely to be a good use of healthcare resources in the Spanish setting. [ABSTRACT FROM AUTHOR]

Background: Support groups are an integral part of bariatric surgery (BS) programs yet there is limited evidence for an association between support group attendance and BS weight outcomes. Settings: University Hospital, Spain. Objectives: This study examined the effect of support group attendance on weight loss (WL) at short- and long-term follow-up (FU) following BS. Methods: Participants were 531 (mean body mass index (BMI) = 45.8 (5.4) kg/m2; mean age 45.9 (11.1) years, 76.4% females) who underwent BS (Roux-en-Y gastric bypass (RYGB): 233 (43.8%); sleeve gastrectomy (SG): 298 (56.2%)) in our clinic. The bariatric support group program (BSGP) consisted of two subprograms: Novel-BSGP (N-BSGP; first 12 months after surgery) and Experienced-BSGP (E-BSGP; FU between 12 months 5 years after BS). Results: Three hundred and twenty-three (60.8%) and 129 (24.3%) participants attended at least one session of N-BSGP and E-BSGP, respectively. Linear regression analyses showed that number of sessions attended during year 1 predicted percent total body WL (%TBWL (β = 0.381, p < 0.001)) and percent excess WL (%EWL (β = 0.928, p < 0.001)) at one year and number of sessions attended during years 2–5 were positively related to %TBWL and %EWL achieved at 5 years (%EWL: β = 0.162 (p = 0.014) and %TBWL: β = 0.378 (p = 0.013)) respectively. Conclusion: We observed a significant beneficial effect of a post-surgical support group program on short- and long-term body WL after BS. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia pre-dating bariatric surgery (BS) has been suggested as concern for the use of BS in older-adults with morbid obesity. Objective: To evaluate the impact of age on the prevalence of sarcopenic obesity (SO) in BS-candidates. Methods: Cross-sectional study including 1370 consecutive BS-candidates aged ≥18, and grouped according to age: 18–39 (reference group), 40–49, 50–59 and ≥ 60 years. From body composition analysis data obtained using bioelectrical impedance, skeletal muscle mass (SMM), SMM index (SMMI=SMM/height2), and percentage of SMM (%SMM = SMM/BW*100) were calculated. Class I or class II SO was adjudicated, respectively, when a value between > − 1 and − 2, or > −2 standard deviations from the regression line from the gender-specific distribution of the relationship between BMI and SMMI or the %SMM in the reference group was encountered. Results: According to the SMMI distribution, prevalence of class I and class II SO in the whole cohort was respectively 16.4% and 4.6%. SO was more prevalent in females (p < 0.005). Proportion of subjects with SO positively correlated with older age category in females (Tau-c = 0.149, p < 0.001) but not in males. In females aged ≥60, class I SO was present in 29.1%, and class II in 12.8%. Similar results were obtained when %SMM was used (Cohen's k-coefficient = 0.886, p < 0.001). Age and female gender were identified as independent preditors of SO, whereas CRP or the presence of obesity-associated comorbidities were not. Conclusion: Age is a risk factor for SO in BS-candidates. SO is fairly common in female subjects aged >60 years that are candidates to BS. [ABSTRACT FROM AUTHOR]

Introduction: Once-weekly semaglutide has been associated with greater reductions in glycated hemoglobin (HbA1c) and body weight than sitagliptin and dulaglutide in the SUSTAIN 2 and 7 clinical trials, respectively. These trials also assessed the proportions of patients achieving treatment targets capturing glycemic control and avoidance of hypoglycemia and weight gain. This study assessed the cost of bringing patients with type 2 diabetes to three clinically relevant endpoints with semaglutide versus sitagliptin and dulaglutide in Spain. Methods: The proportions of patients achieving endpoints of HbA1c < 7.0%, HbA1c < 7.0% without hypoglycemia and without weight gain, and a ≥ 1.0% HbA1c reduction with ≥ 5.0% weight loss were taken from SUSTAIN 2 and 7. Cost of control was calculated as the annual per patient cost of each medication, expressed in 2019 euros (EUR), divided by the proportion of patients achieving each endpoint. Results: Based on SUSTAIN 2, cost of control was lower for sitagliptin for the HbA1c < 7.0% endpoint, results were comparable for the HbA1c < 7.0% without hypoglycemia and without weight gain endpoint, and both doses of semaglutide were associated with lower costs of control for the ≥ 1.0% HbA1c reduction with ≥ 5.0% weight loss endpoint. Based on SUSTAIN 7, both doses of semaglutide were associated with lower costs of control for all three endpoints. Conclusion: Both doses of semaglutide were associated with comparable or lower costs of control versus sitagliptin when considering endpoints incorporating hypoglycemia and weight loss alongside glycemic control, and lower costs of control versus dulaglutide 1.5 mg for all endpoints in Spain. Plain Language Summary: Plain language summary available for this article. [ABSTRACT FROM AUTHOR]

