Manipulation of food intake and weight dynamics using retrograde neural gastric electrical stimulation in a chronic canine model

Neural gastric electrical stimulation (NGES) could be a new technique for treating obesity. However, chronic animal experimentation exploring the efficacy of this therapy is lacking. In this study we investigated the utility of retrograde NGES in a chronic canine model. Nine mongrel dogs (26.8 ± 5.2 kg) underwent laparoscopic implantation of 2-channel neurostimulator leads in the distal antrum. Five dogs formed a control group and four dogs underwent stimulation. Food intake and weight dynamics were regularly monitored during two separate research protocols, each comprising 2-week baseline, stimulation and washout periods. The stimulation voltage was constant in the first protocol and was ramped in the second. In the first protocol three out of the four stimulated dogs demonstrated significant decrease in food intake (P <0.05). However, this materialized in a significant weight reduction in one dog only. In the second protocol, all stimulated dogs exhibited significant food intake and weight reduction (P <0.05) compared to controls. Necropsies and histopathological analysis did not reveal any abnormalities in the stomach, the adjacent organs or around the implant. NGES could be a safe new technique for reducing food intake and weight and, therefore, it might be helpful for treating obesity

Coronary Artery Disease Evaluation in Rheumatoid Arthritis (CADERA): Study protocol for a randomized controlled trial

Background: The incidence of cardiovascular disease (CVD) in rheumatoid arthritis (RA) is increased compared to the general population. Immune dysregulation and systemic inflammation are thought to be associated with this increased risk. Early diagnosis with immediate treatment and tight control of RA forms a central treatment paradigm. It remains unclear, however, whether using tumor necrosis factor inhibitors (TNFi) to achieve remission confer additional beneficial effects over standard therapy, especially on the development of CVD. Methods/Design: Coronary Artery Disease Evaluation in Rheumatoid Arthritis (CADERA) is a prospective cardiovascular imaging study that bolts onto an existing single-centre, randomized controlled trial, VEDERA (Very Early versus Delayed Etanercept in Rheumatoid Arthritis). VEDERA will recruit 120 patients with early, treatment-naïve RA, randomized to TNFi therapy etanercept (ETN) combined with methotrexate (MTX), or therapy with MTX with or without additional synthetic disease modifying anti-rheumatic drugs with escalation to ETN following a 'treat-to-target' regimen. VEDERA patients will be recruited into CADERA and undergo cardiac magnetic resonance (CMR) assessment with; cine imaging, rest/ stress adenosine perfusion, tissue-tagging, aortic distensibility, T1 mapping and late gadolinium imaging. Primary objectives are to detect the prevalence and change of cardiovascular abnormalities by CMR between TNFi and standard therapy over a 12-month period. All patients will enter an inflammatory arthritis registry for long-term follow-up. Discussion: CADERA is a multi-parametric study describing cardiovascular abnormalities in early, treatment-naïve RA patients, with assessment of changes at one year between early biological therapy and conventional therapy