Fundoplication is superior to medical therapy for Barrett's esophagus disease regression and progression: a systematic review and meta-analysis.

BACKGROUND: Fundoplication and medical management are current mainstays for management of Barrett's esophagus (BE), however our understanding of differences in outcomes between these two treatments is limited. The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy of these interventions on BE disease regression and progression. METHODS AND PROCEDURES: A comprehensive search in MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library databases was performed on February 22, 2021. Inclusion criteria were studies with both medical and surgical management comparators, BE diagnosis prior to treatment, patients aged ≥ 18 years, and studies with greater than five patients. Primary outcomes of interest included evaluating changes in histopathologic BE regression and disease progression between interventions. Meta-analysis was performed using a Mantel-Haenszel random-effects model (RevMan 5.4.1). RESULTS: A total of 7231 studies were retrieved after initial search with nine studies (1 randomized trial, 7 prospective cohorts, 1 retrospective cohort) meeting final inclusion criteria. Of included studies, 890 (65%) patients received medical management while 470 (35%) received surgical management. Medical management included proton pump inhibitors (n = 807, 91%; 6 studies), H2-receptor blockers (n = 40, 4% patients; 3 studies), and combination therapy (n = 43, 5%; 1 study). Nissen fundoplication was the most commonly performed type of fundoplication (n = 265, 93%). Median length of follow-up ranged from 1.5-7 years. Meta-analysis revealed that fundoplication was associated with improved histopathologic regression of metaplasia/low-grade dysplasia (OR 4.38; 95% CI 2.28-8.42; p < 0.00001) and disease progression to dysplasia/adenocarcinoma (OR 0.34; 95% CI 0.12-0.96; p = 0.04) compared to medical therapy. CONCLUSION: Fundoplication is superior to medical therapy with regards to improved odds of histopathologic BE disease regression and disease progression. Additional randomized trials which directly compare medical management and surgical intervention are required to delineate the optimal delivery and timing of these interventions.

Selecting the right anticoagulant for stroke prevention in atrial fibrillation.

OBJECTIVE: The embolization of thrombi formed within the atria can occur in any form of atrial fibrillation (AF), i.e., paroxysmal, persistent, or permanent. Although ischemic stroke is the most frequent embolic event associated with AF, embolization to other sites in the pulmonary and systemic circulations may occasionally occur. To avert the risk of embolization, long-term oral anticoagulation therapy is recommended for all AF patients if the CHA2DS2-VASC score is at least 1 for men and at least 2 for women. Since anticoagulant therapy is associated with an increased risk of bleeding, the choice of oral anticoagulant agent should be made by careful consideration of the benefit-to-risk ratio. The use of a newer class of direct oral anticoagulants (DOACs) as an alternative to the anti-vitamin K (AVK) anticoagulants (warfarin, acenocumarol, etc.) can help mitigate the need for periodic monitoring of International Normalized Ratio (INR) and adverse bleeding events that are commonly associated with the use of AVK anticoagulants. Though the use of DOACs (dabigatran, rivaroxaban, edoxaban, apixaban, etc.) is gaining ground due to their relative safety profile and the low overall cost, quite a few clinicians remain skeptical about their use. PATIENTS AND METHODS: Our objective was to evaluate the risk of thromboembolism, stroke, neuropsychiatric illness, depression, and dementia, in patients with non-valvular atrial fibrillation who have been treated with either acenocumarol or apixaban, as well as to see the inflammatory status (ESR) and levels of fibrinogen. Our team at Municipal Emergency University Hospital, Timisoara, Romania, conducted a retrospective study using the medical records of AF patients who were treated with either apixaban or acenocumarol between 2016-2019. We divided the patients into two groups and compared the groups for the aforementioned outcomes. RESULTS: AF patients who were prescribed apixaban had a lower rate of stroke and psychiatric illness compared to those on acenocumarol. No significant correlation was found in terms of risk of developing depression or dementia between the groups. CONCLUSIONS: Non-valvular AF patients on apixaban had lower rates of thromboembolic events than the patients on acenocumarol. This article will serve as a reminder of the positive health and financial outcomes of apixaban use, especially to those healthcare systems that are still oblivious to the decrease in economic burden and gain in quality-adjusted life years (QALY) by the long-term use of NOACS/ DOACS instead of the AVK anticoagulants.

ASSOCIATION OF GHRELIN RECEPTOR AND INFLAMMATION IN PERI-ATRIAL ADIPOSE TISSUE FROM OBESE PATIENTS WITH POSTOPERATIVE ATRIAL FIBRILLATION.

