The role of 2-[18F]FDG PET/CT in Erdheim-Chester disease.

OBJECTIVE: To analyze the body distribution of Erdheim-Chester disease (ECD) and determine the utility of 2-[18 F]FDG PET/CT compared to other imaging techniques. Additionally, to assess the aggressiveness and extent of the disease based on the presence/absence of the BRAFV600E mutation. MATERIALS AND METHODS: The 2-[18F]FDG-PET/CT scans of all patients diagnosed with ECD between 2008 and 2021 were reviewed, including 19 patients. The affected territories were classified as detectable by PET/CT or detectable only by other imaging techniques (bone scintigraphy, contrast-enhanced CT, or MRI). Descriptive analysis and correlation of the BRAF mutation with the affected organs and maximum SUV were performed using the Student's t-test. RESULTS: Out of the 19 patients (14 males; mean age 60.3 years), 11 had the BRAFV600E mutation. A total of 127 territories (64 organ-systems) affected were identified using different imaging modalities, of which 112 were detected by PET/CT, and an additional 15 territories were solely identified by cerebral and cardiac MRI. The presence of BRAFV600E mutation was associated with greater organ involvement (p < 0.05) without differences in SUVmax (p > 0.05). CONCLUSION: 2-[18F]FDG PET/CT is a highly effective diagnostic tool in patients with ECD, detecting the majority of affected territories. MRI was the only imaging modality with additional findings in territories showing high physiological uptake of 2-[18F]FDG (cerebral and cardiac). The presence of the BRAFV600E mutation correlated with a higher extent of the disease.

Caloric restriction modulates the monoaminergic system and metabolic hormones in aged rats.

Caloric restriction (CR) can attenuate the general loss of health observed during aging, being one of the mechanisms involved the reduction of hormonal alteration, such as insulin and leptin. This change could also prevent age-specific fluctuations in brain monoamines, although few studies have addressed the effects of CR on peripheral hormones and central neurotransmitters exhaustively. Therefore, the variations in brain monoamine levels and some peripheral hormones were assessed here in adult 4-month old and 24-month old male Wistar rats fed ad libitum (AL) or maintained on a 30% CR diet from four months of age. Noradrenaline (NA), dopamine (DA), serotonin (5-HT) and its metabolites were measured by high-performance liquid chromatography with electrochemical detection (HPLC-ED) in nine brain regions: cerebellum, pons, midbrain, hypothalamus, thalamus, hippocampus, striatum, frontal cortex, and occipital cortex. In addition, the blood plasma levels of hormones like corticosterone, insulin and leptin were also evaluated, as were insulin-like growth factor 1 and other basal metabolic parameters using enzyme-linked immunosorbent assays (ELISAs): cholesterol, glucose, triglycerides, albumin, low-density lipoprotein, calcium and high-density lipoprotein (HDLc). CR was seen to increase the NA levels that are altered by aging in specific brain regions like the striatum, thalamus, cerebellum and hypothalamus, and the DA levels in the striatum, as well as modifying the 5-HT levels in the striatum, hypothalamus, pons and hippocampus. Moreover, the insulin, leptin, calcium and HDLc levels in the blood were restored in old animals maintained on a CR diet. These results suggest that a dietary intervention like CR may have beneficial health effects, recovering some negative effects on peripheral hormones, metabolic parameters and brain monoamine concentrations.

A comparison between biostimulation and bioaugmentation in a solid treatment of anaerobic sludge: Drug content and microbial evaluation.

