Bariatric surgery and type 2 diabetes: are there weight loss-independent therapeutic effects of upper gastrointestinal bypass?

Type 2 diabetes (T2D) is a major worldwide public health concern. Despite a large armamentarium of T2D medications, a large proportion of patients fail to achieve recommended treatment goals for glycemic control. Weight loss has profound beneficial effects on the metabolic abnormalities involved in the pathogenesis of T2D. Accordingly, bariatric surgery, which is the most effective available weight loss therapy, is also the most effective therapy for treating patients with T2D. Surgical procedures that bypass the upper gastrointestinal (UGI) tract are particularly effective in achieving partial and even complete remission of T2D, suggesting that UGI bypass has weight loss-independent effects on glycemic control. Although a number of hypotheses (e.g. a role for multiorgan insulin sensitivity, ß-cell function, incretin response, the gut microbiome, bile acid metabolism, intestinal glucose metabolism and browning of adipose tissue) have been proposed to explain the potential unique effects of UGI tract bypass surgery, none has yet been adequately evaluated to determine therapeutic importance in patients with T2D. Here, we review the efficacy of UGI bypass surgery in treating T2D and the mechanisms that have been proposed to explain its potential weight loss-independent therapeutic effects.

Left main bronchus obstruction after patent ductus arteriosus ligation: an unusual complication.

This report discusses a premature complex newborn with persistent pulmonary difficulties following the clipping of the PDA. Bronchoscopy was critical in revealing a metallic clip obstructing the bronchus. Thoracothomy revealed that the clip had been placed across the bronchus. This case illustrates the importance of bronchoscopy in the face of persistent unexplained pulmonary symptoms as well as having clear intraoperative exposure of the anatomy in this region to assure accurate placement of PDA metallic clips.

The Outpatient Developmental Services Project: integration of pediatric psychology with primary medical care for children infected with HIV.

OBJECTIVE: To present a model in which pediatric psychology services are programmatically integrated into the primary care of children seen in a special immunology program. The program centers around serial neurodevelopmental/neuropsychological evaluation of children infected with HIV. METHOD: We describe the population served and the particular services provided, with specific focus on how the program was developed. We include a discussion of the barriers to service provision that have been encountered and the strategies employed to overcome these challenges. CONCLUSIONS: This approach, while not ideal, serves as a good example of how pediatric psychology can merge with primary medical care to maximize the benefits of both specialties for a patient population that is underserved in many respects.

Prevention of prolapsed silicone stents in lacrimal intubation using an intrasac fixation suture.

Silicone stents are routinely used for the maintenance of patent mucosal passages in patients with nasolacrimal disorders. A common complication associated with the use of silicone stents is lateral migration or displacement of the tubes, which can be difficult to correct. This report describes a modified Quickert-Dryden approach with fixation of the tubes by an intrasac suture. From 1990 to 1996, 53 patients had silicone stents placed by this method with no complications related to tube displacement. The intrasac fixation suture has distinct advantages over other fixation methods.

General overview of rehabilitation in the rheumatoid patient.

This article provides a general overview of rehabilitation in the rheumatoid patient. It discusses the physical therapy management of both the systemic musculoskeletal involvement of RA and of the specific postoperative rehabilitation associated with total joint arthroplasty. It is intended to highlight the major components of treatment and to guide the clinician in assessing these challenging, yet rewarding cases. Its emphasis is to support a multidisciplinary approach to patient care.

FMRFamide is endogenous to the Aplysia heart.

The presence of the molluscan neuropeptide FMRFamide was investigated in the heart of the sea hare, Aplysia californica. Immunohistochemical localization and high performance liquid chromatography (HPLC) coupled with radioimmunoassays of HPLC fractions were used to demonstrate the presence of FMRFamide and FLRFamide in the heart. FMRFamide-immunoreactive (FMRFamide-IR) nerve fibers, varicosities, and neuronal somata were observed in whole-mounts of the hearts. The atrium and atrioventricular (AV) valve regions contained significantly higher densities (P < 0.05, ANOVA) of immunoreactive varicosities compared to the ventricle. The high density of FMRFamide-IR varicosities in the atrium and the lack of sensitivity of this region to FMRFamide suggest that the atrium may be a neurohemal organ for the release of FMRFamide. The presence of FMRFamide-IR somata in the Aplysia heart suggests that peripheral neurons may play a role in modifying heart activity, independent of the central nervous system.

Morphological cues to verb meaning: verb inflections and the initial mapping of verb meanings.