This paper provides a methodology for the dimensioning of the access network in remote rural areas, considering the progressive introduction of cellular services in these regions. A 3G small cell (SC) network with one or several carriers deployed at the SC, fed with solar panels and connected to a backhaul with limited capacity is considered for the analysis. Because the backhaul may be inexistent or very expensive (e.g., satellite-based backhaul) the network design pursues the minimization of the required backhaul bandwidth. The required backhaul bandwidth and the required energy units (i.e., the size of the solar panels and the required number of batteries) are then obtained as an output of the dimensioning analysis. Both the backhaul minimization objective and the constraints associated with each of the carriers (low maximum radiated power and low number of users connected simultaneously) require a novel methodology compared to the classical dimensioning techniques. We also develop a procedure for switching on/off carriers in order to minimize the energy consumption without affecting the quality of service (QoS) perceived by the users. This technique allows reducing the required size of the energy units, which directly translates into a cost reduction. In the development of this on/off switching strategy, we first assume perfect knowledge of the traffic profile and later, we develop a robust Bayesian approach to account for possible error modeling in the traffic profile information. [ABSTRACT FROM AUTHOR]

This paper deals with the development of several strategies for associating users to base stations (BSs) in heterogeneous networks. These strategies are able to balance the rate among users and BSs and increase the overall network utility. Constraints related to the energy availability at BSs are considered explicitly in the design, assuming that the BSs are equipped with batteries that are recharged through energy harvesting. We develop a general association strategy, and then we present several suboptimum but less complex solutions suitable for scenarios with high mobility or deployments of BSs with low computational capabilities. We also present an implementation that is to be executed in a distributed way among users and BSs without the need of having a central entity gathering all the information. The performance of the proposed strategies is evaluated through simulations in terms of rate balancing and the effect of the energy harvesting capabilities on the network throughput is shown. We also compare the proposed strategies with the traditional max-SINR user association approach. [ABSTRACT FROM AUTHOR]

Background: Specific data is needed to safely expand bariatric surgery and to preserve good surgical outcomes in response to the non-stop increase in obesity prevalence worldwide. Objective: The aims of this study are to provide an overview of the baseline characteristics, type of surgery, and 30-day postoperative morbidity and mortality in patients undergoing bariatric surgery in Spanish public hospitals, and evaluate changes throughout the 2000-2014 period. Material and Methods: This is a descriptive study using data from the RICIBA, a computerized multicenter and multidisciplinary registry created by the Obesity Group of the Endocrinology and Nutrition Spanish Society. Three periods according to the date of surgery were created: January 2000 to December 2004 (G1), January 2005 to December 2009 (G2), and January 2010 to December 2014 (G3). Results: Data from 3843 patients were available (44.8 ± 10.5 years, a 3:1 female-to-male ratio, 46.9 ± 8.2 kg/m). Throughout the 15-year period assessed, candidate patients for bariatric surgery were progressively older and less obese, with an increase in associated comorbidities and in the prevalence of men. The global trend also showed a progressive decrease in Roux-en-Y gastric bypass, the most performed bariatric procedure (75.1 % in G1, 69.3 % in G2, and 42.6 % in G3; p < 0.001), associated with a parallel increase in sleeve gastrectomy (0.8 % in G1, 18.1 % in G2, and 39.6 % in G3; p < 0.001). An overall mortality rate of 0.3 % was reported. Conclusions: Data from Spain is similar to data observed worldwide. Information recorded in the National Registries like RICIBA is necessary in order to safely expand bariatric surgery in response to increasing demand. [ABSTRACT FROM AUTHOR]

In recent years, a marked increase in the relative use of sleeve gastrectomy (SG) has occurred. However, long-term head-to-head comparison of the impact of this bariatric surgery (BS) procedure with the still considered 'gold standard' Roux-en-Y gastric bypass (GBP) in subjects with type 2 diabetes mellitus (T2DM) is surprisingly low. The aim of this review manuscript is to appraise current evidence on the potential of GBP and SG as long-term therapeutic tool for subjects with T2DM. In our opinion, unfortunately, review of current literature does not allow to properly answer which of the two surgeries would be better as procedure of choice for subjects with T2DM. Arguably, the apparent superiority of GBP over SG could be overcome by the addition of a malabsortive component to SG in a staged approach restricted to those failing to achieve the desired metabolic outcomes. Nonetheless, whether this serves as basis for the election of SG as primary strategy for those with T2DM is questionable. [ABSTRACT FROM AUTHOR]

Background: The relationship between airway hyperresponsiveness (AHR) and obesity, a low-grade systemic inflammatory condition, remains largely unknown. It is established that AHR to indirect stimuli is associated with active airway inflammation. The objectives were to investigate the rate of AHR to mannitol in obese subjects and its changes 1 year after bariatric surgery (BS). Methods: We enrolled 58 candidates to BS severely obese (33 nonsmokers and 25 smokers) without history of asthma and 20 healthy, nonobese participants and related AHR to functional findings and serum and exhaled biomarkers. Results: Before surgery, AHR was observed in 16 (28 %) obese with the provocation doses of mannitol to induce a 15 % fall in FEV (PD) of (geometric mean [95 % CI]) 83 (24-145) mg. Compared to control participants, obese participants had lower spirometric values and higher serum and exhaled biomarkers ( p < 0.05 each). After surgery, AHR was abolished ( p < 0.01) in all but four obese subjects. Conclusions: Weight loss induced by BS was the key independent factor associated to AHR improvement. AHR to mannitol is highly prevalent in obesity, and it is largely abolished by BS. [ABSTRACT FROM AUTHOR]

