Comment on Dutia et al. Limited Recovery of β-Cell Function After Gastric Bypass Despite Clinical Diabetes Remission. Diabetes 2014;63:1214−1223

The article in this issue of Diabetes by Dutia et al. (1) shows that in obese diabetic patients returning to normal glucose tolerance (NGT) after gastric bypass β-cell function appears to recover if evaluated through oral glucose tolerance test (OGTT), but not if evaluated through isoglycemic glucose clamp. In fact, the plot indicating Δinsulin/Δglucose (insulin release [IR]) versus 1/homeostasis model assessment of insulin resistance (HOMA-IR) (insulin sensitivity [IS]) grows during OGTT, but stays flat or moves right, indicating

Humanitarian aid as an integral part of the European Union's external action: the challenge of reconciling coherence and independence

The article focuses on the European Union's (EU) humanitarian aid policy. It addresses the challenge for the EU to deliver independent humanitarian aid while simultaneously seeking to establish more coherence between its external policies. The article examines how the EU tries to reconcile these potentially conflicting policy goals, both de jure and in practice. Empirically, it explores the interaction between EU humanitarian aid and development cooperation, the Common Foreign and Security Policy, and trade policy. While the independence of the humanitarian aid delivery is, for the most part, not being undermined, it remains difficult to establish positive synergies with other external policies because of institutional hurdles and legal constraints, as well as political obstacles and operational incompatibilities

Long-term mortality and incidence of cardiovascular diseases and type 2 diabetes in diabetic and nondiabetic obese patientsundergoing gastric banding: a controlled study

Background and aim: Aim of this retrospective study was to compare long-term mortality and incidence of new diseases [diabetes and cardiovascular (CV) disease] in morbidly obese diabetic and nondiabetic patients, undergoing gastric banding (LAGB) in comparison to medical treatment. Patients and methods: Medical records of obese patients [body mass index (BMI) > 35 kg/m(2) undergoing LAGB (n = 385; 52 with diabetes) or medical treatment (controls, n = 681; 127 with diabetes), during the period 1995-2001 (visit 1)] were collected. Patients were matched for age, sex, BMI, and blood pressure. Identification codes of patients were entered in the Italian National Health System Lumbardy database, that contains life status, causes of death, as well as exemptions, drug prescriptions, and hospital admissions (proxies of diseases) from visit 1 to September 2012. Survival was compared across LAGB patients and matched controls using Kaplan-Meier plots adjusted Cox regression analyses. Results: Observation period was 13.9 +/- 1.87 (mean +/- SD). Mortality rate was 2.6, 6.6, and 10.1 % in controls at 5, 10, and 15 years, respectively; mortality rate was 0.8, 2.5, and 3.1 % in LAGB patients at 5, 10, and 15 years, respectively. Compared to controls, surgery was associated with reduced mortality [HR 0.35, 95 % CI 0.19-0.65, p < 0.001 at univariate analysis, HR 0.41, 95 % CI 0.21-0.76, p < 0.005 at adjusted analysis], similar in diabetic [HR 0.34, 95 % CI 0.13-0.87, p = 0.025] and nondiabetic [HR 0.42, 95 % CI 0.19-0.97, p = 0.041] patients. Surgery was also associated with lower incidence of diabetes (15 vs 48 cases, p = 0.035) and CV diseases (52 vs 124 cases, p = 0.048), and of hospital admissions (88 vs 197, p = 0.04). Conclusion: Up to 17 years, gastric banding is associated with reduced mortality in diabetic and nondiabetic patients, and with reduced incidence of diabetes and cardiovascular diseases

Snoring, hypertension and Type 2 diabetes in obesity. Protection by physical activity

