Search

Akathisia continues to present a significant challenge in clinical practice. As a class, so-called atypical, or second-generation, antipsychotics (SGAs) are the mainstay of treatment for schizophrenia and are commonly used to treat mood disorders. These medications have traditionally been distinguished from first-generation antipsychotics by their lowered risk of extrapyramidal side effects (EPS) such as dystonia, dyskinesia, akathisia, and pseudoparkinsonism. However, the occurrence of EPS, particularly akathisia, has been demonstrated to some degree in all commercially available SGAs. This review examines the incidence of akathisia in nine newer SGAs in patients with schizophrenia, bipolar disorder, and major depressive disorder (MDD). We performed a search of PubMed, ClinicalTrials.gov, Cochrane Central Register, and Google Scholar, as well as manufacturer websites and product labeling for published and unpublished clinical trials, meta-analyses, and systematic reviews. Studies evaluating adult patients with schizophrenia, bipolar disorder, or MDD were eligible for inclusion. Data on treatment-emergent akathisia rates were gathered from each study, and potential dose-response relationships were explored. A total of 177 studies were included in this review, comprising 58,069 patients across 414 treatment arms. Compared with placebo with a composite 3.7% incidence of akathisia, individual SGAs produced akathisia at total composite rates ranging from 2.9-13.0% across the included studies. High doses of an SGA were generally associated with an increased risk of akathisia. Clinicians should consider the risk of akathisia when choosing a treatment option and monitor for akathisia in patients beginning therapy with an SGA or following a dose increase of the SGA.

Graduate students who serve as teaching assistants are a critical part of STEM (science, technology, engineering, mathematics) education and research at large universities in the U.S. Yet just like faculty, graduate students are not immune to the publish or perish paradigm, which can compete with one's dedication to teaching. While in recent years many STEM faculty members have become aware of how well undergraduates can assist instructors in their teaching, many, if not most, university faculty still teach in traditional settings, where graduate students are the norm and use of undergraduates is a completely unexploited opportunity. Undergraduates can serve as effective teaching assistants and may bring unique skills and experience to undergraduate instruction not held by graduate students. Undergraduate teaching assistants (UTAs) can provide additional support for reformed practices, which raise student learning. Based on cost, prior experience and success as students in same course, and shared vision with professors, a number of institutions have initiated UTA programs and reported increased student learning. The audience of this paper is faculty who are not familiar with the use of UTAs in university teaching, and the purpose is to review the literature on UTAs, contrast the contributions of UTAs and graduate teaching assistants, and examine the potential value of UTAs in undergraduate education.

Purpose Obesity is associated with alterations in appetite, gastrointestinal hormone levels and excessive fat mass. We previously published a double-blind, placebo-controlled, randomized, 16-week trial on effects of once-daily glucagon-like peptide-1 (GLP-1) analog, liraglutide on weight, satiation, and gastric functions in obese volunteers. The aim of this substudy is to compare to placebo the effects of liraglutide on appetite, taste preference, regional body fat stores, and anthropometric measurements. Methods Forty obese adults received standard instruction for weight management, monthly behavioral intervention utilizing motivational interviews, and 16-week treatment of once-daily liraglutide (escalated to 3 mg SQ daily). At baseline and 16 weeks, the following were measured: appetite and taste preferences rated every 30 min for 5 h after ingesting 300 mL Ensure®; maximal tolerated volume (MTV) with a nutrient drink test; fasting and postprandial bioactive GLP-1 (7–36) and peptide YY (PYY) levels; total and regional body fat with dual-energy X-ray absorptiometry, and waist and hip circumference. Results Thirty-five participants (17 liraglutide; 18 placebo) completed the trial. Compared to placebo group, liraglutide group had significant reductions in MTV; prospective food consumption score; desire to eat something sweet, salty, savory or fatty; and an increase in perceived fullness. Postprandial plasma levels of GLP-1 decreased and PYY levels increased with liraglutide relative to baseline. Significant reductions in total body, trunk, and upper and lower body fat without reduction in lean body mass were observed. Conclusion Liraglutide 3 mg SQ modulates appetite, taste preference, gut hormones, and regional body fat stores in adults with obesity without reduction in lean body mass.