Background: Despite the health benefits of bariatric surgery (BS) extend beyond WL, better understanding of the WL response may help improve the outcomes of BS. In this context, we aimed to assess patterns within the variability of weight loss (WL) after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Methods: WL data from 658 subjects that underwent RYGB ( n = 464) or SG ( n = 194) as first BS were analyzed. Based on excess WL (EWL), subjects were categorized as good WL responders (EWL ≥ 50 % at nadir weight and throughout follow-up), primarily poor WL responders (1-PWL:EWL < 50 % at nadir weight and thereafter), and secondarily poor WL responders (2-PWL:EWL ≥ 50 % at nadir weight, but <50 % at last follow-up visit). Predictors associated with different WL outcomes were ascertained using regression analysis. Results: Median follow-up was 55.7 months. Nadir EWL ranged 12.4-143.6 %; last follow-up visit EWL ranged −22.1-143.6 % and weight regain (WR) ranged 0-64.1 kg. Good WL was found in 75.7 of the cohort. 1-PWL response (4.7 %) was characterized by lesser WL but similar WR as compared to good WL and was associated with larger BMI and diabetes prior to surgery. 2-PWL response (19.6 %) was characterized by larger WR as compared to the other groups and was more common following SG. Lesser percentage of medical appointments kept was associated with 1-PWL and 2-PWL. Conclusion: Our data show the high inter-individual variability of the WL response at mid-term after RYGB and SG and that poor WL after BS could be illustrated by two different patterns, characterized either by sustained limited WL (1-PWL), or pronounced weight regain (2-PWL). [ABSTRACT FROM AUTHOR]

Background: The degree of bariatric surgery (BS) induced vitamin D (VD) malabsorption is not well established. Objective: The aim of this study is to evaluate the efficacy and safety of achieving 25-hydroxy VD (25(OH)D) levels ≥75 nmol/L with two regimens of VD supplementation after BS. Methods: We performed two open-label, prospective studies in patients undergoing BS from 2009 to 2011. Postoperatively, all patients received Ca citrate 1,000 mg and 800 IU of VD/day. In the first study, additional VD was prescribed according to preoperative 25(OH)D levels- < 25 nmol/L:2,800 IU/day; 26-50 nmol/L:2,000-1,200 IU/day, 51-62 nmol/L:1,000 IU; >63 nmol/L:0 IU/day-and we evaluated the patients at baseline and at 4 months. In the second study, an additional fixed high dose of 2,000 IU/day of VD was administered, and we evaluated patients at baseline and at 4 and 12 months after BS. Results: The first study included 176 patients [mean age 44 (11)]; 140 were females. Before BS, 171 subjects (98 %) presented 25(OH)D levels <75 nmol/L. Postoperatively, the mean 25(OH)D levels increased from 40 (17) to 77 nmol/L (29) ( p < 0.001) with no differences in parathormone (PTH) or 25(OH)D levels between dose groups. In the second study, we enrolled 52 patients [mean age 45 (10)]; 32 were females. Postoperatively, the mean 25(OH)D levels increased from 32 (12) to 80 (22) and to 75 nmol/L (15) ( p < 0.001) at 4 and 12 months, respectively. In both studies, a high percentage of patients achieved 25(OH)D ≥75 nmol/L levels and no subject reported any serious adverse event. Conclusions: Both schedules of daily VD supplementation were effective and safe under conditions of clinical practice. [ABSTRACT FROM AUTHOR]

The parallel occurrence of improved glucose tolerance and increased glucagon-like peptide 1 (GLP-1) response to meal intake following metabolic surgery (MS) demonstrated in several studies has led to the notion that GLP-1 is the culprit for the impressive rates of remission of type 2 diabetes mellitus (T2DM) following MS. In this article, we critically review current evidence supporting this view. Recent studies specifically designed to elucidate a causative role of GLP-1 in the antidiabetic effects of MS call into question GLP-1 as a key player for T2DM outcome following MS procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese subjects. Whether GLP-1 plays a more prominent role in the remission of T2DM following MS in subjects with moderate obesity warrants further studies. Appraisal of the mechanisms involved in the amelioration of hyperglycemia following MS is a priority, as it could help in the battle against the current combined epidemics of obesity and T2DM. [ABSTRACT FROM AUTHOR]

Background: The relative contribution of anthropometric, hormonal, and metabolic changes after bariatric surgery (BS) on sexual function (SF) in severely obese subjects is not well established. Methods: Prospective observational case series study of 39 men undergoing BS. SF was assessed by means of the international index of erectile function (IIEF) before and at 1 year after surgery. At the same time points, anthropometric (body mass index, waist circumference), hormonal (testosterone, sex hormone binding globulin, estradiol, gonadotropins, inhibin B, prolactin, leptin), and metabolic parameters (insulin sensitivity, C-reactive protein, lipid profile, hemoglobin A1c, presence of hypertension or sleep apnea) were assessed. Results: BS was associated with marked weight loss (77.18 % excess weight loss), improved IIEF score (baseline: 54.85 ± 16.59, 1 year: 61.21 ± 14.10; p < 0.01), gonadal function (testosterone: baseline 256.36 ± 120.98, 1 year: 508.01 ± 161.90; p < 0.001), and improved metabolic profile. However, on multivariate regression analysis whereas changes in body mass index (beta: −0.677, p = 0.001), and baseline IIEF score (beta: −0.397, p = 0.023), were independent predictors of the changes in the IIEF score at 1 year after surgery, changes in hormonal and metabolic factors were not. Variables in the model accounted for 66 % of the postsurgical variation in the IIEF score. Similar results were found when the different IIEF-sexual domains were evaluated, except for intercourse satisfaction for which no independent predictor was identified. Conclusions: Weight loss's beneficial effects on SF occurring after BS are beyond the parallel improvement in gonadal and metabolic profiles. [ABSTRACT FROM AUTHOR]