Emerging pollutants can reach the environment through the sludge of Wastewater Treatment Plants. In this work, the use of Trametes versicolor in biopiles at lab-scale was studied, evaluating its capacity to remove the most hydrophobic Pharmaceuticals and assessing the evolution of the biopiles microbial communities. The total removal of drugs at real concentrations from sewage sludge was assessed for non-inoculated and fungal inoculated biopiles, testing if the re-inoculation of the biopiles after 22 days of treatment would improve the removal yields. It was found that 2 out of the 15 initially detected pharmaceuticals were totally degraded after 22 days, and re-inoculated fungal biopiles achieved higher removal rates than non-re-inoculated fungal biopiles for single compounds and for all the drugs simultaneously: 66.45% and 49.18% re-inoculated and non-re-inoculated biopiles, respectively. Finally, the study of the bacterial and fungal communities revealed that fungal inoculated and non-inoculated biopiles evolved to similar communities adapted to the presence of those drugs.

Assessment of micro-scale anaerobic digestion for management of urban organic waste: A case study in London, UK.

This paper describes the analysis of an AD plant that is novel in that it is located in an urban environment, built on a micro-scale, fed on food and catering waste, and operates as a purposeful system. The plant was built in 2013 and continues to operate to date, processing urban food waste and generating biogas for use in a community café. The plant was monitored for a period of 319days during 2014, during which the operational parameters, biological stability and energy requirements of the plant were assessed. The plant processed 4574kg of food waste during this time, producing 1008m3 of biogas at average 60.6% methane. The results showed that the plant was capable of stable operation despite large fluctuations in the rate and type of feed. Another innovative aspect of the plant was that it was equipped with a pre-digester tank and automated feeding, which reduced the effect of feedstock variations on the digestion process. Towards the end of the testing period, a rise in the concentration of volatile fatty acids and ammonia was detected in the digestate, indicating biological instability, and this was successfully remedied by adding trace elements. The energy balance and coefficient of performance (COP) of the system were calculated, which concluded that the system used 49% less heat energy by being housed in a greenhouse, achieved a net positive energy balance and potential COP of 3.16 and 5.55 based on electrical and heat energy, respectively. Greenhouse gas emissions analysis concluded that the most important contribution of the plant to the mitigation of greenhouse gases was the avoidance of on-site fossil fuel use, followed by the diversion of food waste from landfill and that the plant could result in carbon reduction of 2.95kg CO2eq kWh-1 electricity production or 0.741kg CO2eq kg-1 waste treated.

Effects of moderate beer consumption on health and disease: A consensus document.

A large evidence-based review on the effects of a moderate consumption of beer on human health has been conducted by an international panel of experts who reached a full consensus on the present document. Low-moderate (up to 1 drink per day in women, up to 2 in men), non-bingeing beer consumption, reduces the risk of cardiovascular disease. This effect is similar to that of wine, at comparable alcohol amounts. Epidemiological studies suggest that moderate consumption of either beer or wine may confer greater cardiovascular protection than spirits. Although specific data on beer are not conclusive, observational studies seem to indicate that low-moderate alcohol consumption is associated with a reduced risk of developing neurodegenerative disease. There is no evidence that beer drinking is different from other types of alcoholic beverages in respect to risk for some cancers. Evidence consistently suggests a J-shaped relationship between alcohol consumption (including beer) and all-cause mortality, with lower risk for moderate alcohol consumers than for abstainers or heavy drinkers. Unless they are at high risk for alcohol-related cancers or alcohol dependency, there is no reason to discourage healthy adults who are already regular light-moderate beer consumers from continuing. Consumption of beer, at any dosage, is not recommended for children, adolescents, pregnant women, individuals at risk to develop alcoholism, those with cardiomyopathy, cardiac arrhythmias, depression, liver and pancreatic diseases, or anyone engaged in actions that require concentration, skill or coordination. In conclusion, although heavy and excessive beer consumption exerts deleterious effects on the human body, with increased disease risks on many organs and is associated to significant social problems such as addiction, accidents, violence and crime, data reported in this document show evidence for no harm of moderate beer consumption for major chronic conditions and some benefit against cardiovascular disease.

Effects of alcohol and polyphenols from beer on atherosclerotic biomarkers in high cardiovascular risk men: a randomized feeding trial.

