Metabolic surgery: is surgery recommended for T2DM patients with BMI < 35 kg/m²?

La chirurgie bariatrique est normalement réservée aux patients présentant un IMC ≥ 40 kg/m² ou ≥ 35 kg/m² avec des comorbidités susceptibles d’être améliorées par la perte de poids. Les résultats remarquables sur l’évolution du diabète de type 2 (55 % à 95 % de rémission) ont fait progressivement évoluer la vision purement « bariatrique » de cette chirurgie (objectif : perte de poids) vers une vision plus « métabolique » (objectif : rémission du diabète). Il est ainsi légitime de s’interroger sur le bien-fondé de proposer une intervention à des patients diabétiques de type 2 présentant une obésité de grade 1 (IMC 30-35 kg/m²) lorsque leur diabète est mal équilibré malgré une observance diététique et thérapeutique satisfaisantes. Le rapport bénéfice/risque de cette chirurgie chez les patients DT2 avec IMC 7,5 %) malgré un traitement médical optimisé. Cette position se base sur l’analyse d’études d’observation illustrant l’efficacité du traitement chirurgical de l’obésité sur l’équilibre glycémique et la rémission du DT2 dans cette population particulière, avec un taux de décès et de complications postopératoires similaires à ceux retrouvés habituellement. Pour autant, seules des études randomisées menées spécifiquement chez ces patients avec un suivi à long terme, versus une prise en charge basée sur des modifications intensives du mode de vie et/ou des traitements « modernes » comme les agonistes des récepteurs du GLP-1, évaluant également le risque de complications, l’impact sur la qualité de vie et les conséquences socio-économiques, nous permettront d’identifier la place réelle de la chirurgie métabolique dans la stratégie thérapeutique du DT2 chez les patients avec IMC 7.5%) despite optimized medical treatment. This position is based on the analysis of observational studies showing the effectiveness of obesity surgery on glycemic control and remission rate of T2DM in this specific population, with a rate of death and post-operative complications similar to those usually observed. Nevertheless, randomized studies conducted specifically in these patients vs intensive lifestyle changes and/or “modern” therapies as GLP-1 analogues, with long-term monitoring to assess the risk of complications, the impact on quality of life and the socio-economic consequences, are mandatory to identify the actual place of metabolic surgery in the therapeutic strategy for T2D patients with a BMI < 35 kg/m²

Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

AIMS/HYPOTHESIS: This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). METHODS: The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. RESULTS: We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th-75th percentile) 28.4 (25.0-32.4) kg/m(2). Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5-14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. CONCLUSIONS/INTERPRETATION: In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04324736

Autoantibodies against type I IFNs in patients with critical influenza pneumonia

In an international cohort of 279 patients with hypoxemic influenza pneumonia, we identified 13 patients (4.6%) with autoantibodies neutralizing IFN-alpha and/or -omega, which were previously reported to underlie 15% cases of life-threatening COVID-19 pneumonia and one third of severe adverse reactions to live-attenuated yellow fever vaccine. Autoantibodies neutralizing type I interferons (IFNs) can underlie critical COVID-19 pneumonia and yellow fever vaccine disease. We report here on 13 patients harboring autoantibodies neutralizing IFN-alpha 2 alone (five patients) or with IFN-omega (eight patients) from a cohort of 279 patients (4.7%) aged 6-73 yr with critical influenza pneumonia. Nine and four patients had antibodies neutralizing high and low concentrations, respectively, of IFN-alpha 2, and six and two patients had antibodies neutralizing high and low concentrations, respectively, of IFN-omega. The patients' autoantibodies increased influenza A virus replication in both A549 cells and reconstituted human airway epithelia. The prevalence of these antibodies was significantly higher than that in the general population for patients 70 yr of age (3.1 vs. 4.4%, P = 0.68). The risk of critical influenza was highest in patients with antibodies neutralizing high concentrations of both IFN-alpha 2 and IFN-omega (OR = 11.7, P = 1.3 x 10(-5)), especially those <70 yr old (OR = 139.9, P = 3.1 x 10(-10)). We also identified 10 patients in additional influenza patient cohorts. Autoantibodies neutralizing type I IFNs account for similar to 5% of cases of life-threatening influenza pneumonia in patients <70 yr old

Intentional weight loss in older adults: useful or wasting disease generating strategy?

International audiencePurpose of review Strategies for weight management in older adults remain controversial as overweight may protect them against mortality whereas weight loss may have harmful effects by promoting sarcopenia and bone loss. It has been suggested that weight management for obese older adults should focus more on maintaining weight and improving physical function than promoting weight loss. This review aims to specify whether intentional weight loss in older adults is a useful or a wasting disease generating strategy. Recent findings Recent randomized controlled studies have shown that a supervised, moderate caloric restriction coupled with regular exercise (both aerobic and resistance) in obese older adults do not increase mortality risk and may conversely reduce insulin resistance, metabolic complications, and disabilities without exacerbating lean mass and bone mineral density loss. Summary In obese older adults, moderate weight loss may have beneficial effects on comorbidities, functional performances, and quality of life provided that regular physical activity can be associated. An individual approach considering life expectancy, chronic comorbidities, functional status, personal motivation, and social support should be preferred. More research is needed to define the circumstances in which cautious dietary restrictions are reasonably justified in older adults. In any case, in the oldest (>= 80 years) as in frail individuals, it seems reasonable to abstain from recommending weight loss