Background: Despite obesity being closely associated with two common risk factors for albuminuria, namely type 2 diabetes mellitus (T2DM) and hypertension, information on the impact of weight loss on albumin excretion rate in morbidly obese (MO) subjects is scarce. Objective: To evaluate the independent contribution of weight loss following bariatric surgery (BS) to the improvement of the albumin-to-creatinine ratio (ACR) in MO subjects with T2DM. Subjects and methods: Observational prospective study, including consecutive ( n = 255) patients undergoing Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) of whom 37.6 % ( n = 96) presented with T2DM. Stepwise logistic regression analysis was used to assess the contribution of T2DM-related, hypertension-related, and weight loss-related variables, and type of surgery to normalization of ACR (<30 mg/g) at 12 and 24 months follow-up. Results: In T2DM subjects, baseline ACR was 85.7 ± 171 mg/g with ACR ≥30 mg/g being present in 45.7 % of the cohort. At 12 months, the ACR significantly decreased in T2DM subjects (42.2 ± 142.8 mg/g; p < 0.005) with no further reduction at 24 months after surgery (44.4 ± 227.7; p = 0.862). Among T2DM subjects with ACR ≥30 mg/g at baseline, the ACR became <30 mg/g in 58.5 % and 76.9 % at 12 and 24 months, respectively ( p < 0.001 relative to baseline). Body mass index (BMI) change from baseline was the only independent predictor of ACR normalization at 12 months [Exp( B) 1.373, 95 % confidence interval 1.075-1.703; p < 0.05]. None of the evaluated variables appeared as an independent predictor of ACR normalization at 24 months. Conclusions: Our data suggest that, in MO subjects with T2DM, interventions aiming at slowing the progression of nephropathy should not only focus on optimization of glucose and blood pressure control but also include effective weight loss strategies. [ABSTRACT FROM AUTHOR]

Purpose: Population based studies have demonstrated that children and adolescents often complain of low back pain. A group-randomized controlled trial was carried out to investigate the effects of a postural education program on school backpack habits related to low back pain in children aged 10-12 year. Methods: The study sample included 137 children aged 10.7 years (SD = 0.672). Six classes from two primary schools were randomly allocated into experimental group (EG) ( N = 63) or control group (CG) ( N = 74). The EG received a postural education program over 6 weeks consisting of six sessions, while the CG followed the usual school curriculum. A questionnaire was fulfilled by the participants at pre-test, post-test, and 3 months after the intervention finished. The outcomes collected were: (1) try to load the minimum weight possible, (2) carry school backpack on two shoulders, (3) belief that school backpack weight does not affect to the back, and (4) the use of locker or something similar at school. A sum score was computed from the four items. Results: Single healthy items mostly improved after the intervention and remained improved after 3-month follow-up in EG, while no substantial changes were observed in the CG. Healthy backpack use habits score was significantly increased at post-test compared to baseline in the EG ( P < 0.000), and remained significantly increased after 3-month, compared to baseline ( P = 0.001). No significant changes were observed in the CG ( P > 0.2). Conclusions: The present study findings confirm that children are able to learn healthy backpack habits which might prevent future low back pain. [ABSTRACT FROM AUTHOR]

Background: The effects of bariatric surgery (BS) in metabolically healthy morbidly obese (MO) subjects are not well established. Against this background, we characterized the metabolic and inflammatory profiles of MO subjects with insulin sensitivity (IS) in the normal range, and evaluated the changes on these parameters following BS in this population. Methods: We conducted a retrospective analysis of prospectively collected data in MO women undergoing BS between 2006 and 2010. Anthropometric, metabolic comorbidities, and inflammatory markers were compared at baseline and 12 months after BS, between 52 women (10.4 %) presenting with a HOMA-IR <2.94 (80th percentile reference population) (IS-MO group) and an age- and BMI-matched group of women ( n = 52) with HOMA-IR >2.94. Results: The IS-MO women presented a more favorable metabolic and inflammatory profile as compared to the IR-MO group. However, an enlarged waist circumference (WC), a high-sensitivity C-reactive protein (hs-CRP) >3 mg/dL, and metabolic syndrome (MS) were present in 100 %, 90 %, and 51.9 % of the IS-MO group at baseline. At 12 months after surgery, all the MS components and hs-CRP improved in IS-MO subjects ( p < 0.01). The prevalence of the MS in the IS-MO group significantly decreased (11 %, p < 0.05) despite WC and hs-CRP being abnormal respectively in 53.3 % and 20.0 % of women in this group. Conclusions: In MO women, an IS in the normal range is associated with a limited protection from metabolic co-morbidities. Nonetheless, BS results in the amelioration of the altered metabolic and inflammatory profiles also in this group of subjects. [ABSTRACT FROM AUTHOR]