BACKGROUND AND AIMS: Moderate alcohol consumption exerts a cardioprotective effect, but no studies have evaluated the alcohol-independent cardiovascular effects of the non-alcoholic components of beer. We aimed to evaluate the effects of ethanol and the phenolic compounds of beer on classical and novel cardiovascular risk factors. METHODS AND RESULTS: Thirty-three high risk male volunteers were included in a randomized, crossover feeding trial. After a washout period, all subjects received beer (30 g alcohol/d, 660 mL), the equivalent amount of polyphenols as non-alcoholic beer (990 mL), and gin (30 g alcohol/d, 100 mL) for 4 weeks. All outcomes were evaluated before and after each intervention period. Moderate alcohol consumption increased serum HDL-cholesterol (∼5%), ApoA-I (∼6%), ApoA-II (∼7%) and adiponectin (∼7%), and decreased serum fibrinogen (∼8%), and interleukin (IL)-5 (∼14%) concentrations, whereas the non-alcoholic fraction of beer (mainly polyphenols) increased the receptor antagonist of IL-1 (∼24%), and decreased lymphocyte expression of lymphocyte function-associated antigen-1 (∼11%), lymphocyte and monocyte expression of Sialil-Lewis X (∼16%) and monocyte expression of CCR2 (∼31%), and tumor necrosis factor (TNF)-ß (∼14%) and IL-15 (∼22%) plasma concentrations. No changes were observed in glucose metabolism parameters or in body weight and adiposity parameters. CONCLUSION: The phenolic content of beer reduces leukocyte adhesion molecules and inflammatory biomarkers, whereas alcohol mainly improves the lipid profile and reduces some plasma inflammatory biomarkers related to atherosclerosis.

Latest evidence of the effects of the Mediterranean diet in prevention of cardiovascular disease.

The first step in the prevention of cardiovascular disease is healthy lifestyle and diet. Recent systematic reviews of observational studies ranked Mediterranean diet as the most likely dietary model to provide cardiovascular protection. This review updates the knowledge on the effects of Mediterranean diet from observational and randomized trials published in the last year. The results of the PREDIMED study, a randomized trial providing a higher level of scientific evidence than cohort studies, confirmed that the Mediterranean diet reduces the incidence of cardiovascular events. This effect may be exerted by reducing blood pressure; improving glucose metabolism, lipid profile, and lipoprotein particle characteristics; and decreasing inflammation and oxidative stress. It may also stem from a favorable interaction between diet and gene polymorphisms related to cardiovascular risk factors and events. These recent results allow us to recommend Mediterranean diet to subjects at high risk for cardiovascular disease with the highest level of scientific evidence.

The EMT activator ZEB1 promotes tumor growth and determines differential response to chemotherapy in mantle cell lymphoma.

Mantle cell lymphoma (MCL) is a B-cell malignancy characterized by a poor response to treatment and prognosis. Constitutive activation of different signaling pathways in subsets of MCLs, through genetic and/or nongenetic alterations, endows tumor cells with enhanced proliferation and reduced apoptosis. The canonical Wnt pathway (ß-catenin/TCF-LEF), implicated in the pathogenesis of numerous cancers, is constitutively active in half of MCLs. Here, we show that ZEB1, a transcription factor better known for promoting metastasis in carcinomas, is expressed in primary MCLs with active Wnt signaling. ZEB1 expression in MCL cells depends on Wnt, being downregulated by ß-catenin knockdown or blocking of Wnt signaling by salinomycin. Knockdown of ZEB1 reduces in vitro cell viability and proliferation in MCL cells, and, importantly, tumor growth in mouse xenograft models. ZEB1 activates proliferation-associated (HMGB2, UHRF1, CENPF, MYC, MKI67, and CCND1) and anti-apoptotic (MCL1, BCL2, and BIRC5) genes and inhibits pro-apoptotic ones (TP53, BBC3, PMAIP1, and BAX). We show that ZEB1 expression in MCL cells determines differential resistance to chemotherapy drugs and regulates transporters involved in drug influx/efflux. Downregulation of ZEB1 by salinomycin increases the sensitivity of MCL cells to the cytotoxic effect of doxorubicin, cytarabine and gemcitabine. Lastly, salinomycin and doxorubicin display a synergistic effect in established and primary MCL cells. These results identify ZEB1 in MCL where it promotes cell proliferation, enhanced tumor growth and a differential response to chemotherapy drugs. ZEB1 could thus potentially become a predictive biomarker and therapeutic target in this lymphoma.

