A Novel Sensory Wave (P25) in Myelin Oligodendrocyte Glycoprotein-induced Experimental Autoimmune Encephalomyelitis Murine Model.

Myelin oligodendrocyte glycoprotein (MOG)-induced experimental autoimmune encephalomyelitis (EAE) is a murine model for multiple sclerosis. This model is characterized by chronic and progressive demyelination, leading to impairment of motor function and paralysis. While the outcomes of the disease, including impaired motor function and immunological changes, are well-characterized, little is known about the impact of EAE on the electrophysiology of the motor and sensory systems. In this study, we assessed evoked potentials as a quantitative marker for in vivo monitoring of nervous system damage. Motor-evoked potentials (MEPs) and sensory-evoked potentials (SEPs) were first standardized in naïve C57BL mice and studied thoroughly in EAE mice. The duration of MEPs and the number of connotative potentials increased significantly alongside an increase in temporal SEP amplitudes. Moreover, a new SEP wave was identified in naïve animals, which significantly increased in MOG-induced EAE animals with no or mild symptoms (clinical score 0-2, 0-5 scale). This wave occurred ∼25 milliseconds poststimulation, thus named p25. P25 was correlated with increased vocalization and was also reduced in amplitude following treatment with morphine. As the EAE score progressed (clinical score 3-4, 0-5 scale), the amplitude of MEPs and SEPs decreased drastically. Our results demonstrate that desynchronized neural motor activity, along with hypersensitivity in the early stages of EAE, leads to a complete loss of motor and sensory functions in the late stages of the disease. The findings also suggest an increase in p25 amplitude before motor deficits appear, indicating SEP as a predictive marker for disease progression. PERSPECTIVE: This article assesses p25, a new sensory electrophysiology wave that correlates with pain-related behavior in MOG-induced EAE mice and appears prior to the clinical symptoms. Motor electrophysiology correlates with traditional motor behavior scoring and histology.

Pregnancy outcome of patients following bariatric surgery as compared with obese women: a population-based study.

OBJECTIVE: To evaluate pregnancy outcome and rates of anemia in patients following bariatric operation in comparison with obese pregnant women. METHODS: A retrospective population-based study comparing pregnancy outcome of patients following bariatric with the obese population was conducted. Multivariate logistic regression models were constructed to control for confounders. To evaluate the change in hemoglobin levels, we included women who had one pregnancy before the bariatric surgery and one following the surgery or two pregnancies for women with obesity. RESULTS: This study included 326 women who had one pregnancy before and after a bariatric surgery and 1612 obese women who had at least two consecutive deliveries. Using a multivariable logistic regression model, controlling for confounders such as maternal age, patients following bariatric surgery had lower rates of gestational diabetes mellitus (OR 0.7; 95% CI 0.5-0.9; p = 0.49) and macrosomia (OR 0.3; 95% CI 0.2-0.5; p < 0.001) as compared with obese parturients. Women post bariatric surgery were more likely to be anemic (hemoglobin <10 g/dL) as compared to obese parturients (48% versus 37%; OR, 1.5; 95% CI, 1.2-1.9; p < 0.001). A significant decline in hemoglobin level was noted in patients following bariatric surgery (a decline of 0.33 g/dL versus 0.18 g/dL between two consecutive pregnancies of obese women). Using another multivariable model with anemia as the outcome variable, bariatric was noted as a risk factor for anemia (adjusted OR = 1.45, 95%CI 1.13-1.86, p = 0.004). CONCLUSION: Women following bariatric surgery have lower risk for gestational diabetes mellitus and fetal macrosomia as compared with obese parturients. Nevertheless, bariatric surgery is a risk factor for anemia.

Downsizing pregnancy complications: a study of paired pregnancy outcomes before and after bariatric surgery.

BACKGROUND: Overweight and obesity have been shown to be associated with increased adverse pregnancy outcomes. Weight reduction improves maternal health status and reduces the risk of pregnancy complications, as well as long-term consequences. Our objective was to compare the pregnancy outcomes of the same women who delivered before and after bariatric surgery. METHODS: A retrospective study comparing pregnancy outcomes, of the same women, delivered before and after a bariatric surgery was conducted. The observed deliveries occurred from 1988 to 2008 at Soroka University Medical Center, the sole tertiary hospital in the southern region of Israel. RESULTS: The present study included 288 paired pregnancies: 144 deliveries before and 144 after bariatric surgery. A significant reduction in the prepregnancy and predelivery maternal body mass index was noted after bariatric surgery (36.37 ± 5.2 versus 30.50 ± 5.4 kg/m(2), P < .001; and 40.15 ± 4.92 versus 34.41 ± 5.42 kg/m(2), P < .001; respectively). Only 8 patients (5.6%) were admitted during their pregnancy for bariatric complications. Pregnancy complications, such as hypertensive disorders (31.9% versus 16.6%; P = .004) and diabetes mellitus (20.8% versus 7.6%; P = .001), were significantly reduced after bariatric surgery. The rate of cesarean deliveries because of labor dystocia was significantly lower after bariatric surgery (5.6% versus 2.1%, P < .05). Using a multiple logistic regression model, controlling for maternal age, the reduction in hypertensive disorders (odds ratio .4, 95% confidence interval .2-.8) and diabetes mellitus (odds ratio .15, 95% confidence interval .1-.4) remained significant. CONCLUSION: A significant decrease in pregnancy complications, such as hypertensive disorders and diabetes mellitus, is achieved after bariatric surgery.