Background: Obesity impairs quality of life, but the perception of the impairment could be different from one country to another. The purpose was to compare weight-related quality of life (QOL) between cohorts from Spain and North America. Methods: A cross-sectional case-control study was performed between two populations. Four hundred Spanish and 400 North American obese subjects suitable for bariatric surgery closely matched for race, gender, age, and body mass index (BMI) were included. Two non-obese control groups matched for gender, age, and BMI from each population were also evaluated ( n = 400 in each group). The participants completed the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, a measure of weight-related QOL. Results: Spanish morbidly obese patients showed poorer QOL than their North American counterparts in physical function, sexual life, work, and total score. By contrast, Spanish non-obese control subjects reported better QOL in all domains than their North American counterparts. Women, both in Spain and North America, reported reduced QOL compared to men on the domain of self-esteem. In addition, North American women reported reduced QOL on the sexual life domain compared to men. BMI correlated negatively with all domains of QOL except for self-esteem in both national groups. Conclusions: Spanish obese subjects suitable for bariatric surgery report poorer weight-related quality of life than their North American counterparts, and obese women, regardless of nationality, perceive a reduced quality of life compared to men. [ABSTRACT FROM AUTHOR]

Background: Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) are associated with similar type 2 diabetes mellitus (T2DM) resolution rates for morbidly obese subjects. However, the mechanisms underlying the resolution of T2DM after SG have not been clarified to date. This study aimed to compare the early changes in gastrointestinal hormones involved in insulin and glucagon secretion in morbidly obese T2DM subjects undergoing SG or RYGBP. Methods: This prospective study investigated 12 subjects with T2DM who had undergone SG ( n = 6) or RYGBP ( n = 6). Five body mass index (BMI)-matched obese non-diabetic subjects and five BMI-matched obese diabetic subjects served as control subjects. Glucose, insulin, glucagon, glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and GLP-2 were determined after a standardized mixed liquid meal before surgery and 6 weeks afterward. Results: After 6 weeks, five of the six subjects in each surgical group presented with T2DM remission, although the area under the curve (AUC) of glucose was greater than that of the non-diabetic control subjects ( P < 0.01). Postsurgically, the indices of insulin and glucagon secretion were comparable between the two surgical groups. The AUC of GLP-1 ( P < 0.05) and GLP-2 ( P < 0.05) was significantly and comparably enlarged after SG and RYGB. The postsurgical GIP response was significantly associated with the glucagon response throughout the meal test (ρ = 0.747; P < 0.01). Conclusions: The data show that in a cohort of morbidly obese T2DM subjects, SG and RYGBP are associated with an early improvement in glucose tolerance, similar changes in insulin and glucagon secretion, and a similar GLP-1, GIP, and GLP-2 response to a standardized mixed liquid meal. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery (BS) is widely accepted for the treatment of patients with morbid obesity (MO). We aimed to determine presurgical predictors of and surgical technique-related differences in excess weight loss (EWL) 1 year after BS. Methods: This retrospective study included 407 subjects (F/M 3:1, median age = 44 years) who underwent laparoscopic Roux-en-Y gastric bypass (RYGB, n = 307) or sleeve gastrectomy (SG, n = 100) at our University Hospital and were evaluated 1 year after surgery. Results: Baseline median (min-max) body mass index (BMI) was 47 kg/m (range = 36-71). BMI was higher in the SG than in the RYGB group (53 vs. 46 kg/m, p < 0.0001). Simple correlation analysis showed negative associations between EWL and age, BMI, waist circumference (WC), fasting glucose, HbA1c, triglycerides (TG), blood pressure, and total cholesterol (all p < 0.01). EWL (mean ± SD) did not differ by gender ( p = 0.2), was lower in diabetic than in nondiabetic subjects (71 ± 17% vs. 79 ± 17%, p < 0.0001), and higher in the RYGB vs. SG group (76 ± 18% vs. 68 ± 15%, p < 0.0001). However, SG vs. RYGB differences in EWL disappeared ( p = 0.4) after taking into account baseline BMI. Multiple regression and logistic analysis showed that younger individuals with lower BMI but higher WC, and lower HbA1c and TG, had higher EWL and a higher rate of successful (EWL ≥ 60%) weight loss. Conclusions: Our data indicate that some of the characteristics that would have subjects referred early for BS were associated with higher weight loss. Therefore, the timing of laparoscopic BS might be an important factor for MO individuals in which medical weight loss intervention has failed. [ABSTRACT FROM AUTHOR]