Lesion of the commissural nucleus of the solitary tract/A2 noradrenergic neurons facilitates the activation of angiotensinergic mechanisms in response to hemorrhage.

In the present study, we investigated the effects of lesions of A2 neurons of the commissural nucleus of the solitary tract (cNTS) alone or combined with the blockade of angiotensinergic mechanisms on the recovery of arterial pressure (AP) to hemorrhage in conscious rats. Male Holtzman rats (280-320g) received an injection of anti-dopamine-beta-hydroxylase-saporin (12.6ng/60nl; cNTS/A2-lesion, n=28) or immunoglobulin G (IgG)-saporin (12.6ng/60nl, sham, n=24) into the cNTS and 15-21days later had a stainless steel cannula implanted in the lateral ventricle. After 6days, rats were submitted to hemorrhage (four blood withdrawals, 2ml/300g of body weight every 10min). Both cNTS/A2-lesioned and sham rats had similar hypotension to hemorrhage (-62±7 and -73±7mmHg, respectively), however cNTS/A2-lesioned rats rapidly recovered from hypotension (-5±3mmHg at 30min), whereas sham rats did not completely recover until the end of the recording (-20±3mmHg at 60min). Losartan (angiotensin type 1 receptor antagonist) injected intracerebroventricularly (100µg/1µl) or intravenously (i.v.) (10mg/kg of body weight) impaired the recovery of AP in cNTS/A2-lesioned rats (-24±6 and -35±7mmHg at 30min, respectively). In sham rats, only i.v. losartan affected the recovery of AP (-39±6mmHg at 60min). The results suggest that lesion of the A2 neurons in the cNTS facilitates the activation of the angiotensinergic pressor mechanisms in response to hemorrhage.

Cocoa consumption reduces NF-κB activation in peripheral blood mononuclear cells in humans.

BACKGROUND AND AIMS: Epidemiological studies have demonstrated an association between high-polyphenol intake and reduced incidence of atherosclerosis. The healthy effects of cocoa-polyphenols may be due to their antioxidant and anti-inflammatory actions, although the exact mechanisms are unknown and depend on the matrix in which cocoa-polyphenols are delivered. Nuclear factor κB (NF-κB) is a key molecule in the pathophysiology of atherosclerosis involved in the regulation of adhesion molecules(AM) and cytokine expression and its activation is the first step in triggering the inflammatory process. The aim of this study was to evaluate the effect of acute cocoa consumption in different matrices related to the bioavailability of cocoa-polyphenols in NF-κB activation and the expression of AM. METHODS AND RESULTS: Eighteen healthy volunteers randomly received 3 interventions: 40g of cocoa powder with milk (CM), with water (CW), and only milk (M). NF-κB activation in leukocytes and AM (sICAM, sVCAM, E-selectin) were measured before and 6h after each intervention. Consumption of CW significantly decreased NF-κB activation compared to baseline and to CM (P < 0.05, both), did not change after CM intervention, and significantly increased after M intervention (P = 0.014). sICAM-1 concentrations significantly decreased after 6h of CW and CM interventions (P ≤ 0.026; both) and E-selectin only decreased after CW intervention (P = 0.028). No significant changes were observed in sVCAM-1 concentrations. CONCLUSIONS: The anti-inflammatory effect of cocoa intake may depend on the bioavailability of bioactive compounds and may be mediated at least in part by the modulation of NF-κB activation and downstream molecules reinforcing the link between cocoa intake and health.