Objectives: To investigate the impact of arthroscopic shoulder labral repair on return to play (RTP), career longevity, workload, and performance of Major League Baseball (MLB) athletes Methods: A retrospective review of MLB players after arthroscopic shoulder labral repair from 2004-2018 was performed. A 2:1 control group matched by demographic information was used. Demographics, workload, and performance metrics were collected. Statistical analysis examined workload/performance at one and three-years after injury compared to one-year before. Workload/performance percentage relative to baseline was also compared. Results: 26/ 39 (66%) pitchers and 18/25 (72%) positional players RTP and were matched with 54 and 34 controls, respectively. Following surgery, players experienced shorter careers (2.3 ± 2.6 vs 5.8 ± 2.8, pConclusions: Following RTP after arthroscopic shoulder labral repair, MLB players had reduced career longevity and workload/performance one-year post-index, but these stats returned towards baseline at three-years post-index. [Figure: see text][Figure: see text][Table: see text][Table: see text]

Summary Background Liraglutide, a long-acting GLP-1 receptor agonist, is approved for treatment of obesity; however, the mechanisms of action of liraglutide are incompletely understood. We compared effects of liraglutide versus placebo on gastric motor functions, satiation, satiety, and weight in obese individuals over 16 weeks. Methods We did a randomised, double-blind, placebo-controlled pilot trial at a single centre (Mayo Clinic, Rochester, MN, USA). Participants were randomly allocated (1:1) by a computer generated randomisation schedule with no stratification to receive subcutaneous liraglutide (3·0 mg) or placebo, with standardised nutritional and behavioural counselling. Allocation was concealed from participants and study investigators. Otherwise healthy, local residents aged 18–65 years with body-mass index (BMI) 30 kg/m 2 or higher were included. Liraglutide or placebo was escalated by 0·6 mg/day each week for 5 weeks and continued until week 16. The primary outcome was change in gastric emptying (delay relative to baseline) of solids T 1/2 (time taken for half the radiolabelled meal to empty from the stomach), measured at 5 weeks and 16 weeks in all patients who received at least one dose of study drug, with missing data imputed. Secondary outcomes included weight loss at weeks 5 and 16, satiation (volume to fullness and maximum tolerated volume), satiety, and fasting and postprandial gastric volumes at 16 weeks. This trial is registered with ClinicalTrials.gov, number NCT02647944, and is closed to new participants. Findings Between Dec 18, 2015, and Sept 1, 2016, 40 adults were enrolled and randomly allocated (19 to the liraglutide group; 21 to the placebo group). Compared with placebo, liraglutide delayed gastric emptying of solids at 5 weeks (median 70 min [IQR 32 to 151] vs 4 min [–21 to 18]; p vs −1 min [–19 to 7]; p=0·025). There was also significantly greater weight loss in the liraglutide group than in the placebo group (at 5 weeks: median 3·7 kg [IQR 2·8 to 4·8] vs 0·6 kg [–0·3 to 1·4], p vs 2·5 kg [0·1 to 4·2], p=0·0009). Satiation, as assessed by maximum tolerated volume at 16 weeks, was lower in the liraglutide group (median 750 mL [IQR 651 to 908]) compared with the placebo group (1126 mL [944–1185]; p=0·054). No significant differences were noted between groups in terms of volume to fullness, satiety, or fasting and postprandial gastric volumes at week 16. Post-hoc analysis showed that the T 1/2 of gastric emptying of solids at 5 weeks correlated with change in weight loss at week 16 with liraglutide (Rs 0·567, p=0·018). Nausea was the most common adverse event in the liraglutide group (12 of 19) compared with placebo (four of 21). Interpretation Effects of liraglutide on weight loss are associated with delay in gastric emptying of solids; measurement of gastric emptying (eg, at 5 weeks of treatment) may be a biomarker of responsiveness and may help to select individuals for prolonged treatment with this class of drug. Funding US National Institutes of Health grant R56-DK67071.

