The influence of bariatric (metabolic) surgery on blood polyunsaturated fatty acids: A systematic review.

BACKGROUND AND AIMS: Bariatric, also termed metabolic, surgery is an increasingly common treatment for severe and complex obesity. It decreases macronutrient intake, influences nutrient absorption and modifies gastrointestinal physiology with the aim of reducing adiposity, improving metabolism and reducing disease risk. Bariatric surgery has been shown to result in micronutrient deficiencies. Whether it results in deficiencies of essential fatty acids (EFAs) and their bioactive polyunsaturated fatty acid (PUFA) derivatives is not clear. The aim of this systematic review is to identify whether there are effects of bariatric surgery on the blood levels of EFAs and other PUFAs. METHODS: A database search was conducted up to November 2020 using Medline, Embase and Cinahl databases, using relevant search terms identified by a PICO protocol. Only human studies reporting on PUFAs in a blood pool, published in the English language and available in full text were included. The Cochrane tool for assessing risk of bias was used and data were extracted. RESULTS: Fifteen papers from fourteen studies with relevant data were identified for inclusion. Studies differed according to surgical intervention, duration, measured timepoints, sample size and PUFAs reported. Both increases and decreases in selected PUFAs were reported in different studies. For the EFAs linoleic acid and α-linolenic acid and for the longer-chain omega-3 PUFA eicosapentaenoic acid, bariatric surgery is associated with a transient decline in status (to about 6 months post-surgery) with a later return to pre-surgery levels. All studies had some risk of bias and most studies were of small size. CONCLUSION: There is a decrease in blood levels of both EFAs and of eicosapentaenoic acid in the months following bariatric surgery. This may partly counter the desired effects of the surgery on blood lipids, insulin sensitivity and inflammation. Nutritional strategies (e.g. use of modified formulas or of supplements) may be able to correct the decrease in those PUFAs. Nevertheless, the observed decrease in PUFAs is transient.

A new species of Andean lizard, Proctoporus (Gymnophthalmidae: Cercosaurinae), from the highland of Parque Nacional Otishi in Peru.

The gymnophthalmid Andean lizards of the genus Proctoporus (Gymnophthalmidae, Cercosaurinae) are semifossorial species that inhabit the montane forests, inter-Andean valley, and humid grasslands across the Cordillera de los Andes from Peru to Argentina. The distribution range of Proctoporus is discontinuous, with many places lacking herpetological surveys. Here, based on morphological data, we describe a new species of Proctoporus from a remote location on a mountaintop north of the Cordillera de Vilcabamba in southeastern Peru. The new species is readily distinguished from all other species of Proctoporus by the presence of three anterior infralabials, three rows of pregular scales and the absence of enlarged pregular scales. With this new species, the species diversity has increased to 19 since 18 species have previously been identified.

Applied science facilitates the large-scale expansion of protected areas in an Amazonian hot spot.

Meeting international commitments to protect 17% of terrestrial ecosystems worldwide will require >3 million square kilometers of new protected areas and strategies to create those areas in a way that respects local communities and land use. In 2000-2016, biological and social scientists worked to increase the protected proportion of Peru's largest department via 14 interdisciplinary inventories covering >9 million hectares of this megadiverse corner of the Amazon basin. In each landscape, the strategy was the same: convene diverse partners, identify biological and sociocultural assets, document residents' use of natural resources, and tailor the findings to the needs of decision-makers. Nine of the 14 landscapes have since been protected (5.7 million hectares of new protected areas), contributing to a quadrupling of conservation coverage in Loreto (from 6 to 23%). We outline the methods and enabling conditions most crucial for successfully applying similar campaigns elsewhere on Earth.

Actions on sustainable food production and consumption for the post-2020 global biodiversity framework.

Current food production and consumption trends are inconsistent with the Convention on Biological Diversity's 2050 vision of living in harmony with nature. Here, we examine how, and under what conditions, the post-2020 biodiversity framework can support transformative change in food systems. Our analysis of actions proposed in four science-policy fora reveals that subsidy reform, valuation, food waste reduction, sustainability standards, life cycle assessments, sustainable diets, mainstreaming biodiversity, and strengthening governance can support more sustainable food production and consumption. By considering barriers and opportunities of implementing these actions in Peru and the United Kingdom, we derive potential targets and indicators for the post-2020 biodiversity framework. For targets to support transformation, genuine political commitment, accountability and compliance, and wider enabling conditions and actions by diverse agents are needed to shift food systems onto a sustainable path.