Sleep-related breathing disorders are recognized as major health problems in obesity. They are involved in both hypertension and Type 2 diabetes, through mechanisms possibly related to increased sympathetic tone. We studied the association of habitual snoring with diabetes, hypertension, weight cycling and physical activity in a large Italian database of treatment-seeking obese subjects. Clinical and behavioral data were assessed by standardized questionnaires. Consecutive data of 1890 obese patients were analyzed [average body mass index (BMI), 38.2 kg/m(2), median age: 46 yr, 78% females], from 25 obesity Italian centers, with low prevalence of clinical manifestations of cardiovascular disease. Habitual snoring was reported in 56% of the cases, and was associated with day-time sleepiness. The prevalence increased with obesity class and waist circumference, and was positively associated with weight cycling and weight gain since the age of 20, and smoking. Regular physical activity had a protective effect. Snoring was associated with diabetes and hypertension at univariate analysis, but in multivariate analysis an independent effect was only observed for hypertension. After adjustment for age, gender and BMI, physical activity maintained an independent, protective effect on both snoring (odds ratio 0.65, 95% confidence interval 0.49-0.84; p = 0.001), diabetes (0.50, 0.30-0.86; p = 0.011) and hypertension (0.71, 0.53-0.95; p = 0.023). We conclude that in treatment-seeking, obese subjects with low prevalence of cardiovascular disease, snoring independently increases the risk of hypertension, whereas physical activity exerts a protection on both snoring and complications. These data underline the importance of lifestyle interventions to limit the burden of obesity and associated diseases.ABSTRACT. Sleep-related breathing disorders are recognized as major health problems in obesity. They are involved in both hypertension and Type 2 diabetes, through mechanisms possibly related to increased sympathetic tone. We studied the association of habitual snoring with diabetes, hypertension, weight cycling and physical activity in a large Italian database of treatmentseeking obese subjects. Clinical and behavioral data were assessed by standardized questionnaires. Consecutive data of 1890 obese patients were analyzed [average body mass index (BMI), 38.2 kg/m2, median age: 46 yr, 78% females], from 25 obesity Italian centers, with low prevalence of clinical manifestations of cardiovascular disease. Habitual snoring was reported in 56% of the cases, and was associated with day-time sleepiness. The prevalence increased with obesity class and waist circumference, and was positively associated with weight cycling and weight gain since the age of 20, and smoking. Regular physical activity had a protective effect. Snoring was associated with diabetes and hypertension at univariate analysis, but in multivariate analysis an independent effect was only observed for hypertension. After adjustment for age, gender and BMI, physical activity maintained an independent, protective effect on both snoring (odds ratio 0.65, 95% confidence interval 0.49–0.84; p=0.001), diabetes (0.50, 0.30–0.86; p=0.011) and hypertension (0.71, 0.53–0.95; p=0.023). We conclude that in treatment-seeking, obese subjects with low prevalence of cardiovascular disease, snoring independently increases the risk of hypertension, whereas physical activity exerts a protection on both snoring and complications. These data underline the importance of lifestyle interventions to limit the burden of obesity and associated diseases

Zn-doped titania nanoparticles as building blocks for solid foam filters of water and air via photocatalytic oxidation

Photocatalytic oxidation (PCO) could provide energy-efficient purification of water and air. Its efficacy is constrained mainly by limited photocatalytic activity and active surface. To address both, solid foams with hierarchic porous structures spanning multiple length-scales, stabilized by photocatalytic Zn-doped titania nanoparticles (NP) were synthesized and tested. The NP were characterized by SEM, EDS, DLS, XRD, Raman and UV–Vis spectroscopies. Solid foams were stabilized by NP complexes with cationic surfactants. The foam morphology was characterized and photocatalytic activity was demonstrated in water. The present work paves the way for the development of efficient systems for air and water purification in demanding technological sectors, such as aerospace

Giant resonant enhancement for photo-induced superconductivity in K3_3C60_{60}

Photo-excitation at terahertz and mid-infrared frequencies has emerged as a new way to manipulate functionalities in quantum materials, in some cases creating non-equilibrium phases that have no equilibrium analogue. In K$_3$C$_{60}$, a metastable zero-resistance phase was documented with optical properties and pressure dependences compatible with non-equilibrium high temperature superconductivity. Here, we report the discovery of a dominant energy scale for this phenomenon, along with the demonstration of a giant increase in photo-susceptibility near 10 THz excitation frequency. At these drive frequencies a metastable superconducting-like phase is observed up to room temperature for fluences as low as ~400 $\mu J/cm^2$. These findings shed light on the microscopic mechanism underlying photo-induced superconductivity. They also trace a path towards steady state operation, currently limited by the availability of a suitable high-repetition rate optical source at these frequencies.Comment: 35 pages, 13 figures, including supplementar

Prospecting environmental mycobacteria: combined molecular approaches reveal unprecedented diversity

Background: Environmental mycobacteria (EM) include species commonly found in various terrestrial and aquatic environments, encompassing animal and human pathogens in addition to saprophytes. Approximately 150 EM species can be separated into fast and slow growers based on sequence and copy number differences of their 16S rRNA genes. Cultivation methods are not appropriate for diversity studies; few studies have investigated EM diversity in soil despite their importance as potential reservoirs of pathogens and their hypothesized role in masking or blocking M. bovis BCG vaccine. Methods: We report here the development, optimization and validation of molecular assays targeting the 16S rRNA gene to assess diversity and prevalence of fast and slow growing EM in representative soils from semi tropical and temperate areas. New primer sets were designed also to target uniquely slow growing mycobacteria and used with PCR-DGGE, tag-encoded Titanium amplicon pyrosequencing and quantitative PCR. Results: PCR-DGGE and pyrosequencing provided a consensus of EM diversity; for example, a high abundance of pyrosequencing reads and DGGE bands corresponded to M. moriokaense, M. colombiense and M. riyadhense. As expected pyrosequencing provided more comprehensive information; additional prevalent species included M. chlorophenolicum, M. neglectum, M. gordonae, M. aemonae. Prevalence of the total Mycobacterium genus in the soil samples ranged from 2.3×107 to 2.7×108 gene targets g−1; slow growers prevalence from 2.9×105 to 1.2×107 cells g−1. Conclusions: This combined molecular approach enabled an unprecedented qualitative and quantitative assessment of EM across soil samples. Good concordance was found between methods and the bioinformatics analysis was validated by random resampling. Sequences from most pathogenic groups associated with slow growth were identified in extenso in all soils tested with a specific assay, allowing to unmask them from the Mycobacterium whole genus, in which, as minority members, they would have remained undetected