[Nutrition, metabolic syndrome and morbid obesity]. / Nutrición, síndrome metabólico y obesidad mórbida.

INTRODUCTION: Obesity, and specifically morbid obesity (MO), is a chronic disease with serious health consequences related to the associated comorbidities and constitutes a leading risk factor for the metabolic syndrome (MS) and cardiovascular disease (CVD). In the present study we analyze the abnormalities related to MO in the plasmatic levels of nutrients (both macro and micronutrients). METHODS: We retrospectively evaluated data of 497 patients, 369 women and 128 men diagnosed of MO. The average age of the patients was 40.07 (rank: 16-62). Previous to the study anthropometric measures, blood pressure (BP) and plasma levels of insulin and macronutrients and micronutrients were measured. RESULTS: The higher body mass index (BMI) in women and the waist circumference (WC) in both sexes demonstrates the existence of visceral obesity. Hypertensive disease (HD) was found in 18.6% of men and 33.5% of women. 55.1% of the men and 42.3% of the women had three or more criteria defining the risk of developing MetS. We found hyperglycemia, insulinemia and dyslipemia. We did not find protein malnutrition, but there were elevated values of reactive C-protein. Biochemical indicators of macro and micronutrients were not altered. DISCUSSION AND CONCLUSIONS: The high incidence of patients with HD, carriers of three or more criteria that defines the metabolic syndrome (SM), suggests that a very significant part of our patients suffered the metabolic syndrome (MS). The term metabolic syndrome defines the group of factors of metabolic risk of CVD, which is confirmed by the elevated levels of reactive C-protein. We did not find abnormalities in the plasmatic levels of biochemical markers of nutrients.

Moderate consumption of red wine, but not gin, decreases erythrocyte superoxide dismutase activity: a randomised cross-over trial.

BACKGROUND AND AIMS: Several studies have shown that moderate alcohol consumption reduces the risk of coronary heart disease, a disease related to oxidative stress. However, the effects of different alcoholic beverages on antioxidant status are not fully known. Our aim was therefore to compare the effects of a moderate intake of an alcoholic beverage with high polyphenol content (red wine) and another without polyphenol content (gin) on plasma antioxidant vitamins, lipid profile and oxidability of low-density lipoprotein (LDL) particles. METHODS AND RESULTS: Forty healthy men (mean age, 38 years) were included in a randomised cross-over trial. After a 15-day washout period, subjects received 30 g/ethanol/d as either wine or gin for 28 days. Diet and exercise were monitored. Before and after each intervention, we measured serum vitamins, malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase activities, lipid profile, oxidized LDL and LDL resistance to ex-vivo oxidative stress. Compared to gin intervention, wine intake reduced plasma SOD activity [-8.1 U/gHb (95% confidence interval, CI, -138 to -25; P=0.009)] and MDA levels [-11.9 nmol/L (CI, -21.4 to-2.5; P=0.020)]. Lag phase time of LDL oxidation analysis also increased 11.0 min (CI, 1.2-20.8; P=0.032) after wine, compared to gin, whereas no differences were observed between the two interventions in oxidation rate of LDL particles. Peroxide concentration in LDL particles also decreased after wine [-0.18 nmol/mL (CI, -0.3 to-0.08;P=0.020)], as did plasma oxidized LDL concentrations [-11.0 U/L (CI,-17.3 to -6.1; P=0.009)]. CONCLUSION: Compared to gin, red wine intake has greater antioxidant effects, probably due to its high polyphenolic content.

Solid phase microextraction as a methodology in the detection of irradiation markers in ground beef.

