Beta cell function after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention

The effects of various weight loss strategies on pancreatic beta cell function remain unclear. We aimed to compare the effect of intensive lifestyle intervention (ILI) and Roux-en-Y gastric bypass surgery (RYGB) on beta cell function. Design One year controlled clinical trial (ClinicalTrials.gov identifier NCT00273104). One hundred and nineteen morbidly obese participants without known diabetes from the MOBIL study (mean (s.d.) age 43.6 (10.8) years, body mass index (BMI) 45.5 (5.6) kg/m2, 84 women) were allocated to RYGB (n=64) or ILI (n=55). The patients underwent repeated oral glucose tolerance tests (OGTTs) and were categorised as having either normal (NGT) or abnormal glucose tolerance (AGT). Twenty-nine normal-weight subjects with NGT (age 42.6 (8.7) years, BMI 22.6 (1.5) kg/m2, 19 women) served as controls. OGTT-based indices of beta cell function were calculated. One year weight reduction was 30 % (8) after RYGB and 9 % (10) after ILI (P<0.001). Disposition index (DI) increased in all treatment groups (all P<0.05), although more in the surgery groups (both P<0.001). Stimulated proinsulin-to-insulin (PI/I) ratio decreased in both surgery groups (both P<0.001), but to a greater extent in the surgery group with AGT at baseline (P<0.001). Post surgery, patients with NGT at baseline had higher DI and lower stimulated PI/I ratio than controls (both P<0.027). Gastric bypass surgery improved beta cell function to a significantly greater extent than ILI. Supra-physiological insulin secretion and proinsulin processing may indicate excessive beta cell function after gastric bypass surgery

Morbidly Obese Patients—Who Undergoes Bariatric Surgery?

Treatment seeking patients with severe obesity might choose between specialized medical treatment and surgical treatment. Knowledge of what distinguishes patients that choose either treatment is sparse, with greater understanding also needed on what consequences this choice has for the prevalence, remission and new onset of comorbidities, as well as for the bioavailability of drugs. This has prompted the studies in Gunn Signe Jakobsen and her coauthors work on treatment seeking patients with severe obesity focusing on the prevalence of comorbidities, changes in the use of drugs for hypertension, diabetes and dyslipidaemia, as well as changes in bioavailability of atorvastatin. The methods used in the studies in the thesis; "Bariatric surgery and specialized medical treatment for severe obesity Impact on cardiovascular risk factors and postsurgical pharmacokinetics of atorvastatin "; are a cross-sectional study, a registry based cohort study and a prospective pharmacokinetic study. The results of the studies presented were: - The type and number of comorbidities associated with morbid obesity did not necessarily impact upon choice of treatment, but there was an increased odds for choosing surgery for patients with higher BMI, younger age and earlier onset of obesity. - Patients opting for bariatric surgery as opposed to specialized medical treatment had higher odds of experiencing remission, and significantly lower odds for new-onset of drug treated hypertension, diabetes and dyslipidaemia. Bariatric surgery seemed to not only induce remission but was also effective in preventing disease. - The bioavailability of atorvastatin was increased after bariatric surgery, with a normalization in the long term. This knowledge can give a better understanding of the population of patients seeking treatment for severe obesity and should be included in the shared decision process when helping the patient identify their preferences for treatment of severe obesity in the context of their values

Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention

Objective: Weight reduction improves several obesity-related health conditions. We aimed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesityrelated cardiovascular risk factors. Design: One-year controlled clinical trial (ClinicalTrials.gov identifier NCT00273104). Methods: Morbidly obese subjects (19–66 years, mean (S.D.) body mass index 45.1 kg/m2 (5.6), 103 women) were treated with either Roux-en-Y gastric bypass surgery (nZ80) or intensive lifestyle intervention at a rehabilitation centre (nZ66). The dropout rate within both groups was 5%. Results: Among the 76 completers in the surgery group and the 63 completers in the lifestyle group, mean (S.D.) 1-year weight loss was 30% (8) and 8% (9) respectively. Beneficial effects on glucose metabolism, blood pressure, lipids and low-grade inflammation were observed in both groups. Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group; 70 vs 33%, PZ0.027, and 49 vs 23%, PZ0.016. The improvements in glycaemic control and blood pressure were mediated by weight reduction. The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome, albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group. Gastrointestinal symptoms and symptomatic postprandial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention. There were no deaths. Conclusions: Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies. However, the improvements were greatest in those patients treated with gastric bypass surgery

Ethical Considerations in Crowdfunding

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Leads in Arctic pack ice enable early phytoplankton blooms below snow-covered sea ice