Background: Validated equations for body composition analysis using bioelectrical impedance (BIA) in morbidly obese (MO) subjects are scarce. Thus, our aim was to develop new equations from physical and BIA parameters to estimate whole-body and segmental body composition in MO subjects, with dual-energy X-ray absorptiometry (DXA) as the reference method. Methods: A cross-sectional study on 159 Caucasian MO subjects (female 78%, age 43.5 ± 11.8 years, BMI 45.6 ± 4.9 kg/m) divided in two groups was conducted: model building cohort ( n = 110) and model validation cohort ( n = 49). Stepwise regression analysis was used to develop specific fat free mass (FFM) and fat mass (FM) equations. Results: Gender, body weight, and height/impedance accounted, respectively, for 89.4% ( p < 0.001) and 89.3% ( p < 0.001) of the variability of DXA-total FFM in the two cohorts. Using the new equation, the mean difference between the DXA-FFM and BIA-FFM estimates was +0.180 kg (95% CI: -0.34 to +0.7 kg, p = NS), and the resulting limits of agreement were +6.76 and −6.40 kg. Similarly, good estimates of DXA truncal-, android-, and gynoid-FM from anthropometric and BIA parameters could be obtained from weight, height/impedance, and waist and hip circumferences (respectively, R adjusted: 0.657, 0.776, and 0.770; p < 0.001). Conclusions: The new equations derived from physical and BIA parameters provide accurate estimates of body composition in MO subjects. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity in Spain is on the rise with the consequent increase in bariatric surgery. Studies in non-Mediterranean populations have shown that micronutrient deficits are present before surgery. However, there is no data on this topic in a Spanish population. Methods: We evaluated food intake and the prevalence of nutritional deficiencies in 231 obese patient (72.3% women, 45.6 ± 9.9 years, BMI 48.2 ± 7.8 kg/m) candidates for bariatric surgery. Forty-six normal weight individuals with similar demographic variables except BMI were included for comparison of deficiencies. Results: In obese subjects, the mean estimated energy intake was 2,584 ± 987 kcal/day in males and 2,094 ± 669 kcal/day in females ( p < 0.05). After adjusting for kilocalorie intake, carbohydrate intake was of 38.7% [CI 36.2 to 41.1] and 39.9% [CI 37.8 to 40.8] (n.s.), lipid intake was 41.9% [CI 39.6 to 44.2] and 43.0% [CI 41.7 to 44.8] (n.s.) and protein intake was 19.1% [CI 17.7 to 20.5] and 17.3% [CI 16.4 to 18.1] (n.s.) for men and women, respectively. The most prevalent deficiency was vitamin D25(OH): obese 94%, control 24%; ( p < 0.0001). Above normal PTH levels were observed in 41.0% and 20.0% of obese and normal weight subjects, respectively ( p < 0.0497). Increased prevalence of deficiencies in obese patients included magnesium, vitamin B6 and anaemia ( p < 0.05). Other vitamin deficiencies were observed although did not reach statistical significance. Conclusions: Nutritional deficiencies are commonly found in the Spanish obese population undergoing bariatric surgery and are significantly more prevalent than in normal weight individuals. [ABSTRACT FROM AUTHOR]

Background: Daily protein intake recommendations have recently been proposed for the bariatric patient. We aimed to evaluate the accomplishment of these recommendations, and the influence of protein intake (PI) on fat free mass (FFM) and protein status changes following bariatric surgery. Methods: We examined 101 consecutive patients undergoing laparoscopic Roux-in-Y gastric gypass (LGBP) or laparoscopic sleeve gastrectomy (LSG). Based on 3-day food records, PI from food and supplements were quantified at 4, 8, and 12 months after surgery. The association between PI and body composition (bioelectrical impedance), plasma albumin and pre-albumin was evaluated at all study time points. Results: A PI <60 g/day was present respectively in 45%, 35%, and 37% of the cohort at 4, 8, and 12 months after surgery ( p < 0.001 relative to baseline). Despite our universal recommendation of protein supplementation, supplements were taken only by 63.4, 50.5, and 33.7% of the participants at 4, 8, and 12 months. However, protein supplementation was effective in helping patients to achieve the daily protein intake goal. In linear regression analysis, male gender and weight loss, but not PI, were significantly associated with loss of FFM ( p < 0.001). No significant correlation between PI and plasma albumin or pre-albumin was found. Conclusions: Our study underscores the value of protein supplementation for the achievement of the recommended daily protein intake in the bariatric patient. However, our data does not help to define a PI goal as critical in determining the FFM and protein status changes following LGBP or LSG. [ABSTRACT FROM AUTHOR]

Life-long nutrition education and diet evaluation are key to the long-term success of surgical treatment of obesity. Diet guidelines provided for bariatric surgery patients generally focus on a progression through dietary stages, from the immediate post-surgical period to 6 months after surgery. However, long-term dietary guidelines for those surgically treated for obesity are not readily available. Therefore, there is a need for dietary recommendations for meal planning and nutritional supplementation for bariatric surgery patients beyond the short-term, post-operative period. The purpose of this paper is to construct an educational tool to provide long-term nutritional and behavioral advice for the post-bariatric patient. The manuscript summarizes the current knowledge on dietary strategies and behaviors associated with beneficial nutritional outcomes in the long term of post-bariatric surgery patients. Dietary and nutritional recommendations are presented in the form of a “bariatric food pyramid” designed to be easily disseminated to patients. The development of educational tools that are easy to understand and follow is essential for effective patient management during the surgery follow-up period. The pyramid can be used as a tool to help both therapists and patients to understand nutrition recommendations and thus promote a healthy long-term post-op dietary pattern based on high-quality protein, balanced with nutrient-dense complex carbohydrates and healthy sources of essential fatty acids. [ABSTRACT FROM AUTHOR]

Precise calcium (Ca) and vitamin D intestinal absorption after gastric bypass (GB) remains unknown. We evaluated the effect of receiving or not Ca and vitamin D supplementation on Ca, PTH, and vitamin D axis in patients undergoing GB. Two hundred twenty-two patients were evaluated prior to GB and at 1 year. Baseline characteristics were registered, and bone metabolism markers were determined before surgery and at 12 months. After surgery, oral calcium carbonate (1,200 mg/daily) and vitamin D3 (800 IU) were prescribed with PTH >70 pg/ml. In the whole group, before surgery and at 1 year, 36 and 30% had hyperparathyroidism (HPT), respectively. Baseline vitamin D deficiency (<50 nmol/L) was observed in 52% with insufficiency (50–75 nmol/L) in 28%. Linear regression analysis showed a significant positive relationship between PTH and excess body weight (EBW) ( r 0.190) with a significant negative relationship between PTH and 25 (OH) D ( r−0.243). Only EBW was independently associated with HPT on multivariate logistic regression. PTH and 25 (OH) D significantly improved at 1 year with Ca supplementation, but HPT continued in 35 and in 71%, 25 (OH) D was <75 nmol/L. 25 (OH) D only increased 11.5 nmol/L with supplementation. Without Ca supplementation, both PTH and 25 (OH) D increased. HPT developed in 15% with 25 (OH) D < 75 nmol/L in 66%. Ca and vitamin D supplementation after GB should be universal and individualized to overcome mal-absorption and improve previous 25 (OH) D deficiency. [ABSTRACT FROM AUTHOR]

