Effects of obesity surgery on type 2 diabetes mellitus Asian patients

BACKGROUND

Obesity is a major risk factor for the development of type 2 diabetes mellitus (T2DM). Surgery is the most effective treatment for morbid obesity, and it has been shown to lead to dramatic improvement in type T2DM. However, data concerning obese Asian patients have not been reported, and the mechanism of improving T2DM after bariatric surgery in this population remains speculative.

METHODS

From April 1997 to March 2006, 1,375 patients undergoing obesity surgery were recruited for our study of the effects of weight loss surgery on type 2 diabetes mellitus (T2DM). Laparoscopic vertical banded gastric partition (LVBG) was performed in 552 patients (40.1%), laparoscopic gastric bypass in 660 patients (48.0%), and laparoscopic adjustable gastric banding (LAGB) in 140 patients (10.2%). Another 23 patients (1.7%) received open or revision surgery. We evaluated the clinical data and effect of obesity surgery on T2DM, impaired fasting glucose (IFG) and compared the changes with those with normal fasting glucose.

RESULTS

Among all the patients, 166 (12.1%) had impaired fasting glucose (IFG) and 247 (18.0%) had T2DM. Patients with IFG or DM were significantly older, more central obese, and they had higher insulin resistance and a higher HbA1C level than those with normal fasting glucose. The mean total weight loss for the population was 28.6%, 29.1%, 28.5%, 23.8%, and 24.4% (at 1, 2, 3, 5, and 7 years after surgery). There was no increase of surgical risk in T2DM or IFG patients. One year after operation, fasting plasma glucose returned to normal in 78.5% of T2DM patients and 94.7% of IFG patients. The HbA1C level returned to under 7.0 in 81.5% of T2DM and in 100% of IFG patients. Laparoscopic gastric bypass patients had a greater weight loss and a higher rate of glucose normalization (93.1%) than the LVBG patients (85.3%) and LAGB patients (73.9%), but no difference in HbA1C normalization.

CONCLUSIONS

Obesity surgery resulted in significant and sustained weight loss with a cure rate of T2DM up to 80% in morbidly obese Asian patients. Gastric bypass surgery had a better result in T2DM cure rate than LVBG and LAGB because of better weight reduction.

Consumption of groundwater as an independent risk factor of Salmonella choleraesuis infection: a case-control study in Taiwan

Infection with Salmonella enterica serovar Choleraesuis (S. Choleraesuis) in humans can be considered as an endemic disease in certain regions of Taiwan, and the number of cases has increased in recent years. The goal of the case-control study discussed in this article was to identify the possible demographic and environmental risk factors associated with S. Choleraesuis infection in Taiwan. During the period of December 2005 to March 2007, the case-control study was conducted in human patients with Salmonella infection from two medical centers. Structured questionnaires were applied to collect information of relevant risk factors after interviewing 13 culture-confirmed S. Choleraesuis cases and 84 controls with other Salmonella serotype infection. After evaluation by univariate and multivariate statistical models, the results suggested that consumption of groundwater could be an independent risk factor associated with S. Choleraesuis in Taiwan. Therefore, appropriate health education needs to be conducted especially in areas where groundwater is used.

Gastrocolic fistula: a rare complication of gastric carcinoma

Malignant gastrocolic fistula formation is a rare complication of gastric carcinoma. We report a cachectic 82-year-old woman who presented with upper abdominal pain, diarrhoea, loss of weight and loss of appetite. Further investigation of her symptoms revealed a gastrocolic fistula connecting the ulcerated tumour of the body of the stomach to the splenic flexure of the colon.

Co-expression of Argonaute2 Enhances Short Hairpin RNA-induced RNA Interference in Xenopus CNS Neurons In Vivo