Mitoxantrone in relapsing-remitting and rapidly progressive multiple sclerosis: Ten-year clinical outcomes post-treatment with mitoxantrone.

BACKGROUND: Mitoxantrone (MTX) has been used as an effective disease modifying treatment (DMT) in multiple sclerosis (MS). Evidence from studies demonstrates benefits of reduced relapse rates, MRI disease activity and disability progression in patients treated with MTX. While effective, MTX use has been limited due to potential adverse effects (AE) ranging from mild to potentially life-threatening AEs such as cardiotoxicity, bone marrow suppression and hematological malignancies. In this study we aimed to review the long-term clinical efficacy, tolerability, and AE profile of treatment with MTX in patients both with relapsing-remitting and rapidly progressive MS over a 10-year follow-up period. METHODS: We collected prospective data of 70 patients with relapsing-remitting and rapidly progressive MS treated with MTX and followed-up over a 10-year period. Expanded disability status scale (EDSS) scores and annualized relapse rates (ARR) were assessed 1 year prior to MTX treatment, and at different time points (1, 2, 3, 5 and 10 years) during follow-up. We recorded the time to first relapse and 0.5-point EDSS increase to assess efficacy. We also obtained frequency data on AEs and patients withdrawn from treatment. RESULTS: 70 patients were started on treatment with MTX with 53 patients (34 relapsing-remitting MS, 19 progressive disease) completing the course. Mean EDSS progressed from 5.5 to 6.5 in the relapsing-remitting group and 6.7 to 9.0 in the progressive group over the study period. ARR in the RRMS group reduced at all time points from 2.2 prior to MTX to 0.3 by year 10. We reported 3 significant AEs, one chicken pox and subsequent acute promyelocytic leukemia, one left ventricular systolic dysfunction, one pancytopenia. The commonest AE reported was nausea/vomiting in 28 (40%) patients. Seventeen patients (5 relapsing-remitting, 12 progressive disease) stopped treatment. In fifteen (87%) of these this was due to lack of efficacy. In the remaining 2 patients, MTX was stopped due to one patient developing chicken pox and the other developing first-degree heart block. CONCLUSION: Our study demonstrated that MTX is an effective disease modifying treatment for relapsing-remitting MS with a well-established risk profile. While MTX is now used less frequently, many MS and neurology services continue to follow-up patients who have been treated with MTX previously. Therefore, understanding the long-term effects risks and benefits remains relevant in this patient group. MTX is also a low-cost treatment in comparison to other high efficacy MS disease-modifying treatments and this may be beneficial in low resource settings.

Four new species of terrestrial-breeding frogs of the genus Phrynopus (Anura: Terrarana: Craugastoridae) from Río Abiseo National Park, Peru.

We describe four new species of terrestrial-breeding frogs belonging to the genus Phrynopus from specimens collected on the eastern slopes of the Cordillera Oriental (2800-3850 m) near and within Río Abiseo National Park, Provincia Mariscal Cáceres, Departments of San Martín and La Libertad, northeastern Peru. All four species lack a visible tympanum and inhabit the upper ridges and slopes within or adjacent to the Park. Phrynopus anancites sp. nov. and P. capitalis sp. nov. inhabit the wet montane grasslands on the upper ridges and valleys from 3600 to 3850 m. Phrynopus anancites (SVL = 25.3 mm) has coarsely aerolated skin and olive green coloration and has small vomerine teeth, while P. capitalis (female SVL = 35.6 mm) is characterized by a large head, short limbs, and distinctive dorsal pattern. Phrynopus dumicola sp. nov. (female SVL = 25.3 mm) has a short head and dark colored body with granular skin on the flanks, and is known only from forest patches along the treeline from 3225 to 3550 m, whereas P. personatus sp. nov. (female SVL = 28.2 mm) has a dark facemask and bright yellow groin spots (possibly aposematic), and inhabits a narrow band of continuous tropical montane rain forest from 2890 to 3110 m. We report infection with Batrachochytrium dendrobatidis from one specimen of P. dumicola collected in July of 1988. With the addition of these four new species, Phrynopus now includes 32 nominal species.

