Intragastric balloon treatment for obesity: results of a large single center prospective study.

BACKGROUND: The intragastric balloon is a widely used method in the treatment of obesity indicated for those patients who have failed to achieve and maintain the weight loss with conventional measures or for preparation of patients who are candidates for bariatric surgery. METHODS: From April 2007 to April 2009, 171 consecutive patients (111 females, 60 males; mean age 39.2 ± 10.5, mean weight 123.2 ± 27.1 kg) were evaluated before and 6 months after bioenteric intragastric balloon (BIB) placement by assessment of anthropometric and biochemical parameters. RESULTS: The mean BMI during balloon treatment declined from 41.9 ± 7.3 to 36.0 ± 7.9 kg/m² (p < 0.001) with a percentage of excess weight loss of 39.7 ± 23.6 and percentage of excess body mass index loss of 39.5 ± 25.1. A significant improvement in blood pressure, glycemia, and triglyceride level but not in total cholesterol, high-density lipoprotein, and low-density lipoprotein cholesterol levels was seen. CONCLUSION: Results of this large prospective single center study confirmed that intragastric balloon is useful and safe method for promoting weight loss. Due to improvement of metabolic parameters, treatment with BIB results in reduction of cardiovascular risk and provides a sustained benefit on liver function in obese patients.

How activity of inflammatory bowel disease influences bone loss.

Bone loss is a common problem for individuals with inflammatory bowel disease (IBD). The aim of our study was to assess bone mineral density (BMD) in patients with IBD and to investigate the role of corticosteroid (CS) use and duration and activity of disease on BMD. Ninety-two patients (56 men and 36 women) with IBD, of whom 32 had ulcerative colitis (UC) and 60 had Crohn's disease (CD), underwent clinical assessment. Lumbar and femoral neck BMDs were measured by dual-energy X-ray absorptiometry. Osteopenia was observed in 14 patients (43%) with UC and in 24 patients (40%) with CD (p=0.187). Four patients (12%) with UC and 7 patients (11%) with CD had osteoporosis (p=0.308). Femoral BMD decreased in patients with long duration of CS use and correlated inversely with disease activity. Multiple regression analysis of BMD showed that statistically significant risk factors were duration of active disease and body mass index as well. Based on our results, it is necessary to take into account the risk of decreased BMD in patients with IBD. It is most important to achieve disease remission as soon as possible in addition to nutritional support.

Spontaneous regression of Merkel cell carcinoma in a patient with chronic lymphocytic leukemia: a case report.

INTRODUCTION: Merkel cell carcinoma is a rare and aggressive primary cutaneous neuroendocrine malignant tumor. The tumor has a high rate of local recurrence after surgical removal. Spontaneous regression appears to be relatively common in this rare type of tumor. CASE PRESENTATION: We describe the clinical course, cytological and histological findings of a Merkel cell carcinoma in a 70-year-old Caucasian woman, simultaneously diagnosed with chronic lymphatic leukemia. The tumor showed clinical regression after fine needle aspiration. At primary presentation, the tumor had no apparent leukocyte infiltration, but was completely cleared by T-cell mediated immunity within 3 weeks after fine needle aspiration. CONCLUSION: Fine needle aspiration may have acted as a mechanical trigger involved in the activation of cell-mediated immunity, leading to the clinical and histological regression of the tumor. To the best of our knowledge, this is the first case report of spontaneous regression of Merkel cell carcinoma in a patient with a co-malignancy, that is to say, chronic lymphocytic leukemia.

BMP signaling and podocyte markers are decreased in human diabetic nephropathy in association with CTGF overexpression.

Diabetic nephropathy is characterized by decreased expression of bone morphogenetic protein-7 (BMP-7) and decreased podocyte number and differentiation. Extracellular antagonists such as connective tissue growth factor (CTGF; CCN-2) and sclerostin domain-containing-1 (SOSTDC1; USAG-1) are important determinants of BMP signaling activity in glomeruli. We studied BMP signaling activity in glomeruli from diabetic patients and non-diabetic individuals and from control and diabetic CTGF(+/+) and CTGF(+/-) mice. BMP signaling activity was visualized by phosphorylated Smad1, -5, and -8 (pSmad1/5/8) immunostaining, and related to expression of CTGF, SOSTDC1, and the podocyte differentiation markers WT1, synaptopodin, and nephrin. In control and diabetic glomeruli, pSmad1/5/8 was mainly localized in podocytes, but both number of positive cells and staining intensity were decreased in diabetes. Nephrin and synaptopodin were decreased in diabetic glomeruli. Decrease of pSmad1/5/8 was only partially explained by decrease in podocyte number. SOSTDC1 and CTGF were expressed exclusively in podocytes. In diabetic glomeruli, SOSTDC1 decreased in parallel with podocyte number, whereas CTGF was strongly increased. In diabetic CTGF(+/-) mice, pSmad1/5/8 was preserved, compared with diabetic CTGF(+/+) mice. In conclusion, in human diabetic nephropathy, BMP signaling activity is diminished, together with reduction of podocyte markers. This might relate to concomitant overexpression of CTGF but not SOSTDC1.

Prevalence of plagiarism among medical students.

AIM: To determine the prevalence of plagiarism among medical students in writing essays. METHODS: During two academic years, 198 second year medical students attending Medical Informatics course wrote an essay on one of four offered articles. Two of the source articles were available in an electronic form and two in printed form. Two (one electronic and one paper article) were considered less complex and the other two more complex. The essays were examined using plagiarism detection software "WCopyfind," which counted the number of matching phrases with six or more words. Plagiarism rate, expressed as the percentage of the plagiarized text, was calculated as a ratio of the absolute number of matching words and the total number of words in the essay. RESULTS: Only 17 (9%) of students did not plagiarize at all and 68 (34%) plagiarized less than 10% of the text. The average plagiarism rate (% of plagiarized text) was 19% (5-95% percentile=0-88). Students who were strictly warned not to plagiarize had a higher total word count in their essays than students who were not warned (P=0.002) but there was no difference between them in the rate of plagiarism. Students with higher grades in Medical Informatics exam plagiarized less than those with lower grades (P=0.015). Gender, subject source, and complexity had no influence on the plagiarism rate. CONCLUSIONS: Plagiarism in writing essays is common among medical students. An explicit warning is not enough to deter students from plagiarism. Detection software can be used to trace and evaluate the rate of plagiarism in written student assays.