CONTEXT: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. The increasing evidence supports links between inflammation and AF. There is evidence showing that obesity is a major cause of adipose tissue (AT) inflammation. Ghrelin (GHRL), through its growth hormone secretagogue receptor (GHS-R) present on adipose tissue macrophages (ATMs), could modulate AT inflammation. OBJECTIVE: Our study aimed to evaluate the role of adipose tissue macrophages (ATMs) and their GHS-R in adipose tissue samples of right atrial appendages (RAA) biopsies. SUBJECTS AND METHOD: We obtained RAA biopsies from 10 obese patients, undergoing cardiac surgery for coronary artery bypass graft (CABG) and developing postoperative atrial fibrillation (POAF). The epicardial tissue samples were examined using immunohistochemistry to visualize and quantify CD68 and GSH-R expression of the ATMs. RESULTS: Histologically, the mean adipocyte diameter (MAD) of epicardial adipose tissue (EAT) was larger in EAT samples with inflammation as compared to EAT without inflammation (84.2 µm vs. 79.6 µm). The expression of CD68 was lower in EAT without inflammation as compared to EAT with inflammation in adipose tissue samples. Similarly, the expression of GSH-R was lower in EAT samples without inflammation as compared to EAT samples with inflammation in adipose tissue. CONCLUSIONS: Increased epicardial fat area, macrophage infiltration, and GHS-R expression in epicardial ATMs appeared to be associated with postoperative atrial fibrillation in obese patients.

INSIGHTS ON AROMATASE IMMUNOHISTOCHEMISTRY: VARIATIONS BETWEEN INTRINSIC MOLECULAR SUBTYPES OF BREAST CANCERS.

CONTEXT: Aromatase is a key enzyme in local estrogen production by androgen conversion, especially in women post-menopause. There have been controversies concerning aromatase localization in breast carcinomas and its association with current histopathological variables. MATERIAL AND METHODS: Using polyclonal antibody immunohistochemistry we assessed (by intensity and percentage scores) the immunolocalization of aromatase in 70 tissue samples, and described particularities within the molecular subtypes of breast cancer. RESULTS: Aromatase was found in all tissue compartments: tumor (95.7%), stroma (58.6%) and adipose tissue (94.3%). Aromatase expression in tumor cells correlated inversely with tumor grading (p=-0.361, p=0.027), and positively with estrogen receptor status (ER, p=0.143, p<0.001). Dividing the study group by intrinsic subtypes, a strongly inversely association between tumor aromatase and grading (p=-0.486, p<0.001), and between stromal aromatase and Ki67-index (p=-0.448, p=0.048) was observed in luminal A breast cancer. Tumor aromatase and ER percentage scores had stronger correlations in luminal B HER2 negative (p=0.632, p=0.002), and positive (p=0.324, p=0.026) tumors. In contrast, in triple negative tumors, a positive association stromal aromatase and Ki67 index (p=-0.359, p=0.007) was observed. CONCLUSION: Local aromatase was linked to better tumor differentiation and proliferation in luminal breast subtypes, and not in triple negative cases, suggesting a potential prognostic role of aromatase in breast carcinomas.

Lights4Violence: a quasi-experimental educational intervention in six European countries to promote positive relationships among adolescents.

BACKGROUND: Preventing intimate partner violence or dating violence (DV) among adolescents is a public health priority due to its magnitude and damaging short and long-term consequences for adolescent and adult health. In our study protocol, we complement prior experiences in DV prevention by promoting protective factors (or assets) against gender violence such as communication skills, empathy and problem-solving capability through "Cinema Voice", a participatory educational intervention based on adolescents' strengths to tackle DV. METHODS/DESIGN: A longitudinal quasi-experimental educational intervention addressed to boys and girls ages 13-17 years, enrolled in secondary education schools in Alicante (Spain), Rome (Italy), Cardiff (UK), Iasi (Romania), Poznan (Poland) and Matosinhos (Portugal). Both process and results evaluations will be carried out with 100-120 intervention and 120-150 control group students per city at three time periods: before, after and 6 months after the implementation of the following interventions: 1) Training seminar with teachers to promote knowledge and skills on the core issues of intervention; 2) Workshops with intervention groups, where participants produce their own digital content presenting their perspective on DV; and 3) Short film exhibitions with participants, their families, authorities and other stakeholders with the objective of share the results and engage the community. Outcome measures are self-perceived social support, machismo, sexism, tolerance towards gender violence, social problem-solving and assertiveness as well as involvement in bullying/cyberbullying. Other socio-demographic, attitudes and violence-related co-variables were also included. DISCUSSION: This study may provide relevant information about the effectiveness of educational interventions that combine a positive youth development framework with educational awareness about the importance of achieving gender equality and preventing and combating gender violence. To our knowledge, this is the first study that involves six European countries in an educational intervention to promote violence protective assets among enrolled adolescents in secondary schools. This study may provide the needed tools to replicate the experience in other contexts and other countries. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03411564 . Unique Protocol ID: 776905. Date registered: 18-01-2018.

