Simvastatin and its impact on healing of craniofacial bone and cartilage: A systematic review

Aims and objectives: Many bone regeneration techniques have been introduced in dentistry in order to address lacking of bone tissue. Besides autogenous bone, considered the gold standard, many biomaterials have been involved, such as bone substitutes, barrier membranes, autologous and recombinant growth factors, stem cells and, lately, osteo-promotive pharmacological compounds, such as BMPs, teriparatide, statins, and others. Preclinical and clinical studies, systematic reviews and meta-analyses have investigated the potential of simvastatin in enhancing bone formation. This review aimed at assessing the relevance of simvastatin in bone regeneration, focusing on clinical and histological outcomes in oral surgery. Methodology: The PICO question was \u201cIs the adjunctive use of simvastatin beneficial respect to control for bone regeneration in dentistry?\u201d An electronic search was performed on MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) using a combination of keywords. A hand search was undertaken on seven oral surgery Journals: Previous systematic reviews were considered for further potential eligible studies. No limitation of language and publication year was placed. Both animal and clinical comparative studies were considered. After inclusion, data on methodology, efficacy and safety were extracted. Included studies underwent risk of bias assessment. Results: One randomized clinical study and 23 studies on animal models (rats, pigs, dogs, rabbits) were included. Simvastatin was tested in different oral applications, such as: periodontal disease, distraction osteogenesis, temporomandibular joint disease, socket preservation, orthodontics. In the range 0.5-1mg and 2.2-2.5mg simvastatin was associated with higher bone formation rate and decreased osteoclastic activity as compared to control. Immunohistochemistry revealed the increased activity of TRAP, MMP-1 and BMP and decreased activity of RANKL when using simvastatin. The outcomes were unrelated to the administration route (local or systemic). Conclusion: This review provided a detailed insight into the osteopromotive effects of simvastatin through clinical, histological and immunohistochemical markers associated with bone regeneration

Standardization of the Fully Stapled Laparoscopic Roux-en-Y Gastric Bypass for Obesity Reduces Early Immediate Postoperative Morbidity and Mortality: A Single Center Study on 2606 Patients

Various techniques of laparoscopic Roux-en-Y gastric bypass have been described. We completely standardized this procedure to minimize its sometimes substantial morbidity and mortality. This study describes our experience with the standardized fully stapled laparoscopic Roux-en-Y gastric bypass (FS-LRYGB) and its influence on the 30-day morbidity and mortality.status: publishe

Metabolic profile and psychological variables after bariatric surgery: association with weight outcomes

Purpose This study aims to examine associations between metabolic profile and psychological variables in post-bariatric patients and to investigate if metabolic and psychological variables, namely high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), glycated hemoglobin (HbA 1c), impulsivity, psychological distress, depressive and eating disorder symptoms are independently associated with percentage of excess weight loss (%EWL) after bariatric surgery.Methods One hundred and fifty bariatric patients (BMI = 33.04 +/- 5.8 kg/m(2)) who underwent to bariatric surgery for more than 28.63 +/- 4.9 months were assessed through a clinical interview, a set of self-report measures and venous blood samples. Pearson's correlations were used to assess correlations between %EWL, metabolic and psychological variables. Multiple linear regression was conducted to investigate which metabolic and psychological variables were independently associated with %EWL, while controlling for type of surgery.Results Higher TG blood levels were associated with higher disordered eating, psychological distress and depression scores. HDL-C was associated with higher depression scores. Both metabolic and psychological variables were associated with %EWL. Regression analyses showed that, controlling for type of surgery, higher % EWL is significantly and independently associated with less disordered eating symptoms and lower TG and HbA_1c blood concentrations (R-2 aj = 0.383, F (4, 82) = 14.34, p < 0.000).Conclusion An association between metabolic and psychological variables, particularly concerning TG blood levels, disordered eating and psychological distress/depression was found. Only higher levels of disordered eating, TG and HbA_1c showed and independent correlation with less weight loss. Targeting maladaptive eating behaviors may be a reasonable strategy to avoid weight regain and optimize health status post-operatively.This research was partially supported by Fundacao para a Ciencia e a Tecnologia/Foundation for Science and Technology through European Union COMPETE program Grant to Eva Conceicao (IF/01219/2014) and (PTDC/MHC-PCL/4974/2012), doctoral scholarship (SFRH/BD/104159/2014) to Ana Pinto-Bastos and doctoral scholarship (SFRH/BD/104182/2014) to Sofia Ramalho

Can medical therapy mimic the clinical efficacy or physiological effects of bariatric surgery?

The number of bariatric surgical procedures performed has increased dramatically. This review discusses the clinical and physiological changes, and in particular, the mechanisms behind weight loss and glycaemic improvements, observed following the gastric bypass, sleeve gastrectomy and gastric banding bariatric procedures. The review then examines how close we are to mimicking the clinical or physiological effects of surgery through less invasive and safer modern interventions that are currently available for clinical use. These include dietary interventions, orlistat, lorcaserin, phentermine/topiramate, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, pramlintide, dapagliflozin, the duodenal–jejunal bypass liner, gastric pacemakers and gastric balloons. We conclude that, based on the most recent trials, we cannot fully mimic the clinical or physiological effects of surgery; however, we are getting closer. A ‘medical bypass' may not be as far in the future as we previously thought, as the physician's armamentarium against obesity and type 2 diabetes has recently got stronger through the use of specific dietary modifications, novel medical devices and pharmacotherapy. Novel therapeutic targets include not only appetite but also taste/food preferences, energy expenditure, gut microbiota, bile acid signalling, inflammation, preservation of β-cell function and hepatic glucose output, among others. Although there are no magic bullets, an integrated multimodal approach may yield success. Non-surgical interventions that mimic the metabolic benefits of bariatric surgery, with a reduced morbidity and mortality burden, remain tenable alternatives for patients and health-care professionals