© The Author(s), 2017. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Scientific Reports 7 (2017): 40850, doi:10.1038/srep40850.The Arctic icescape is rapidly transforming from a thicker multiyear ice cover to a thinner and largely seasonal first-year ice cover with significant consequences for Arctic primary production. One critical challenge is to understand how productivity will change within the next decades. Recent studies have reported extensive phytoplankton blooms beneath ponded sea ice during summer, indicating that satellite-based Arctic annual primary production estimates may be significantly underestimated. Here we present a unique time-series of a phytoplankton spring bloom observed beneath snow-covered Arctic pack ice. The bloom, dominated by the haptophyte algae Phaeocystis pouchetii, caused near depletion of the surface nitrate inventory and a decline in dissolved inorganic carbon by 16 ± 6 g C m−2. Ocean circulation characteristics in the area indicated that the bloom developed in situ despite the snow-covered sea ice. Leads in the dynamic ice cover provided added sunlight necessary to initiate and sustain the bloom. Phytoplankton blooms beneath snow-covered ice might become more common and widespread in the future Arctic Ocean with frequent lead formation due to thinner and more dynamic sea ice despite projected increases in high-Arctic snowfall. This could alter productivity, marine food webs and carbon sequestration in the Arctic Ocean.This study was supported by the Centre for Ice, Climate and Ecosystems (ICE) at the Norwegian Polar Institute, the Ministry of Climate and Environment, Norway, the Research Council of Norway (projects Boom or Bust no. 244646, STASIS no. 221961, CORESAT no. 222681, CIRFA no. 237906 and AMOS CeO no. 223254), and the Ministry of Foreign Affairs, Norway (project ID Arctic), the ICE-ARC program of the European Union 7th Framework Program (grant number 603887), the Polish-Norwegian Research Program operated by the National Centre for Research and Development under the Norwegian Financial Mechanism 2009–2014 in the frame of Project Contract Pol-Nor/197511/40/2013, CDOM-HEAT, and the Ocean Acidification Flagship program within the FRAM- High North Research Centre for Climate and the Environment, Norway

Leads in Arctic pack ice enable early phytoplankton blooms below snow-covered sea ic

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Long-Term Results of Antireflux Surgery Indicate the Need for a Randomized Clinical Trial

Background: Well conducted, comparative trials of laparoscopic versus open antireflux surgery with an adequate patient enrolment are few and they do not demonstrate obvious advantages for the laparoscopic approach except for a marginal gain in shorter hospital stay. The aim of this study was to compare the effectiveness of laparoscopic and open procedures. Methods: Two unselected groups of 230 patients were identified through a register of all inpatient public care in Sweden. Outcomes of laparoscopic and open antireflux surgery were compared using a disease-specific questionnaire 4 years after operation. Results: Failure and dissatisfaction were significantly more common in the laparoscopy group than among patients having conventional open surgery. Treatment failure rates were 29·0 and 14·6 per cent respectively (P = 0·004). Dissatisfaction rates were 15·0 and 7·0 per cent respectively (P = 0·005). There was no other questionnaire item for which the proportion of failures differed significantly between the two groups. Conclusion: This study does not support the presumption that laparoscopic antireflux surgery is to be preferred to the open procedure. It is strongly recommended that a randomized controlled trial be conducted

Laparoscopic Antireflux Surgery in Routine Hospital Care

Background: The frequency of antireflux surgery has tripled since laparoscopic techniques were introduced. In Sweden, laparoscopic antireflux surgery is often done at local hospitals with a very low annual number of patients. Many surgeons, who may have limited experience with conventional antireflux surgery, have started to perform laparoscopic antireflux procedures, in spite of the well-known fact that there is a long learning curve for laparoscopic antireflux surgery. Methods: A random sample of 225 of 660 patients operated on at high-volume and all 220 patients from low-volume hospitals were identified through a nation-wide register. Outcome 4 years after laparoscopic antireflux surgery was studied using a disease-specific questionnaire. Results: Treatment failures were more common in the high-volume group than among patients operated on at low-volume hospitals, 29.0% and 19.7%, respectively. In the high volume group, medication (specifically to relieve heartburn or acid regurgitation) was taken at least once a week and revisional surgery was found in 19.5% and 6.0%, respectively. Corresponding results in the low-volume group were 11.1% and 2.9%, respectively. None of these differences was statistically significant at the overall 0.05 level. Conclusion: A failure rate of almost 30% at 4 years\u27 follow-up for patients operated on at relatively high-volume hospitals was disappointing, despite the fact that these results are population-based. Hospitals are encouraged to provide accounts of their results in an effort to identify the reasons for treatment failures, and for the public to have access to more objective information on different therapeutic options

Laparoscopic Antireflux Surgery in Routine Hospital Care

Background: The frequency of antireflux surgery has tripled since laparoscopic techniques were introduced. In Sweden, laparoscopic antireflux surgery is often done at local hospitals with a very low annual number of patients. Many surgeons, who may have limited experience with conventional antireflux surgery, have started to perform laparoscopic antireflux procedures, in spite of the well-known fact that there is a long learning curve for laparoscopic antireflux surgery. Methods: A random sample of 225 of 660 patients operated on at high-volume and all 220 patients from low-volume hospitals were identified through a nation-wide register. Outcome 4 years after laparoscopic antireflux surgery was studied using a disease-specific questionnaire. Results: Treatment failures were more common in the high-volume group than among patients operated on at low-volume hospitals, 29.0% and 19.7%, respectively. In the high volume group, medication (specifically to relieve heartburn or acid regurgitation) was taken at least once a week and revisional surgery was found in 19.5% and 6.0%, respectively. Corresponding results in the low-volume group were 11.1% and 2.9%, respectively. None of these differences was statistically significant at the overall 0.05 level. Conclusion: A failure rate of almost 30% at 4 years\u27 follow-up for patients operated on at relatively high-volume hospitals was disappointing, despite the fact that these results are population-based. Hospitals are encouraged to provide accounts of their results in an effort to identify the reasons for treatment failures, and for the public to have access to more objective information on different therapeutic options