Objective To analyse incidence of hemorrhagic and thrombotic events in a series of ambulatory patients receiving acenocoumarol in a rural area of Spain (1997–2007). Results Out of 1,544 patients, 1,086 are receiving acenocoumarol at present (2% of our region’s population). The total follow-up was 5,462 patients-years. Median age was 74 years. INR therapeutic range was 2.0–3.0 in 82.5%. Atrial fibrillation (AF) was the most frequent indication (73%). Incidence of hemorrhagic and thrombotic events was 2.27 and 0.2/100 patients-year, respectively. Gastrointestinal tract was the most frequent site of bleeding. In multivariate analysis, patients with AF and prosthetic heart valves (PHV) had increased risk of bleeding (OR 2.1 and 4.8, respectively). Age and therapeutic ranges of INR were not associated with increased risk of bleeding. Conclusions 2% of our population is receiving acenocoumarol. Incidence of hemorrhagic and thrombotic events was low. Patients with AF and PHV had increased risk of bleeding. [ABSTRACT FROM AUTHOR]

In future wireless networks devices may cooperate to form logical links. Each of these links may consist of several independent physical channels which are shared by the cooperating partners. Even without multiple antennas this cooperation provides diversity in time and space. This so-called cooperation diversity increases the robustness of the link vs. fading and interference. After surveying approaches in cooperation diversity we focus on optimizing its performance by combining several cooperation schemes and by integrating cooperation into space-time coding. For multiple scenarios, we further discuss the factors and benefits introduced by user cooperation and how cooperation-aware resource allocation can be employed to further increase the performance of cooperative networks. When it comes to implementation, the question arises how cooperation can be integrated efficiently into existing wireless networks. A case study for 802.11-based WLANs reveals the issues that need to be solved in order to deploy cooperative techniques. We provide an overview of the state of the art in implementing cooperation approaches, analyze how appropriate these approaches solve the issues, and, where appropriate, point out their deficiencies. We conclude with a road map for future research necessary to tackle these deficiencies for the practical implementation of cooperation in next generation mesh, WLAN, WMAN, and cellular standards. [ABSTRACT FROM AUTHOR]

Background: It has been proposed, that the dramatic amelioration of type 2 diabetes following Roux-en-Y gastric bypass (RYGBP) could by accounted for, at least in part, by changes in glucagon-like peptide-1 (GLP-1) secretion. However, human data supporting this hypothesis is scarce. Methods: A 12-month prospective study on the changes in glucose homeostasis, and active GLP-1 in response to a standard test meal (STM) was conducted in 34 obese subjects (BMI 49.1±1.0 kg/m2) who had different degrees of glucose tolerance: normal glucose tolerance (NGT, n=12), impaired glucose tolerance (IGT, n=12), and type 2 diabetes (n=10). Results: At 6 weeks after RYGBP, despite the subjects still being markedly obese (BMI 43.5±0.9 kg/m2), fasting plasma glucose and HbA1c decreased in the 3 study groups ( P<0.05). Insulin sensitivity improved, but was still abnormal in a comparable proportion of subjects among groups ( P=0.717). When insulin secretion was accounted for the prevailing insulin sensitivity, an increase was found in subjects with diabetes ( P<0.05) although it remained lower compared to NGT- and IGT-subjects ( P<0.01). At 12 months follow-up, no differences among groups were found in the evaluated glucose homeostasis parameters. Compared to baseline, at 6 weeks the incremental AUC0-120' of active GLP-1 in response to the STM increased in NGT and IGT ( P<0.05) but not in subjects with diabetes ( P=0.285). However, the GLP-1 response to a STM was comparable among groups at 12 months follow-up ( P=0.887). Conclusions: 1) RYGBP was associated with an improvement but not complete restoration of glucose homeostasis at 6 weeks after surgery. 2) GLP-1 is not a critical factor for the early changes in glucose tolerance. [ABSTRACT FROM AUTHOR]