RNA interference (RNAi) is an evolutionarily conserved mechanism for sequence-specific gene silencing. Recent advances in our understanding of RNAi machinery make it possible to reduce protein expression by introducing short hairpin RNA (shRNA) into cells of many systems, however, the efficacy of RNAi-mediated protein knockdown can be quite variable, especially in intact animals, and this limits its application. We built adaptable molecular tools, pSilencer (pSi) and pReporter (pRe) constructs, to evaluate the impact of different promoters, shRNA structures and overexpression of Ago2, the key enzyme in the RNA-induced silencing complex, on the efficiency of RNAi. The magnitude of RNAi knockdown was evaluated in cultured cells and intact animals by comparing fluorescence intensity levels of GFP, the RNAi target, relative to mCherry, which was not targeted. Co-expression of human Ago2 with shRNA significantly enhanced efficiency of GFP knockdown in cell lines and in neurons of intact Xenopus tadpoles. Human H1- and U6-promotors alone or the U6-promotor with an enhancer element were equally effective at driving GFP knockdown. shRNA derived from the microRNA-30 design (shRNA^mir30) enhanced the efficiency of GFP knockdown. Expressing pSi containing Ago2 with shRNA increased knockdown efficiency of an endogenous neuronal protein, the GluR2 subunit of the AMPA receptor, functionally accessed by recording AMPA receptor-mediated spontaneous synaptic currents in Xenopus CNS neurons. Our data suggest that co-expression of Ago2 and shRNA is a simple method to enhance RNAi in intact animals. While morpholino antisense knockdown is effective in Xenopus and Zebrafish, a principle advantage of the RNAi method is the possibility of spatial and temporal control of protein knockdown by use of cell type specific and regulatable pol II promoters to drive shRNA and Ago2. This should extend the application of RNAi to study gene function of intact brain circuits.

Investigation of carbapenem-resistant Acinetobacter baumannii isolates in a district hospital in Taiwan

A total of 34 Acinetobacter baumannii isolates from a district hospital in Taiwan were identified with carbapenem-hydrolyzing oxacillinase OXA-66/OXA-51-like. In addition, 26 of 28 carbapenem-resistant isolates harbored plasmid-encoded bla(OXA-23)-like genes. Twenty of 28 carbapenem-resistant isolates mapped to the major genotype cluster A of carbapenemase producer by pulsed-field gel electrophoresis.

Analysis of the UCHL1 genetic variant in Parkinson's disease among Chinese

The inverse association of the functional ubiquitin carboxy-terminal hydrolase L1 (UCHL1) S18Y variant with Parkinson's disease (PD) among Caucasian populations has been debated. We conducted a large-scale analysis to investigate the age-of-onset effect of the UCHL1 variant in PD among ethnic Chinese. Individual data sets from 5 centers comprising a total of 4088 study subjects were analyzed. In the univariate analysis, only data from 1 center showed a trend towards a protective effect among young subjects. However, in the combined analysis, no significant association between the UCHL1 variant and PD was detected (A allele frequency 0.531 vs. 0.528, p=0.87, OR 1.01, 95% CI 0.92-1.1). Among subjects less than 60 years old, the OR is 0.99 (95% CI 0.84-1.16, p=0.88). A multivariate logistic regression analysis showed that family history, UCHL1 variant and the interaction of UCHL1 variant and age at onset (p=0.816) were not significantly associated with PD.

Treating high-mercury-containing lamps using full-scale thermal desorption technology

The mercury content in high-mercury-containing lamps are always between 400 mg/kg and 200,000 mg/kg. This concentration is much higher than the 260 mg/kg lower boundary recommended for the thermal desorption process suggested by the US Resource Conservation and Recovery Act. According to a Taiwan EPA survey, about 4,833,000 cold cathode fluorescent lamps (CCFLs), 486,000 ultraviolet lamps and 25,000 super high pressure mercury lamps (SHPs) have been disposed of in the industrial waste treatment system, producing 80, 92 and 9 kg-mercury/year through domestic treatment, offshore treatment and air emissions, respectively. To deal with this problem we set up a full-scale thermal desorption process to treat and recover the mercury from SHPs, fluorescent tube tailpipes, fluorescent tubes containing mercury-fluorescent powder, and CCFLs containing mercury-fluorescent powder and monitor the use of different pre-heating temperatures and desorption times. The experimental results reveal that the average thermal desorption efficiency of SHPs and fluorescent tube tailpipe were both 99.95%, while the average thermal desorption efficiencies of fluorescent tubes containing mercury-fluorescent powder were between 97% and 99%. In addition, a thermal desorption efficiency of only 69.37-93.39% was obtained after treating the CCFLs containing mercury-fluorescent powder. These differences in thermal desorption efficiency might be due to the complexity of the mercury compounds contained in the lamps. In general, the thermal desorption efficiency of lamps containing mercury-complex compounds increased with higher temperatures.