Anomalies de l'axe corticotrope dans l'obésité

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Dichotomic actions of glutamine in host versus tumour: an emerging concept

PURPOSE OF REVIEW: Malignancy is characterized by a systemic deficiency of glutamine (GLN). The debate over whether GLN supplementation should be standard of cancer patients is still topical. This review focuses on recent findings on the effect of GLN administration on the incidence and severity of adverse effects in host due to radiotherapy or chemotherapy or both and on its putative adjuvant role on cytotoxicity of radiotherapy and chemotherapy on tumour. RECENT FINDINGS: Animal and human studies have reported that high-dose GLN supplementation could prevent gastrointestinal tract injury after radiotherapy and chemotherapy. Animal studies are suggesting that GLN could actually decrease tumour growth by upregulating the immune system and through a regulation of the redox status associated to the metabolism of glutathione. GLN could enhance the selectivity of antitumour drugs by protecting normal tissues from chemotherapy and by sensitizing tumour cells to chemotherapy. SUMMARY: Recent studies have shown that GLN could have dichotomic actions in host versus in tumour, probably in link with glutathione metabolism, suggesting that GLN could be used in clinical practice to increase the therapeutic index of oncological treatments

SecP2I A Secure Multi-party Discovery of Personally Identifiable Information (PII) in Structured and Semi-structured Datasets

International audienc

Economic impact and quality of life as endpoints of nutritional therapy

PURPOSE OF REVIEW: The present review exposes why considering primary endpoints such as cost-effectiveness and quality of life in wasting disease research is critical for promoting medical nutrition therapy. RECENT FINDINGS: Despite growing evidence that nutritional support improves patients' clinical outcome, its use is not widely considered as a routine by most healthcare professionals. Many factors, depending on physicians, patients and institutions, could explain such a resistance to implement nutritional therapy in routine care. One of these factors is the lack of indisputable evidence that nutritional intervention improves patients' quality of life and is cost-effective. SUMMARY: In today's resource-constrained environment, disease management strategies are judged in terms of not only clinical efficacy and safety but also patient satisfaction and economic dimensions. The demonstration of a positive costs/saving ratio is crucial to obtain the political backing of health administrators and sustain further investment in research. Moreover, improving patients' quality of life promotes their capacity to cope with psychological distress, increases their tolerance and response to treatments, and enhances the global image of the healthcare system. In wasting diseases research, there is a need for well designed clinical trials from which cost-utility performance of nutritional interventions could be assessed in order to convince all the stakeholders and to get support from clinicians and patients themselves

Computing and interpreting the Number Needed to Treat for Cardiovascular Outcomes Trials

International audienceThe recent results of Cardiovascular Outcomes Trials (CVOTs) in type 2 diabetes have clearly established the cardiovascular (CV) safety or even the benefit of two therapeutic classes, Glucagon-Like Peptide-1 receptor agonists (GLP-1 RA) and Sodium-Glucose Co-Transporter-2 inhibitors (SGLT-2i). Publication of the latest CVOTs for these therapeutic classes also led to an update of ESC guidelines and ADA/EASD consensus report in 2019, which considers using GLP-1 RA or SGLT-2i with proven cardiovascular benefit early in the management of type 2 diabetic patient with established cardiovascular disease (CVD) or at high risk of atherosclerotic CVD. The main beneficial results of these time-to event studies are supported by conventional statistical measures attesting the effectiveness of GLP-1 RA or SGLT2i on cardiovascular events (absolute risk, absolute risk difference, relative risk, relative risk reduction, odds ratio, hazard ratio). In addition, another measure whose clinical meaning appears to be easier, the Number Needed to Treat (NNT), is often mentioned while discussing the results of CVOTs, in order to estimating the clinical utility of each drug or sometimes trying to establish a power ranking. While the value of the measure is admittedly of interest, the subtleties of its computation in time-to-event studies are little known. We provide in this article a clear and practical explanation on NNT computation methods that should be used in order to estimate its value, according to the type of study design and variables available to describe the event of interest, in any randomized controlled trial. More specifically, a focus is made on time-to-event studies of which CVOTs are part, first to describe in detail an appropriate and adjusted method of NNT computation and second to help properly interpreting NNTs with the example of CVOTs conducted with GLP-1 RA and SGLT-2i. We particularly discuss the risk of misunderstanding of NNT values in CVOTs when some specific parameters inherent in each study are not taken into account, and the following risk of erroneous comparison between NNTs across studies. The present paper highlights the importance of understanding rightfully NNTs from CVOTs and their clinical impact to get the full picture of a drug's effectiveness

"hasSignification()": une nouvelle fonction de distance pour soutenir la d\'etection de donn\'ees personnelles

Today with Big Data and data lakes, we are faced of a mass of data that is very difficult to manage it manually. The protection of personal data in this context requires an automatic analysis for data discovery. Storing the names of attributes already analyzed in a knowledge base could optimize this automatic discovery. To have a better knowledge base, we should not store any attributes whose name does not make sense. In this article, to check if the name of an attribute has a meaning, we propose a solution that calculate the distances between this name and the words in a dictionary. Our studies on the distance functions like N-Gram, Jaro-Winkler and Levenshtein show limits to set an acceptance threshold for an attribute in the knowledge base. In order to overcome these limitations, our solution aims to strengthen the score calculation by using an exponential function based on the longest sequence. In addition, a double scan in dictionary is also proposed in order to process the attributes which have a compound name.Comment: in French languag