The global prevalence of obesity continues to rise at an alarming rate and 37.7% of US adults are obese. Understanding the causes of excessive weight gain is extremely important, as it paves the way for the development of new therapies to control this epidemic. Obesity is a heterogeneous chronic disease where multiple factors interact to produce a state of positive energy balance leading to an increase in body weight. This review focuses on the major biological, environmental, and behavioral determinants of obesity. The key biological factors include genetics, brain-gut axis, prenatal determinants, pregnancy, menopause, neuroendocrine conditions, medications, physical disability, gut microbiome, and viruses. Propensity to develop obesity owing to one or more of these elements is exacerbated by environmental and behavioral influences. Environmental factors include food abundance, built environments, socioeconomic status, culture, social bias, and environmental chemicals. Behavioral factors comprise excessive calorie intake, eating patterns, sedentary lifestyles, insufficient sleep, and smoking cessation. It is essential to identify the determinants of adiposity in individuals with obesity to tailor prevention and treatment techniques effectively.

Grape pomace contains considerable amounts of polyphenols and it has been reported to exhibit specific inhibitory activity against mammalian intestinal α-glucosidases. This study aims to investigate the anti-diabetes potential of Chambourcin, Merlot, Norton, Petit Verdot, Syrah and Tinta Cão red wine grape pomaces by assessing their rat intestinal α-glucosidase inhibitory activity in relation to their total phenolic content and individual identified phenolic compounds by HPLC. Among the selected pomaces, Tinta Cão, Syrah and Merlot extracts showed higher potency in inhibiting α-glucosidase, and appeared to have higher respective total phenolic contents. Fifteen phenolic compounds were identified in the pomace samples, however, none of them showed significant inhibition of intestinal α-glucosidases. Red grape pomace, namely Tinta Cão, appears to be a promising functional food for the potential future development of a food-derived α-glucosidase inhibitor for preventing and treating diabetes.

The Orbera intragastric balloon (OIB) is a single fluid-filled intragastric balloon approved for the induction of weight loss and treatment of obesity. However, little is known about the effectiveness and safety of the OIB outside clinical trials, and since approval, the Food and Drug Administration has issued warnings to health care providers about risk of balloon hyperinflation requiring early removal, pancreatitis, and death. We analyzed data on patients who have received the OIB since its approval to determine its safety, effectiveness, and tolerance in real-world clinical settings.We performed a postregulatory approval study of the safety and efficacy of the OIB, and factors associated with intolerance and response. We collected data from the Mayo Clinic's database of patient demographics, outcomes of OIB placement (weight loss, weight-related comorbidities), technical aspects of insertion and removal, and adverse events associated with the device and/or procedure, from 8 centers (3 academic, 5 private, 4 surgeons, and 4 gastroenterologists). Our final analysis comprised 321 patients (mean age, 48.1 ± 11.9 y; 80% female; baseline body mass index, 37.6 ± 6.9). Exploratory multivariable linear and logistic regression analyses were performed to identify predictors of success and early balloon removal. Primary effectiveness outcomes were percentage of total body weight lost at 3, 6, and 9 months. Primary and secondary safety outcomes were rates of early balloon removal, periprocedural complications, dehydration episodes requiring intravenous infusion, balloon migration, balloon deflation or hyperinflation, pancreatitis, or other complications.Four patients had contraindications for placement at the time of endoscopy. The balloon was safely removed in all instances with an early removal rate (before 6 months) in 16.7% of patients, at a median of 8 weeks after placement (range, 1-6 mo). Use of selective serotonin or serotonin-norepinephrine re-uptake inhibitors at the time of balloon placement was associated with increased odds of removal before 6 months (odds ratio, 3.92; 95% CI, 1.24-12.41). Total body weight lost at 3 months was 8.5% ± 4.9% (n = 204), at 6 months was 11.8% ± 7.5% (n = 199), and at 9 months was 13.3% ± 10% (n = 47). At 6 months, total body weight losses of 5%, 10%, and 15% were achieved by 88%, 62%, and 31% of patients, respectively. Number of follow-up visits and weight loss at 3 months were associated with increased weight loss at 6 months (β = 0.5 and 1.2, respectively) (P.05). Mean levels of cholesterol, triglycerides, low-density lipoprotein, and hemoglobin A1c, as well as systolic and diastolic blood pressure, were significantly improved at 6 months after OIB placement (P.05).In an analysis of a database of patients who received endoscopic placement of the OIB, we found it to be safe, effective at inducing weight loss, and to reduce obesity-related comorbidities in a real-world clinical population. Rates of early removal (before 8 weeks) did not differ significantly between clinical trials and the real-world population, but were affected by use of medications.

