Successful Medical Management of Status Post-Roux-en-Y-Gastric-Bypass Hyperinsulinemic Hypoglycemia

Roux-en-Y gastric bypass (RYGBP) is the most commonly performed type of bariatric surgery, which is used in the treatment of obesity and type 2 diabetes. Recent case reports and case series have described a rare complication of RYGBP, status post-gastric-bypass hyperinsulinemic hypoglycemia, which was mainly managed successfully with pancreatectomy. In this letter, we describe the first successful management of status post-gastric-bypass hyperinsulinemic hypoglycemia with diazoxide

Doppler and birth weight Z score: predictors for adverse neonatal outcome in severe fetal compromise

BACKGROUND: An adequate placental perfusion is crucial for the normal growth and well being of the fetus and newborn. The blood flow through the placenta can be compromised in a variety of clinical situations, always causing important damage to the gestation. Our objective is to identify significant predictors for adverse neonatal outcome in severe fetal compromise. METHODS: Consecutive premature fetuses at between 25 and 32 weeks with severe placental insufficiency were examined prospectively. Inclusion criteria were: (i) singletons (ii) normal anatomy; (iii) abnormal umbilical artery Doppler pulsatility index (PI); (iv) abnormal cerebroplacental ratio; (v) middle cerebral artery (MCA) PI < - 2SD ("brain sparing"); (vi) last Doppler examination performed within 24 hours prior to delivery. All 46 patients that met criteria and started the study were followed to the end. We considered as independent potential predicting variables: absent or reversed end diastolic flow in umbilical artery, abnormal ductus venosus S/A ratio, absent or reversed flow during atrial contraction in the ductus venosus and birth weight Z score. Outcome parameters were: neonatal mortality and severe neonatal morbidity. RESULTS: Backward stepwise logistic regression analysis was used to determine the optimal model for the prediction of neonatal mortality and severe neonatal morbidity. In this analysis birth weight Z score index showed the strongest association OR = 1,87 [1,17-2,99] with all neonatal outcome, all other independent variables were excluded for the optimal model. There was no mortality for the group with normal birth weight Z score. CONCLUSION: Our study suggests that birth weight Z score is the strongest predictor of adverse neonatal outcome in severe placental insufficiencies. Such use of Z scores, allowing to get rid of gestational age or sex covariates could be extended to estimated fetal weight and might help in making important decisions in the management of compromised pregnancies

Evaluation of major depression in a routine clinical assessment

<p>Abstract</p> <p>Background</p> <p>Major depression is a disorder that significantly worsens a patient's morbidity and mortality. The association of depression and diabetes is well documented and has clinical impact in diabetes treatment's outcome. Patients usually aren't evaluated initially by a psychiatrist, so it is important that non-psychiatrists learn to evaluate major depression and its impact.</p> <p>Conclusions</p> <p>Major depression can and should be evaluated on a routine clinical assessment. Depression's impact on the patients' quality of life, productivity and social interactions is well documented. The initial diagnosis of depression should lead to its prompt treatment, and it has to be emphasized that the incorrect treatment can lead to worsening of the condition, relapses, recurrences or even chronification of major depression.</p

The Wnt Transcriptional Switch: TLE Removal or Inactivation?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141086/1/bies201700162.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141086/2/bies201700162_am.pd

Prediction of binding hot spot residues by using structural and evolutionary parameters

In this work, we present a method for predicting hot spot residues by using a set of structural and evolutionary parameters. Unlike previous studies, we use a set of parameters which do not depend on the structure of the protein in complex, so that the predictor can also be used when the interface region is unknown. Despite the fact that no information concerning proteins in complex is used for prediction, the application of the method to a compiled dataset described in the literature achieved a performance of 60.4%, as measured by F-Measure, corresponding to a recall of 78.1% and a precision of 49.5%. This result is higher than those reported by previous studies using the same data set

Effects of experimental warming at the microhabitat scale on oak leaf traits and insect herbivory across a contrasting environmental gradient