The usefulness of solid phase microextraction (SPME) to detect the occurrence of the irradiation markers 2-dodecylcyclobutanone (2-DCB) and 1,3-bis(1,1-dimethylethyl)benzene in irradiated ground beef was evaluated. To that aim, beef samples were irradiated with different irradiation doses and subsequently examined together with non-irradiated beef samples used as control samples. The SPME conditions applied were selected as a result of performing an optimization process including different fibers (PDMS, DVB/CAR/PDMS, polyacrylate and PDMS/DVB), as well as extraction times (10, 25 and 40min) and temperatures (40 and 60°C). For comparison, 2-DCB and 1,3-bis(1,1-dimethylethyl)benzene were additionally identified in some of the samples by steam distillation-solvent extraction (SDE). Although this study is a preliminary work, from the results obtained SPME seemed to be a rapid and valuable technique to determine 2-DCB and 1,3-bis(1,1-dimethylethyl)benzene in ground beef subjected to irradiation, offering advantages over other methods reported in the literature. In addition, SPME allowed to confirm the validity of 2-DCB as an useful marker to distinguish non-irradiated from irradiated ground beef. On the contrary, the occurrence of 1,3-bis(1,1-dimethylethyl)benzene was however established in both types of samples by SPME and SDE.

[Morbid obesity, non-alcoholic fatty liver disease, metabolic syndrome and bariatric surgery]. / Obesidad mórbida, enfermedad de hígado graso no alcohólico, síndrome metabólico y cirugía bariátrica.

OBJECTIVES: The objectives of the present study are: 1) to assess protein changes in patients diagnosed with morbid obesity (MO) and non-alcoholic fatty liver disease (NAFLD) or steatohepatitis (NASH); 2) to assess the likely reversibility of these entities after bariatric surgery, and 3) to analyze their progression seven years after the gastric bypass. MATERIAL AND METHODS: We retrospectively analyzed the data from 190 patients, 150 women (79%) and 40 men (21%) diagnosed with MO and surgically treated at our Hospital (Capella's gastric bypass). Mean age of the patients was 36.5 years (range: 18.5-54.5). Anthropometric values are gathered: body mass index (BMI), waist circumference (WC) and biochemistry: insulin (INS), glucose (GLU), total proteins (TP), albumin (ALB), transferrin (TRF), ferritin (FER), prealbumin (PBA), retinol binding protein (RBP) and C reactive protein (CRP). The HOMA index was calculated before the bypass and at the following follow-up periods after bypass: 6, 12, 60 and 84 months. RESULTS: Abdominal ultrasound suggesting NAFLD or NASH was found in 34.7% (n = 66; 52 women and 14 men) of MO patients surgically treated. Ninety patients (47.3%; 67 women and 23 men) presented risk factors for metabolic syndrome (MS). All patients with possible liver dysfunction had MS. Before the bypass, we found increased levels of: BMI, WC, CRP, GLU, INS and HOMA index and changes in TP, ALB, PBA, RBP, FER and TRF levels. The first set of parameters start to decrease within 6 months after surgical bypass and at the same time the changes in protein levels start to face off and remain stable at 84 months. CONCLUSIONS: Weight loss due to bariatric surgery represents an effective method of fighting MO and its associated comorbidities (NAFLD, NASH, hyperinsulinemia, hyperglycemia, dyslipidemia and components of the metabolic syndrome).

Lesions of the commissural subnucleus of the nucleus of the solitary tract increase isoproterenol-induced water intake.