Batrachochytrium dendrobatidis and the collapse of anuran species richness and abundance in the Upper Manu National Park, Southeastern Peru.

Amphibians are declining worldwide, but these declines have been particularly dramatic in tropical mountains, where high endemism and vulnerability to an introduced fungal pathogen, Batrachochytrium dendrobatidis (Bd), is associated with amphibian extinctions. We surveyed frogs in the Peruvian Andes in montane forests along a steep elevational gradient (1200-3700 m). We used visual encounter surveys to sample stream-dwelling and arboreal species and leaf-litter plots to sample terrestrial-breeding species. We compared species richness and abundance among the wet seasons of 1999, 2008, and 2009. Despite similar sampling effort among years, the number of species (46 in 1999) declined by 47% between 1999 and 2008 and by 38% between 1999 and 2009. When we combined the number of species we found in 2008 and 2009, the decline from 1999 was 36%. Declines of stream-dwelling and arboreal species (a reduction in species richness of 55%) were much greater than declines of terrestrial-breeding species (reduction of 20% in 2008 and 24% in 2009). Similarly, abundances of stream-dwelling and arboreal frogs were lower in the combined 2008-2009 period than in 1999, whereas densities of frogs in leaf-litter plots did not differ among survey years. These declines may be associated with the infection of frogs with Bd. B. dendrobatidis prevalence correlated significantly with the proportion of species that were absent from the 2008 and 2009 surveys along the elevational gradient. Our results suggest Bd may have arrived at the site between 1999 and 2007, which is consistent with the hypothesis that this pathogen is spreading in epidemic waves along the Andean cordilleras. Our results also indicate a rapid decline of frog species richness and abundance in our study area, a national park that contains many endemic amphibian species and is high in amphibian species richness.

Disease-specific quality of life in multiple sclerosis: the effect of disease modifying treatment.

Disease specific quality of life was measured in the Leeds Multiple Sclerosis (MS) Treatment Programme (n = 210) using the self-report Leeds MS Quality of Life (LMSQoL) scale. The results showed a significant and sustained increase in quality of life associated with 'disease modifying' treatment. This contrasts with the Expanded Disability Status Scores (EDSS), which showed no measurable improvement. An increase in the LMSQoL score did not correlate with baseline age, disease duration, disability or number of prior relapses. There was no significant difference in treatment effect between relapsing-remitting and secondary progressive MS patients, or between patients receiving different products. However, patients with a poor quality of life at baseline showed the most benefit from treatment. Those who had their treatment stopped due to progression, side-effects or lack of effect had significantly lower LMSQoL scores on treatment. In this study, the LMSQoL scale was responsive to change and was easy to administer in a clinical setting.

Trigeminal cephalgias and facial pain syndromes associated with autonomic dysfunction.

Trigeminal autonomic cephalgias (TACs) include a spectrum of primary headache syndromes associated with cranial autonomic dysfunction. Other types of headache and facial pain syndromes can be associated with marked localized facial or ear autonomic changes. We report on a group of patients suffering from episodic migraine with cranial autonomic features, patients with different presentations of the 'red ear syndrome' (RES), cluster headache with prominent lower facial involvement and crossover cases. In our experience crossover between TACs and migraine, RES and cluster headache is not uncommon. We propose that all these conditions belong to the same group and a unifying causative mechanism is proposed.

Pathogenic autoantibodies to neuronal proteins in neurological disorders.

Autoantibodies to acetylcholine receptors and to voltage-gated calcium and potassium channels are thought to be pathogenic in three peripheral neurological disorders: myasthenia gravis, the Lambert Eaton syndrome and acquired neuromyotonia. However, evidence for the role of antibodies in conditions involving the central nervous system, is scanty or unclear. This review describes the ways in which the roles of autoantibodies have been defined in the peripheral diseases, and discusses the more controversial evidence for involvement of autoantibodies in some central disorders such as multiple sclerosis.