The present studies investigated children's use of verb inflections to guide their initial mapping of verb meanings. Given that children initially apply the progressive -ing inflection to verbs denoting actions and the past -ed inflection to verbs denoting results of events, two studies were conducted to investigate whether children use these inflections during mapping of novel verb meanings. In both studies, subjects were taught novel verbs and were asked to extend those verbs to events in which the action or result differed from events used to teach the verbs. It was predicted that subjects would be less likely to extend verbs inflected with -ing to events with new actions and would be less likely to extend verbs inflected with -ed to events with new results. Eighteen three- and five-year-olds and 24 adults participated in Experiment 1 in a between-subjects design that produced weak effects for the youngest subjects tested. Experiment 2 tested 16 three-year-olds and 19 five-year-olds in a within-subjects design and produced the predicted effect for three-year-olds, but not for five-year-olds. The findings are discussed in terms of their implications for early verb learning and regarding the use of the bootstrapping construct in language acquisition research.

Contrasting patterns of c-myc and N-myc expression in proliferating, quiescent, and differentiating cells of the embryonic chicken lens.

The present study uses the polymerase chain reaction and in situ hybridization to examine c-myc and N-myc mRNA in the embryonic chicken lens at 6, 10, 14 and 19 days of development and compares the pattern of expression obtained with the developmental pattern of cell proliferation and differentiation. In the central epithelium, c-myc mRNA levels were proportional to the percentage of proliferating cells throughout development. N-myc mRNA expression in this region was relatively low and showed no correlation with cell proliferation. The ratio of N-myc to c-myc mRNA increased markedly with the onset of epithelial cell elongation and terminal fiber cell differentiation, although both c-myc and N-myc mRNAs continued to be expressed in postmitotic, elongating cells of the equatorial epithelium and in terminally differentiating lens fiber cells. Thus, increased expression of N-myc, a gene whose protein product may compete with c-myc protein for dimerization partners, accompanies the dissociation of c-myc expression and cell proliferation during terminal differentiation of lens fiber cells.

Group psychotherapy for head and neck cancer patients.

The diagnosis of cancer has a profound emotional effect on the patient. We report the two-year experience of a weekly support group attended by 142 hospitalized head and neck cancer patients and 33 family members. The major goal for the group was to provide an open forum for discussion of any problems that faced the patient. Group size was usually four to eight patients and two to four therapists. Weekly data sheets documented attendance and major themes for the group. The most common theme was anticipation of and reaction to treatment. Initial difficulties with the group included ambivalence by the professional staff, low attendance, and logistical problems. Subjective impressions of the staff were that the group improved patients' morale, patient to patient support, compliance, and decreased the rate of discharge against medical advice.

Human tumor cloning assay in advanced head and neck cancer. Prospective correlative trial.

The feasibility and usefulness of chemosensitivity testing with the soft agar cloning assay was tested in 20 patients with advanced head and neck cancer. Pretreatment biopsy specimens could be obtained on only 13 of 20 patients, and chemosensitivity testing could be performed in only two patients. As currently used, the soft agar cloning assay does not contribute to the management of patients with advanced head and neck cancer.

Canine parainfluenza-Bordetella bronchiseptica vaccine immunogenicity.

The immunogenicity and safety of 3 serials of a canine parainfluenza (CPI) virus-Bordetella bronchiseptica vaccine was evaluated. Each serial was used to vaccinate 10 dogs with single doses given intranasally. The 30 vaccinated and 10 nonvaccinated controls dogs were challenge exposed with aerosols of virulent CPI virus and B bronchiseptica at 18 days and at 21 days, respectively, after vaccination. After challenge exposure, none of the 30 vaccinated dogs had clinical signs of disease; however, 9 of the 10 nonvaccinated dogs developed coughing problems. The CPI virus was isolated from nasal swab specimens obtained from nonvaccinated dogs on an average of 5.1 days after challenge exposure, but was not isolated from any of the specimens obtained from the vaccinated dogs. Bordetella bronchiseptica was isolated from nasal swab specimens obtained from both vaccinated and nonvaccinated dogs up to 18 days after challenge exposure. The erythrocyte sedimentation rates and total leukocyte counts for control dogs were generally increased, in contrast to those for the vaccinated groups. Dogs showed a primary serologic response to CPI virus and B bronchiseptica after vaccination and an anamnestic response to the bacterium after challenge exposure. Adverse local or systemic reactions attributable to the bivalent vaccine were not observed in the vaccinated dogs.