Pregnancy outcome of patients who conceive during or after the first year following bariatric surgery.

OBJECTIVE: We sought to compare pregnancy outcome of patients who conceived during or after the first year postbariatric surgery. STUDY DESIGN: A retrospective study comparing pregnancy outcome between patients who conceived during or after the first postoperative year was conducted. RESULTS: The study included 104 pregnancies of patients who conceived during and 385 who conceived after the first postoperative year. Prepregnancy and predelivery body mass index were comparable between the groups. No significant differences were noted regarding hypertensive disorders (15.4% in the early vs 11.2% in the late postoperative pregnancy; P = .392); diabetes mellitus (11.5% vs 7.3%; P = .392); perinatal outcomes, such as congenital malformations (1.9% vs 1.3%; P = .485); or bariatric complications (6.7% vs 7.0%; P = .392) between the groups. Using multiple logistic regression models, controlling for confounders, the interval (in months) was not associated with pregnancy complications. CONCLUSION: Patients who conceived during the first postoperative year had comparable short-term perinatal outcome compared with patients who conceived after the first postoperative year.

Pregnancy outcome in patients following different types of bariatric surgeries.

BACKGROUND: The objective of this study was to investigate pregnancy outcome of patients following different types of bariatric surgery. METHODS: A population-based study includes all pregnancies of patients with bariatric surgeries delivered during 1988-2008. Pregnancy outcome was compared between the different types of surgeries. RESULTS: This retrospective study included 449 deliveries: 394 deliveries following pure restrictive operations-laparoscopic gastric banding (LAGB; n = 202), silastic ring vertical gastroplasty (SRVG; n = 136), and vertical-banded gastroplasty (VBG; n = 56)-and 55 deliveries following restrictive and malabsorptive Roux-en-Y gastric bypass (RGB). While no significant differences were noted between the groups regarding body mass index (BMI) before the bariatric operations or prepregnancy BMI, patients following LAGB had significantly higher BMI before delivery (36.8 +/- 5.9 kg compared to the SRVG 33.4 +/- 6.0, VBG 34.2 +/- 5.4, and RGB 34.9 +/- 6.8 groups; p < 0.001). Following LAGB, patients had higher weight gain during pregnancy (13.1 +/- 9.6 kg) compared to the SRVG (8.8 +/- 7.4), VBG (8.5 +/- 8.0), and RGB (11.6 +/- 9.6; p < 0.001) groups. The interval between operation and pregnancy was shorter in the LAGB group (22.8 months) compared to the SRVG (41.0) and the VBG (42.1) groups and was significantly higher in the RGB group (57.4; p < 0.001). Birth weight was significantly higher among newborns of patients following RBG (3,332.8 +/- 475.5 g) compared to the restrictive procedures (3,104.3 +/- 578.7 in the LAGB, 3,086.7 +/- 533.1 in the SRVG, and 3,199.2 +/- 427.2 in the VBG groups). No significant differences in low birth weight (<2,500 g) or macrosomia (>4,000 g), or low Apgar scores or perinatal mortality were noted between the groups. CONCLUSION: There is no difference in the affect on pregnancy outcome among the different forms of bariatric surgeries; all procedures have basically comparable perinatal outcome.

Effect of bariatric surgery on pregnancy outcome.

OBJECTIVE: To compare the perinatal outcomes of women who delivered before with women who delivered after bariatric surgery. METHODS: A retrospective study was undertaken to compare perinatal outcomes of women who delivered before with women who delivered after bariatric surgery in a tertiary medical center between 1988 and 2006. A multivariate logistic regression model was constructed to control for confounders. RESULTS: During the study period, 301 deliveries preceded bariatric surgery and 507 followed surgery. A significant reduction in rates of diabetes mellitus (17.3% vs 11.0; P=0.009), hypertensive disorders (23.6% vs 11.2%; P<0.001), and fetal macrosomia (7.6% vs 3.2%; P=0.004) were noted after bariatric surgery. Bariatric surgery was found to be independently associated with a reduction in diabetes mellitus (OR 0.42, 95% CI 0.26-0.67; P<0.001), hypertensive disorders (OR 0.38, 95% CI 0.25-0.59; P<0.001), and fetal macrosomia (OR 0.45, 95% CI 0.21-0.94; P=0.033). CONCLUSION: A decrease in maternal complications, such as diabetes mellitus and hypertensive disorders, as well as a decrease in the rate of fetal macrosomia is achieved following bariatric surgery.

Does nonarticlar tenderness change after bariatric surgery?

BACKGROUND: A previous study reported an association between obesity and increased tenderness. However, the effect of weight reduction on tenderness is not known. The aim of the study was to assess tenderness thresholds before and after bariatric surgery. METHODS: 42 obese women were evaluated for tenderness before and 6 months after bariatric surgery. A count of 18 tender points at 9 symmetrical sites was performed by thumb palpation. 13 point sites (9 tender point sites and 4 control sites) were further studied using a dolorimeter. RESULTS: The obese subjects displayed increased tenderness before surgery and its level did not change 6 months later. The mean tender point count before surgery was 8.8+/-3.9 and after surgery was 8.3+/-4.3 (P=0.500). The mean tenderness thresholds at nine tender points were 4.0+/-1.1 and 3.8+/-1.1, respectively (P=0.247). CONCLUSION: Nonarticular tenderness in obese women remained high after weight reduction. These findings are relevant to physicians taking care of obese patients. Further studies are needed to elucidate the relationship between weight reduction and pain thresholds.