MIDDLE TERM IMPACT OF SLEEVE GASTRECTOMY ON MAJOR CARDIOVASCULAR RISK FACTORS IN A GROUP OF ROMANIAN OBESE PATIENTS.

BACKGROUND AND AIM: The goals of bariatric surgery are to improve the quality of life by lowering body mass index (BMI) but also to treat obesity comorbidities. The aim of our study was to evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on metabolic parameters. METHODS: 85 obese patients treated by bariatric surgery LSG procedure were included in the study. Basal, 6 and 12 months after surgery serum glucose levels and lipid fractions were measured. Metabolic syndrome criteria according to IDF 2006 were evaluated at baseline and after bariatric surgery. RESULTS: Our group included 61.2 % female patients, the mean age was 40.2 ±10.2 years and the metabolic syndrome criteria at baseline were confirmed in 69.4% of the study group. At twelve months after the intervention, the mean excess weight loss (%EWL) was 72%, with age and BMI subgroups variations. We found significant improvements of serum concentrations for triglycerides (P-value = 0.001, decreased by 30%), HDL-cholesterol (P-value = 0.017, increased by 26%), total cholesterol (P-value = 0.043, decreased by 12%) and glucose (P-value = 0.007, decreased by 12%). CONCLUSIONS: The positive effect of bariatric surgery was confirmed for lipid fractions and fasting glucose levels, also the metabolic syndrome prevalence was significantly reduced, all these changes contribute to lower cardiovascular risk together with significant weight loss.

[The influence of body weight upon the function of ovarian axis]. / Influenta greutatii asupra functiei axului ovarian.

The relationship between the body weight and the function of hypothalamopituitary-ovarian axis was longtime studied. Frisch and Ravell (1971) have proposed the hypothesis that the onset of menarche is strong related to the achievement of a critical body weight. These authors observed that, despite the decrease in the last 120 years of the menarche age from 16.5 to 12.5 year-old, the body weight at which the menarche appears remains unchanged, 47.5 +/- 0.5 Kg. Many studies show the importance of both, body weight and fat mass percentage, in the appearance of menarche at puberty, or in the restoration of menses after the weight loss amenorrhea. Primary or secondary underweight amenorrhea can be associated to an eating disorder (anorexia nervosa, bulimia nervosa, or the alternation of these to clinical conditions), to severe exercise (athletes, gymnasts, dancers) or to malnutrition. The connected signal between metabolic status and reproductive function may be represented by the substances like: insulin, amino acids, IGFPB-I, leptin. The low levels of leptin were found in underweight female with oligo or amenorrhea. By the other hand, obesity is not a primary factor causing chronic anovulation. However, obesity may aggravate an already existing subtle defect in some women and result in amenorrhea.

[The metabolic effects of the angiotensin converting enzyme inhibitors in experimental diabetes mellitus]. / Les effets métaboliques des inhibiteurs de l'enzyme de conversion de l'angiotensine dans le diabète expérimental.

We have studied the effects exerted by the angiotensin converting enzyme inhibitor (ACEI) Enalapril upon the glycemic profile in diabetic rats. With respect to the subacute character of our experiment (15 days), the following parameters have been recorded: diuresis, glycosuria, ketonuria and glycemia. In the diabetic rats treated with ACEI we haven noted slight, statistically insignificant improvements in glycosuria and glycemia, compared to the untreated diabetic subjects. Conversely, a statistically significant improvement of ketonuria has been noted in the diabetic rats receiving ACEI compared to the untreated ones. The short-term administration of ACEI in experimental diabetes mellitus acutely improves the glycemic profile, probably by the amelioration of the tissular sensitivity to insulin.

[Body composition in amenorrheic and eumenorrheic underweight patients]. / La composition corporelle des patientes sous-ponderales amenorrheiques et eumenorrheiques.