The nucleus of the solitary tract (NTS) is the primary site of the cardiovascular afferent information about arterial blood pressure and volume. The NTS projects to areas in the central nervous system involved in cardiovascular regulation and hydroelectrolyte balance, such as the anteroventral third ventricle region and the lateral parabrachial nucleus. The aim of the present study was to investigate the effects of electrolytic lesion of the commissural NTS on water and 0.3 M NaCl intake and the cardiovascular responses to subcutaneous injection of isoproterenol. Male Holtzman rats weighing 280 to 320 g were submitted to sham lesion or electrolytic lesion of the commissural NTS (N = 6-15/group). The sham-lesioned rats had the electrode placed along the same coordinates, except that no current was passed. Water intake induced by subcutaneous isoproterenol (30 microg/kg body weight) significantly increased in chronic (15 days) commissural NTS-lesioned rats (to 2.4 +/- 0.2 vs sham: 1.9 +/- 0.2 mL 100 g body weight-1 60 min-1). Isoproterenol did not induce any sodium intake in sham or in commissural NTS-lesioned rats. The isoproterenol-induced hypotension (sham: -27 +/- 4 vs commissural NTS-lesioned rats: -22 +/- 4 mmHg/20 min) and tachycardia (sham: 168 +/- 10 vs commissural NTS: 144 +/- 24 bpm/20 min) were not different between groups. The present results suggest that the commissural NTS is part of an inhibitory neural pathway involved in the control of water intake induced by subcutaneous isoproterenol, and that the overdrinking observed in lesioned rats is not the result of a cardiovascular imbalance in these animals.

Lesions of the commissural subnucleus of the nucleus of the solitary tract increase isoproterenol-induced water intake

The nucleus of the solitary tract (NTS) is the primary site of the cardiovascular afferent information about arterial blood pressure and volume. The NTS projects to areas in the central nervous system involved in cardiovascular regulation and hydroelectrolyte balance, such as the anteroventral third ventricle region and the lateral parabrachial nucleus. The aim of the present study was to investigate the effects of electrolytic lesion of the commissural NTS on water and 0.3 M NaCl intake and the cardiovascular responses to subcutaneous injection of isoproterenol. Male Holtzman rats weighing 280 to 320 g were submitted to sham lesion or electrolytic lesion of the commissural NTS (N = 6-15/group). The sham-lesioned rats had the electrode placed along the same coordinates, except that no current was passed. Water intake induced by subcutaneous isoproterenol (30 µg/kg body weight) significantly increased in chronic (15 days) commissural NTS-lesioned rats (to 2.4 ± 0.2 vs sham: 1.9 ± 0.2 mL 100 g body weight-1 60 min-1). Isoproterenol did not induce any sodium intake in sham or in commissural NTS-lesioned rats. The isoproterenol-induced hypotension (sham: -27 ± 4 vs commissural NTS-lesioned rats: -22 ± 4 mmHg/20 min) and tachycardia (sham: 168 ± 10 vs commissural NTS: 144 ± 24 bpm/20 min) were not different between groups. The present results suggest that the commissural NTS is part of an inhibitory neural pathway involved in the control of water intake induced by subcutaneous isoproterenol, and that the overdrinking observed in lesioned rats is not the result of a cardiovascular imbalance in these animals.

HOMA, QUICKI and MFfm to measure insulin resistance in morbid obesity.

BACKGROUND: The relationship between morbid obesity (MO) and insulin resistance (IR) has been widely demonstrated. The euglycemic-hyperglycemic clamp method for diagnosis of IR is neither practical nor cost-effective for population-based studies. However, the application of mathematical models (HOMA, QUICKI and Mf(fm) indices) can be useful. METHODS: The data from 171 patients were retrospectively evaluated. We recorded general anthropometric parameters and the basal levels of glucose, triglycerides and insulin and calculated the metabolic indexes both before surgery (Capella gastric bypass) and 6, 12, 24, 36 and 48 months after the operation. RESULTS: Before surgery, patients could be classified according to their waist-hip ratio (WHR) into 2 groups. Group A (n = 131, 108 females and 23 males) with WHR values 1.10 +/- 0.1 SD for males and 0.94 +/- 0.1 for females (central obesity); and Group B (n = 40, 34 females and 6 males) with WHR values 0.90 +/- 0.1 for males and 0.84 +/- 0.1 for females (peripheral obesity). Group A patients showed elevated serum levels of glucose, triglycerides and insulin and high values of the HOMA index with low values of QUICKI and Mf(fm). Group B patients showed lower levels of glucose, triglycerides, insulin and HOMA index and higher values of QUICKI and Mf(fm). These abnormal levels began to decrease 6 months after bypass and the QUICKI and Mf(fm) began to increase. CONCLUSIONS: The high baseline levels of insulin and the high prevalence of hypertension, diabetes or both conditions in patients with central obesity confirm that they suffer a metabolic syndrome, Meanwhile, patients with peripheral obesity with lower levels of chemical parameters and of the metabolic indices suffer peripheral resistance against insulin. Clinical application of these mathematical indices can be useful in patients with MO; they are easily performed and lack the high costs and risks associated with the clamp technique.

