Customization of biliopancreatic limb length to modulate and sustain antidiabetic effect of gastric bypass surgery.

Although Roux-en-Y Gastric Bypass (RYGB) remains the most effective treatment for obesity and type 2 diabetes (T2D), many patients fail to achieve remission, or relapse. Increasing intestinal limb lengths of RYGB may improve outcomes, but the mechanistic basis for this remains unclear. We hypothesize biliopancreatic (BP) limb length modulates the antidiabetic effect of RYGB. Rats underwent RYGB with a 20-cm (RYGB-20cm) or 40-cm (RYGB-40cm) BP limb and were compared with control animals. After 2 and 4 wk, portal and systemic blood was sampled during intestinal glucose infusion. Portosystemic gradient was used to calculate intestinal glucose utilization (Gutil), absorption (Gabsorp), and hormone secretion. Intestinal morphology and gene expression were assessed. At 2 wk, Gabsorp progressively decreased with increasing BP limb length; this pattern persisted at 4 wk. Gutil increased ≈70% in both RYGB-20cm and -40cm groups at 2 wk. At 4 wk, Gutil progressively increased with limb length. Furthermore, Roux limb weight, and expression of hexokinase and preproglucagon, exhibited a similar progressive increase. At 4 wk, glucagon-like peptide-1 and -2 levels were higher after RYGB-40cm, with associated increased secretion. We conclude that BP limb length modulates multiple antidiabetic mechanisms, analogous to the dose-response relationship of a drug. Early postoperatively, a longer BP limb reduces Gabsorp. Later, Gutil, Roux limb hypertrophy, hormone secretion, and hormone levels are increased with longer BP limb. Sustained high incretin levels may prevent weight regain and T2D relapse. These data provide the basis for customizing BP limb length according to patient characteristics and desired metabolic effect. NEW & NOTEWORTHY Biliopancreatic limb length in gastric bypass modulates multiple antidiabetic mechanisms, analogous to the dose-response relationship of a drug. With a longer biliopancreatic limb, Roux limb hypertrophy, increased glucose utilization, reduced glucose absorption, and sustained high incretin levels may prevent weight regain and diabetes relapse.

Liposarcoma or invasive lipomatosis in flower horn fish, hybrid cichlid: clinical, radiological, ultrasonographical and histopathological study.

Liposarcoma or invasive lipomatosis affecting three indoor aquarium fish (flower horn fish, hybrid cichlid) is characterized, by the presence of mature adipocytes of variable sizes and by an invasive behaviour, which affected internal organs and eyes of all cases. Detailed macroscopic, radiological, ultrasonographical and histopathological features are presented. All fish had bilateral exophthalmia with some masses around the eyes. Ultrasonography confirmed the presence of hyperechoic masses in the eyes. Histopathology of all cases described the presence of variable-sized adipose cells in the eyes. The suggested diagnosis is well-differentiated liposarcoma or invasive lipomatosis. This is the first report of liposarcoma or invasive lipomatosis in flower horn fish, hybrid cichlid.

A Novel open-ended intravascular MRI loop probe.

Recently, intravascular catheter probes have been developed to increase SNR for MR imaging of coronary arteries. Miniaturization of these catheter probes without degrading their performances is very essential in imaging small arteries. Since both signal and noise received by intravascular loop probes are of low level, the noise generated by the cable connecting the probe to the matching circuit may reduce SNR significantly. Therefore, the tuning and matching circuit must be placed very close to the loop probe, which restricts its miniaturization and flexibility. We propose a novel open-ended loop probe for 64 MHz with an input impedance of 20 Ohm and a length of only 4 cm in the bare case. This has two advantages. Firstly, the matching and tuning circuits of the proposed probe can be located outside the vessel. Secondly, its signal level and uniformity is superior to that of the conventional loop antennas.

Novel double-turn loop probe for intravascular MRI.

Key challenges for design of intravascular loop probes are minimization of the cross sectional and length while increasing signal-to-noise ratio (SNR). Although NPO grade captors under 1mm dimensions are now available, the impedance matching network components still constrain tunability. In this study, a new loop probe is proposed for intravascular magnetic resonance imaging (MRI) at 1.5 Tesla. The new design is based on a two-turn loop, separated by a gap, which can be placed over a perfused inflatable balloon structure. The length and impedance of the probe are 1.1 cm and 23.5OHM (bare case), respectively. The SNR of the new probe is greater than the conventional loop probe. To evaluate the performance of the probe, a series of SNR, length, and impedance comparisons with the conventional loop probes are carried out.

Drug treatment of asthma in the 1990s: achievements and new strategies.

Asthma is an inflammatory condition of the airways. First-line therapy involves the use of inhaled corticosteroids as anti-inflammatory agents to control the underlying process. Bronchodilators are used for symptom relief. Short-acting beta-agonists provide rapid relief of bronchoconstriction, whereas long-acting beta-agonists control the symptoms and reduce the frequency of exacerbations when combined with inhaled corticosteroids. Anticholinergic bronchodilators have a minor role in acute exacerbations and in patients troubled by adverse effects from beta-agonists. Theophylline has a bronchodilator action in asthma, but its role as an anti-inflammatory agent needs to be examined further. Because of their toxicity, corticosteroid-sparing agents have a limited role, being restricted to patients with severe uncontrolled asthma. New selective phosphodiesterase IV inhibitors show both anti-inflammatory and bronchodilator characteristics with fewer adverse effects. Other new approaches to the control of inflammation come from the antileukotriene drugs, which improve pulmonary function in patients with chronic asthma. The antileukotrienes have shown promising results, especially in the treatment of asthma caused by aspirin (acetylsalicylic acid), exercise and cold air. Other new therapies being studied include anti-immunoglobulin E, antitryptase and anti-CD4 agents. These newer possibilities suggest that the range of available treatment options will expand significantly over the next decade.