Relationship between weight and hypothalamic-pituitary-ovarian axis has been long time studied. Underweight female patients can have or not disturbances of gonadal system and the importance of the weight or body composition in the mechanisms of these abnormalities is not clear. In our study, we have investigated body composition in 15 underweight female patients. Five patients have had anorexia nervosa, with amenorrhea (group AN), and other 10 patients were eumenorrheic, but with low body weight (hypoanabolic syndrome--group HA). Bioelectrical impedance method was used to investigate body composition. Total body water (TBW), lean mass (LM), and fat mass (FM) were determined. Nutritional status was also assessed using body mass index (BMI). The mean body weight was significantly decreased (p = 0.05, 36.6 +/- 4.68 Kg versus 44.1 +/- 4.67 Kg) in group AN as compared to group HA. Fat mass was very low in group AN (9.45% of body weight versus 11.3% of body weight in group HA), but there was not significant difference. Lean mass was significantly decreased in group AN (33.24 +/- 2.37 Kg) in comparison with group HA (39.3 +/- 4.06 Kg). Correlations between anthropometric indices were studied. Positive significant correlations were obtained between body weight and lean mass, total body water and basal metabolism in both groups. In conclusion, our study reveals that body weight has a relative importance in ovarian axis dysfunction, and the most important of body compartments seems to be lean mass.

The diminution of platelet activity in vitamin E-treated diabetic rats.

BACKGROUND: Because vitamin E deficiency has been demonstrated in platelets obtained from diabetic subjects, in our research we investigated the platelet activity and the oxidative stress in alloxan diabetic rats supplemented with vitamin E. MATERIAL AND METHODS: The platelet activity was estimated by the adhesion index (AI) and the oxidative stress was correlated with the determined level of malondialdehyde (MDA) an end product of lipid peroxidation. RESULTS: We found that alloxanic diabetes was associated with significant increase in the both MDA level and AI (p < 0.01 and p < 0.05, respectively). The AI was better correlated to the MDA level (r = +0.60) than to the hyperglycemia. The administration of vitamin E before and after alloxan was accompanied by a significant decrease of both MDA level and AI comparing to untreated diabetic rats. CONCLUSIONS: Our study suggests that vitamin E supplementation may improve the increased platelet adhesion as a consequence of an increased oxidative stress and therefore the incidence of diabetic angiopathy may be reduced.

[An analysis of the evolution of body compartments in anorexia nervosa--the bioelectrical impedance method]. / Analiza evolutiei compartimentelor corpului în anorexia nervoasa--metoda impedantei bioelectrice.

Body compartments can be assessed by means of bioelectrical impedance, a non-invasive, cost saving and simple physical method. The purpose of this study was to estimate the body compartments in anorexic patients, in the under-nutrition phase (group BMI < 17 kg/m2) and after weight restoration (BMI > 17 kg/m2). Total body water, intracellular and extracellular water have significantly decreased after weight restoration. The fat mass significantly (p < 0.001) increased in group BMI > 17 kg/m2 compared with group BMI < 17 kg/m2, and we have found a positive correlation between body mass index (BMI) and fat mass (r = 0.73, p < 0.0001). The assessment of free fat mass can provide information about the under-nutrition degree and the quality of re-feeding. The increase of free fat mass was significant (p < 0.001) in the group BMI > 17 kg/m2 as compare with the group BMI < 17 kg/m2). We have found a positive correlation between free fat mass and BMI (r = 0.73, p < 0.0001).

[The reduction of dyslipidemia and oxidative stress in experimental diabetes mellitus treated with probucol]. / Reducerera dislipidemiei si a stressului oxidativ în diabetul zaharat experimental tratat cu probucol.

There is considerable controversy regarding the role of oxidative stress in development of macro and microangiopathy in diabetes--a free radical associated disease. Increasing the oxidative glycosylation of plasma lipoproteins by reactive oxygen species (ROS) and reduction of scavenging system under conditions of hyperglycemia may accelerate diabetic vascular disease. We have investigated the effect of Probucol (P) a drug with strong lipophilic radical scavenger action, on plasma lipoproteins variations, malondialdehid (MDA) production, atherosclerotic index (total Cholesterol/HDL Cholesterol), glycemia and glucosuria in Wistar male alloxanic rats with/without enriched cholesterol diet. The inhibition of lipoproteins oxidation, resulting from diminishing MDA, in our study, would furthermore delay the absorption and penetration of lipids and lipoproteins into deeper vascular layers and thereby reduce the risk of atherosclerotic vascular lesion. Our result suggest that treatment with inhibitors of lipoproteins oxidation may reduce the risk of cardiovascular complications in diabetes.