10 páginas, 3 figuras, 2 tablasForest microclimatic variation can result in substantial temperature differences at local scales with concomitant impacts on plant defences and herbivory. Such microclimatic effects, however, may differ across abiotically contrasting sites depending on background environmental differences. To test these cross-scale effects shaping species ecological and evolutionary responses, we experimentally tested the effects of aboveground microhabitat warming on insect leaf herbivory and leaf defences (toughness, phenolic compounds) for saplings of sessile oak Quercus petraea across two abiotically contrasting sites spanning 9° latitude. We found higher levels of herbivory at the low-latitude site, but leaf traits showed mixed patterns across sites. Toughness and condensed tannins were higher at the high-latitude site, whereas hydrolysable tannins and hydroxycinnamic acids were higher at the low-latitude site. At the microhabitat scale, experimental warming increased herbivory, but did not affect any of the measured leaf traits. Condensed tannins were negatively correlated with herbivory, suggesting that they drive variation in leaf damage at both scales. Moreover, the effects of microhabitat warming on herbivory and leaf traits were consistent across sites, i.e. effects at the microhabitat scale play out similarly despite variation in factors acting at broader scales. These findings together suggest that herbivory responds to both microhabitat (warming) and broad-scale environmental factors, whereas leaf traits appear to respond more to environmental factors operating at broad scales (e.g. macroclimatic factors) than to warming at the microhabitat scale. In turn, leaf secondary chemistry (tannins) appears to drive both broad-scale and microhabitat-scale variation in herbivory. Further studies are needed using reciprocal transplants with more populations across a greater number of sites to tease apart plant plasticity from genetic differences contributing to leaf trait and associated herbivory responses across scales and, in doing so, better understand the potential for dynamics such as local adaptation and range expansion or contraction under shifting climatic regimes.This work was supported by the European Research Council (ERC) under the European Union’s Horizon 2020 Research and Innovation Programme (ERC Starting Grant FORMICA 757833, 2018, www.formica.ugent.be) to PDF, CM, KDP and PS, a grant from the Spanish National Research Council (2021AEP082) to XM, and a grant from the Regional Government of Galicia (IN607A 2021/03) to XM.Peer reviewe

Bone mineral density and cytokine levels during interferon therapy in children with chronic hepatitis B: does interferon therapy prevent from osteoporosis?

BACKGROUND: Our aim was to determinate bone mineral density (BMD), levels of biochemical markers and cytokines in children with chronic hepatitis B treated with interferon (IFN)-alpha and to investigate effect of IFN-alpha therapy on these variables. To the best of our knowledge, this is first study carried out about BMD and cytokine levels in pediatric patients with chronic hepatitis B treated with IFN-alpha. METHODS: BMD, levels of parathyroid hormone (PTH), osteocalcin, C-terminal cross-linking telopeptide of type I collagen (CTX), calcium, alkaline phosphates (ALP), cytokines as TNF-alpha, interleukin (IL)-1(β), IL-2r, IL-6, and IL-8 were studied in 54 children with chronic hepatitis B (4–15 years old) treated with interferon alone (n = 19) or in combination with lamivudine (n = 35) for six months and as controls in 50 age-matched healthy children. RESULTS: There was no significant difference in respect to serum IL-1(β), TNF-α and osteocalcin levels while serum IL-2r (p = 0.002), IL-6 (p = 0.001), IL-8 (p = 0.013), PTH (p = 0.029), and CTX (p = 0.021) levels were higher in children with chronic hepatitis B than in healthy controls. BMD of femur neck (p = 0.012) and trochanter (p = 0.046) in patients were higher than in healthy controls. There was a statistically significant correlation between serum IL-1(β )and osteocalcin (r = -0.355, p < 0.01); between serum IL-8 and CTX levels (r = 0.372, p = 0.01), and ALP (r = 0.361, p = 0.01); between serum ALP and femur neck BMD (r = 0.303, p = 0.05), and trochanter BMD (r = 0.365, p = 0.01); between spine BMD and IL-2R (r = -0.330, p < 0.05). CONCLUSION: In conclusion, our study suggest that BMD of femur, serum IL-2r, IL-6, IL-8, PTH, and CTX levels were higher in children with chronic hepatitis B treated with IFN-alpha alone or combination with lamivudine than in healthy children. High femur BMD measurements found in patients may suggest that IFN-alpha therapy in children with chronic hepatitis B could contribute indirectly to prevent from hip osteoporosis. Additionally, further investigations on effects of IFN-alpha for bone structure in children should be performed in the future