Chitosan films incorporated with various concentrations of gallic acid were prepared and investigated for antimicrobial, mechanical, physical and structural properties. Four bacterial strains that commonly contaminate food products were chosen as target bacteria to evaluate the antimicrobial activity of the prepared gallic acid–chitosan films. The incorporation of gallic acid significantly increased the antimicrobial activities of the films against Escherichia coli , Salmonella typhimurium , Listeria innocua and Bacillus subtilis . Chitosan films incorporated with 1.5 g/100 g gallic acid showed the strongest antimicrobial activity. It was also found that tensile strength (TS) of chitosan film was significantly increased when incorporating 0.5 g/100 g gallic acid. Inclusion of 0.5 g/100 g gallic acid also significantly decreased water vapor permeability (WVP) and oxygen permeability (OP). Microstructure of the films was investigated by Fourier transform infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM) and it was found that gallic acid was dispersed homogenously into the chitosan matrix.

This study investigated the potential effects of the digestion process on antioxidant properties and individual phenolic compounds of two European gooseberries (Ribes uva-crispa): Tixia and Invicta. Gooseberries were digested via an in vitro digestive model with active or heat-inactivated enzymes. Digested and undigested samples were subject to antioxidant assays including total phenolic content (TPC) assay, DPPH radical scavenging assay, and oxygen radical absorbance capacity (ORAC) assay. Furthermore, the individual phenolic compounds in gooseberries before and after digestion were extracted and determined. Results revealed that digestion enhances the availability of antioxidants in both gooseberries, where the digested fruits showed higher total phenolic content and antioxidant capacity. In addition, Tixia gooseberry possesses higher antioxidant capacity than Invicta based on TPC, DPPH, and ORAC results. Eight phenolic antioxidants were identified and quantified in Tixia and Invicta gooseberries. Among the identified phonic compounds, only quercetin hydrate was significantly improved by digestion. Our findings indicate that digestion enhances TPC content and antioxidant activity in gooseberries.

Dietary antioxidants may provide a cost-effective strategy to promote health in obesity by targeting oxidative stress and inflammation. We recently found that the antioxidant-rich grape skin extract (GSE) also exerts a novel anti-hyperglycemic activity. This study investigated whether 3-month GSE supplementation can improve oxidative stress, inflammation, and hyperglycemia associated with a Western diet-induced obesity. Young diet-induced obese (DIO) mice were randomly divided to three treatment groups (n = 12): a standard diet (S group), a Western high fat diet (W group), and the Western diet plus GSE (2.4 g GSE/kg diet, WGSE group). By week 12, DIO mice in the WGSE group gained significantly more weight (24.6 g) than the W (20.2 g) and S groups (11.2 g); the high fat diet groups gained 80% more weight than the standard diet group. Eight of 12 mice in the W group, compared to only 1 of 12 mice in the WGSE group, had fasting blood glucose levels above 140 mg/dL. Mice in the WGSE group also had 21% lower fasting blood glucose and 17.1% lower C-reactive protein levels than mice in the W group (P0.05). However, the GSE supplementation did not affect oxidative stress in diet-induced obesity as determined by plasma oxygen radical absorbance capacity, glutathione peroxidase, and liver lipid peroxidation. Collectively, the results indicated a beneficial role of GSE supplementation for improving glycemic control and inflammation in diet-induced obesity.