Background: The effects of adiponectin on glucose and lipid metabolism are mediated by the adiponectin receptors, adipoR1 and adipoR2, which are mainly in liver and muscle. We investigated the presence of adiponectin receptors in intra-abdominal adipose tissue (IAAT) in obesity and diabetes and their association with adiponectin expression and components of the metabolic syndrome and/or other metabolic factors associated with atherosclerotic cardiovascular disease (ASCVD). Methods: AdipoR1 and adipoR2 gene expression was measured by quantitative real time reverse transcription polymerase chain reaction in IAAT from lean and obese patients with or without diabetes type 2. Correlation between metabolic characteristics of obese patients and expression of these receptors was studied. Results: Neither obesity nor diabetes were associated with changes in IAAT-adipoR1 expression. In contrast, IAAT-adipoR2 was decreased by 39.5% in obese non-diabetics and by 52.7% in obese diabetics when compared to lean subjects. AdipoR1 and adiponectin expression was associated in lean (r=0.943, P<0.005) and obese non-diabetic patients (r=0.74, P<0.01), whereas a positive correlation between adipoR2 and adiponectin expression was only found in the presence of diabetes (r=0.883, P<0.002). AdipoR1 expression was associated with plasma free fatty acids (FFA) concentration (r=0.76, P<0.04), and adipoR2 inversely correlated with plasma levels of triglycerides (r=-0.76, P<0.04) and apolipoprotein B (r=-0.74, P<0.05). Conclusion: AdipoR1 expression in IAAT was not altered by obesity and/or diabetes and was related to plasma levels of FFA. IAAT-adipoR2 expression was reduced in obesity and diabetes and associated with components of metabolic processes leading to cardiovascular disease in obesity. [ABSTRACT FROM AUTHOR]

Cooperative transmission can be seen as a "virtual" MIMO system, where the multiple transmit antennas are in fact implemented distributed by the antennas both at the source and the relay terminal. Depending on the system design, diversity/multiplexing gains are achievable. This design involves the definition of the type of retransmission (incremental redundancy, repetition coding), the design of the distributed space-time codes, the error correcting scheme, the operation of the relay (decode & forward or amplify & forward) and the number of antennas at each terminal. Proposed schemes are evaluated in different conditions in combination with forward error correcting codes (FEC), both for linear and near-optimum (sphere decoder) receivers, for its possible implementation in downlink high speed packet services of cellular networks. Results show the benefits of coded cooperation over direct transmission in terms of increased throughput. It is shown that multiplexing gains are observed even if the mobile station features a single antenna, provided that cell wide reuse of the relay radio resource is possible. [ABSTRACT FROM AUTHOR]

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Ca-responsive mitochondrial FAD-linked glycerophosphate dehydrogenase (mGPDH) is a key component of the pancreatic β-cell glucose-sensing device. The purpose of this study was to examine the association of mutations in the cDNA coding for the FAD-binding domain of mGPDH and to explore the functional consequences of these mutations in vitro. To investigate this association in type 2 diabetes mellitus, we studied a cohort of 168 patients with type 2 diabetes and 179 glucose-tolerant control subjects of Spanish Caucasian origin by single-stranded conformational polymorphism analysis. In vitro site-directed mutagenesis was performed in the mGPDH cDNA sequence to reproduce those mutations that produce amino acid changes in a patient with type 2 diabetes. We detected mutations in the mGPDH FAD-binding domain in a single patient, resulting in a Gly to Arg amino acid change at positions 77, 78, and 81 and a Thr to Pro at position 90. In vitro expression of the mutated constructs in Xenopus oocytes resulted in a significantly lower enzymatic activity than in cells expressing the wild-type form of the enzyme. Our results indicate that although mutations in the mGPDH gene do not appear to have a major role in type 2 diabetes mellitus, the reduction in mGPDH enzymatic activity associated with the newly described mGPDH mutations suggests that they may contribute to the disease in some patients. [ABSTRACT FROM AUTHOR]

Ambrosia pollen is known as an importantallergen in North America, and more recently in someEuropean countries. From 1989 to 1995, the Ambrosia pollen levels detected at the stationsmonitored by the Aerobiological Network of Catalonia(Xarxa Aerobiològica de Catalunya, XAC) wereinsignificant. In 1996, a considerable althoughtemporary increase in the concentration of this pollenwas detected in the atmosphere over Girona, Barcelona,Bellaterra, Manresa, and Tarragona. Most of the Ambrosia pollen collected in 1996 was concentrated ina single day. Its appearance on that day wasattributed to long range transportation, caused byunusual conditions of atmospheric circulation, fromthe Lyon region in France where the species isabundant. This is the only day where concentrations of Ambrosia pollen that may be dangerous to humanhealth have been reached. Ambrosia coronopifolia is the most abundantspecies of the genus in Catalonia, and although rare,its expansion is favoured by the fact that it growsthrough rhizomes and sprouts easily. It is, therefore,important to monitor the growth of its population andthe release of its pollen in order to predict theappearance of pollen levels that may precipitateallergic symptoms. [ABSTRACT FROM AUTHOR]

Expanding the mass of pancreatic insulin-producing beta cells through re-activation of beta cell replication has been proposed as a therapy to prevent or delay the appearance of diabetes. Pancreatic beta cells exhibit an age-dependent decrease in their proliferative activity, partly related to changes in the systemic environment. Here we report the identification of CCN4/Wisp1 as a circulating factor more abundant in pre-weaning than in adult mice. We show that Wisp1 promotes endogenous and transplanted adult beta cell proliferation in vivo. We validate these findings using isolated mouse and human islets and find that the beta cell trophic effect of Wisp1 is dependent on Akt signaling. In summary, our study reveals the role of Wisp1 as an inducer of beta cell replication, supporting the idea that the use of young blood factors may be a useful strategy to expand adult beta cell mass. The proliferation of pancreatic beta cells decreases with age, partly due to systemic changes. Here the authors identify Wisp1 as a circulating factor enriched in young serum that induces adult beta cell proliferation, supporting the idea that young blood factors may be useful to expand beta cell mass. [ABSTRACT FROM AUTHOR]