In-vitro activity of tigecycline against clinical isolates of Acinetobacter baumannii in Taiwan

We performed susceptibility testing using the microdilution method to determine the in-vitro activity of tigecycline against 393 Acinetobacter baumannii clinical isolates collected in 2006 from 19 hospitals in Taiwan. Significant proportions of the isolates were resistant to imipenem (44%), ciprofloxacin (75%), amikacin (69%), sulbactam (34%) and all four antibiotics (22%), and susceptibility to tigecycline among these different resistant phenotypes of A. baumannii varied from 71% to 82%. The minimum inhibitory concentration (MIC) of tigecycline ranged from 0.6 to 16 microg/mL (MIC(50) 2 microg/mL; MIC(90) 4 microg/mL). The cumulative curve of tigecycline MICs showed that when the MIC cut-offs were set at 2 microg/mL and 4 microg/mL, 80.9% and 93.1% of the isolates were susceptible, respectively. As tigecycline will be used in the future for infections caused by multidrug-resistant A. baumannii because of limited antibiotic choice, and as resistance to tigecycline in A. baumannii isolates may develop following antibiotic exposure, continuous monitoring of the susceptibility of A. baumannii isolates to tigecycline is warranted.

Nationwide surveillance in Taiwan of the in-vitro activity of tigecycline against clinical isolates of extended-spectrum beta-lactamase-producing Enterobacteriaceae

Tigecycline In-vitro Surveillance in Taiwan (TIST), initiated in 2006, is a nationwide surveillance programme designed to monitor longitudinally the in-vitro activity of tigecycline against commonly encountered resistant bacteria. This study compared the in-vitro activity of tigecycline against clinical isolates of resistant Gram-negative bacteria determined by the broth microdilution and Etest methods. A total of 622 isolates were collected from patients treated at 20 teaching hospitals. Tigecycline had excellent in-vitro activity against extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (N = 275) with MIC(90) 0.5 microg/mL and a 99.6% susceptibility rate, and also against ESBL-producing Klebsiella pneumoniae (N = 324) with MIC(90) 2 microg/mL and a 98.5% susceptibility rate. For ESBL-producing Proteus mirabilis (N = 15) the MIC(90) was 4 microg/mL with a 73.3% susceptibility rate. For ESBL-producing Klebsiella oxytoca (N = 8) the MIC(50) and MIC(90) were 0.5 and 1 microg/mL, respectively, with a 100% susceptibility rate. Limited agreement (<80%) was found between the broth microdilution and the Etest methods when determining the in-vitro activity of tigecycline against ESBL- producing K. pneumoniae and K. oxytoca.

A new method for CE-EC determination of mercaptopurine (MP) in a PMMA biochip with on-chip gold nano-electrode ensemble (GNEE) working and decouple electrodes

This paper presents a new method for CE-EC determination of Mercaptopurine (MP), one of the most important medicines for inflammatory bowel disease (IBD) and acute lymphoblastic leukemia (ALL) treatment, in a PMMA-based microfluidic chip. A simple and reliable process for preparing the template of gold nanoelectrode ensemble (GNEE) and fabricating the integrated microfluidic chip is reported in the present study. The use of GNEE electrodes for both electric current decoupling and signal sensing in the proposed CE-EC chip not only enhances the signal response but also decreases the background noise during detection. Results show that a good detection limit of 100 nM for detecting mercaptopurine is achieved with the proposed method. In addition, the measured results also shows a good linear response between the detected CE-EC signals and the concentration of MP within the range of 100 nM-10 mM (R2 = 0.989). The proposed microchip device provides a novel and fast detection method for mercaptopurine analysis.

Is planned surgery important in sinonasal inverted papilloma?

OBJECTIVE

To evaluate which clinical characteristics of inverted papilloma (IP) can result easily in misdiagnosis by clinicians and to determine the recurrence rate of inverted papilloma depending on diagnosis confirmation pre-operatively, intra-operatively or post-operatively.

PATIENTS AND METHODS

Fifty-one patients were treated for IP and 47 patients attended regular post-operative follow-up appointments for at least one year (mean: 54 months).

RESULTS

The patients were assigned to 3 groups: group Ia, in which IP was not confirmed until the post-operative pathology findings; group Ib, in which IP was confirmed during the operation; and group II, in which IP was confirmed before the operation. There were nineteen (37%) patients in group Ia, nine patients (18%) in group Ib and twenty-three patients (45%) in group II. The recurrence rates for groups Ia, Ib and II were 33%, 11% and 5% respectively.

CONCLUSIONS

The initial presentation of bilateral sinonasal disease can easily lead the doctor into the misdiagnosis of IP. Bony erosion, remodelling, and a widening of the natural orifice of the sinuses on a CT scan are useful signs indicating IP. The correct diagnosis prior to surgery is a determinant of outcome. The use of frozen sections should, however, improve outcome as well. In this study we highlight the high prevalence and relatively low control rate of misdiagnosed IP (pathology undetermined pre-operatively) and hope to remind clinicians that early recognition of the tumour is most beneficial to patients.