A 23-year study of mortality and development of co-morbidities in patients with obesity undergoing bariatric surgery (laparoscopic gastric banding) in comparison with medical treatment of obesity

Background and aimSeveral studies have shown that bariatric surgery reduces long term mortality compared to medical weight loss therapy. In a previous study we have demonstrated that gastric banding (LAGB) is associated with reduced mortality in patients with and without diabetes, and with reduced incidence of obesity co-morbidities (cardiovascular disease, diabetes, and cancer) at a 17year follow-up. The aim of this study was to verify at a longer time interval (23years) mortality and incidence of co-morbidities in patients undergoing LAGB or medical weight loss therapy.Patients and methodsAs reported in the previous shorter-time study, medical records of obese patients [body mass index (BMI)>35kg/m(2) undergoing LAGB (n=385; 52 with diabetes) or medical treatment (controls, n=681; 127 with diabetes), during the period 1995-2001 (visit 1)] were collected. Patients were matched for age, sex, BMI, and blood pressure. Identification codes of patients were entered in the Italian National Health System Lumbardy database, that contains life status, causes of death, as well as exemptions, prescriptions, and hospital admissions (proxies of diseases) from visit 1 to June 2018. Survival was compared across LAGB patients and matched controls using Kaplan-Meier plots adjusted Cox regression analyses.ResultsFinal observation period was 19.51.87years (13.4-23.5). Compared to controls, LAGB was associated with reduced mortality [HR=0.52, 95% CI 0.33-0.80, p=0.003], significant in patients with diabetes [HR=0.46, 95% CI 0.22-0.94, p=0.034], borderline significant in patients without diabetes [HR=0.61, 95% CI=0.35-1.05, p=0.076]. LAGB was associated with lower incidence of diabetes (15 vs 75 cases, p=0.001), of CV diseases (61 vs 226 cases, p=0.009), of cancer (10 vs 35, p=0.01), and of renal diseases (0 vs 35, p=0.001), and of hospital admissions (92 vs 377, p=0.001).Conclusion p id=Par4 The preventive effect of LAGB on mortality is maintained up to 23years, even with a decreased efficacy compared with the shorter-time study, while the preventive effect of LAGB on co-morbidities and on hospital admissions increases with time

Cholesterol metabolism after bariatric surgery in grade 3 obesity : differences between malabsorptive and restrictive procedures

OBJECTIVEdMalabsorptive bariatric surgery (biliopancreatic diversion and biliointestinal bypass [BIBP]) reduces serum cholesterol levels more than restrictive surgery (adjustable gastric banding [AGB]), and this is thought to be due to greater weight loss. Our aim was to evaluate the changes of cholesterol metabolism induced by malabsorptive and restrictive surgery independent of weight loss. RESEARCH DESIGNANDMETHODSdIn a nonrandomized, self-selected, unblinded, active-comparator, bicenter, 6-month study, glucose metabolism (blood glucose and serum insulin levels and homeostasis model assessment of insulin resistance [HOMA-IR] index) and cholesterol metabolism (absorption: serum campesterol and sitosterol levels; synthesis: serum lathosterol levels; catabolism: rate of appearance and serum concentrations of serum 7-a- and serum 27-OH-cholesterol after infusions of deuterated 7-a- and 27-OH-cholesterol in sequence) were assessed in grade 3 obesity subjects undergoing BIBP (n = 10) and AGB (n = 10). Evaluations were performed before and 6 months after surgery. RESULTSdSubjects had similar values at baseline.Weight loss was similar in the two groups of subjects, and blood glucose, insulin levels, HOMA-IR, and triglycerides decreased in a similar way. In contrast, serumcholesterol, LDL cholesterol, non-HDL cholesterol, serum sitosterol, and campesterol levels decreased and lathosterol levels increased only in BIBP subjects, not in AGB subjects. A significant increase in 7-a-OH-cholesterol occurred only with BIBP; serum 27-OHcholesterol decreased in both groups. CONCLUSIONSdMalabsorptive surgery specifically affects cholesterol levels, independent of weight loss and independent of glucose metabolism and insulin resistance. Decreased sterol absorption leads to decreased cholesterol and LDL cholesterol levels, accompanied by enhanced cholesterol synthesis and enhanced cholesterol catabolism. Compared with AGB, BIBP provides greater cholesterol lowering