Morbid obesity, hypertensive disease and the renin-angiotensin-aldosterone axis.

BACKGROUND: Resistance to insulin and secondary hyperinsulinemia seem to be the putative link between morbid obesity (MO) and hypertensive disease (HD). Adipose tissue can secrete leptin and angiotensinogen, among other substances. Leptin activates the sympathetic nervous system, leading to HD. Angiotensinogen is a substrate for renin, therefore taking part in the renin-angiotensin-aldosterone axis and the regulation of blood pressure. In MO, both hypertrophy and hyperplasia of the adipocytes lead to an increase in the secretion of both substances, leading to loss of the equilibrium between the levels of both hormones. The aim of the present study was to evaluate these abnormalities and their potential reversibility following bariatric surgery. METHODS: Data from 100 patients with MO was retrospectively evaluated. Anthropometric data, the plasma renin activity (PRA), plasma levels of aldosterone, ACE, potassium and sodium were collected both prior to surgery and 6, 12, 24 and 36 months after surgery. RESULTS: The waist-hip ratio (WHR) before surgery allowed classification of our patients in two groups: central obesity (WHR > or =0.90 in men and > or =0.85 in women); peripheral obesity (WHR <0.90 in men and <0.85 in women). In patients with central obesity, high levels of PRA, aldosterone and ACE with sodium retention and potassium loss and high insulin levels, were found. These changes were not found in patients with peripheral obesity. After gastric bypass, these abnormalities tended to disappear, mainly in the first 6 months. CONCLUSIONS: The reduction of BMI and WHR after gastric bypass confirmed this operation to be effective against MO. The high basal levels of insulin and the high rate of HD and diabetes in patients with central obesity seem to indicate that they suffer a metabolic syndrome with significant hormonal imbalances and sodium retention. Patients with peripheral obesity only showed a peripheral resistance against insulin, probably with a shorter duration of the hormonal action, but they did not show hormonal abnormalities or sodium retention. After gastric bypass these abnormal hormone levels tended to normalize.

Morbid obesity and gastric bypass surgery: biochemical profile.

BACKGROUND: Morbid obesity (MO) and the pathologies associated with it constitute an important public health problem, accounting for 7% of the health expenditure in industrialized countries. An important percentage of this expense is attributed to the different biochemical tests performed in these patients, who suffer from several metabolic derangements. We evaluated the basic biochemical abnormalities in MO patients and their reversibility by weight loss after gastric bypass, to standardize the surveillance of the different metabolic abnormalities in obese patients. METHODS: By a retrospective analysis on 125 patients operated in our hospital, we evaluated anthropometric and biochemical data before and 1, 3, 6, 12 and 24 months after gastric bypass. RESULTS: Preoperatively hyperinsulinemia, hyperglycemia, dyslipidemia and hypertensive disease were present, and began to improve 1 and 3 months after surgery (although not significantly) and significantly at 6, 12 and 24 months after it. We also observed deficient protein nutrition and a deficiency of micronutrients both before bypass and during the follow-up. CONCLUSION: After gastric bypass, a marked decrease in insulin occurred, with normalization of blood pressure and the biochemical parameters associated with the metabolic syndrome. We propose a biochemical follow-up protocol for MO patients.