Lethal sphenoid fungal sinusitis in an immunocompromised elderly patient

Sphenoid fungal balls are rare and typically indolent lesions, unless superinfected by bacteria or invasive to adjacent neurovascular structures. If the identification or treatment of underlying complications is delayed in an immunocompromised patient, a catastrophic outcome may result. We report the case of an elderly female patient with poorly controlled diabetes mellitus suffering from sphenoid fungal sinusitis that is complicated by cavernous sinus thrombophlebitis and carotid artery stenosis. In spite of reasonable diagnosis and therapy, the patient's general condition deteriorated and she eventually died. The clinical presentation, diagnosis, and treatment strategy are discussed.

Stress-related maternal factors during pregnancy in relation to childhood eczema: results from the LISA Study

BACKGROUND

Stress has been suggested to impact the onset and exacerbation of eczema and other atopic disorders. Whether early exposure to stress-related factors might exert long-term effects remains to be clarified.

OBJECTIVE

The objective of this study was to investigate whether stress-related maternal factors during pregnancy are associated with childhood eczema during the first 6 years of life.

METHODS

Data from 3004 children from a prospective German birth cohort study (LISA) were analyzed. Information from maternity certificates and questionnaire information on unwanted pregnancy were used to evaluate stress-related maternal factors during pregnancy. Prevalence data for physician-diagnosed eczema were available up to the age of 6 years.

RESULTS

Maternal factors during pregnancy were positively associated with childhood eczema in terms of cumulative prevalence up to the age of 2 years (adjusted odds ratio, 1.48; 95% confidence interval, 0.95-2.30) after adjusting for potential confounders. Beyond the second year no increased risk was observed.

CONCLUSIONS

The results of this study suggest that stress-related maternal factors during pregnancy are associated with an increased risk of childhood eczema during the first 2 years of life. The impact of postnatal stress such as parental divorce or separation on this association could not be clarified. Future studies should therefore further elucidate how prenatal and postnatal stress interact and whether prenatal stress might have a programming effect. If future studies confirm the findings of this study, reducing maternal stress during pregnancy might be a possible target in the primary prevention of eczema during childhood.

Insulin receptor signaling regulates synapse number, dendritic plasticity, and circuit function in vivo

Insulin receptor signaling has been postulated to play a role in synaptic plasticity; however, the function of the insulin receptor in CNS is not clear. To test whether insulin receptor signaling affects visual system function, we recorded light-evoked responses in optic tectal neurons in living Xenopus tadpoles. Tectal neurons transfected with dominant-negative insulin receptor (dnIR), which reduces insulin receptor phosphorylation, or morpholino against insulin receptor, which reduces total insulin receptor protein level, have significantly smaller light-evoked responses than controls. dnIR-expressing neurons have reduced synapse density as assessed by EM, decreased AMPA mEPSC frequency, and altered experience-dependent dendritic arbor structural plasticity, although synaptic vesicle release probability, assessed by paired-pulse responses, synapse maturation, assessed by AMPA/NMDA ratio and ultrastructural criteria, are unaffected by dnIR expression. These data indicate that insulin receptor signaling regulates circuit function and plasticity by controlling synapse density.

The role of dietary factors in chronic disease control in China

Using the dietary intake and chronic disease condition data of 39,843 adults aged over 18 years old from the 2002 National Nutrition and Health Survey in China (2002 CNHS) logistic regression analysis was applied to calculate the odd ratios (ORs) of hypertension, diabetes and dyslipidaemia for the various dietary patterns of the subjects. The higher percentage of energy intake from cereals was significantly associated with lower body mass index (BMI), lower total serum cholesterol (TC) and lower low density lipoprotein cholesterol (LDL-C), while it was significantly associated with lower risk of overweight/obesity, hypertension, high TC, high serum triglycerides (TG) and high LDL-C, but the prevalence of underweight was significantly higher in the cluster of subjects with cereal energy share more than 75%. The higher percentage of energy intake of fat was related to higher BMI, higher TC and higher LDL-C which were associated with a high risk of overweight/obesity, hypertension, TC and TG. The study confirmed the important role of dietary pattern in chronic disease control. In particular, an optimum energy contributed from cereals ranged from 55% to 65% of total dietary energy intake and dietary fat energy share no more than 30% which should be the focus of preventive measures.

Overview of obesity in Mainland China

This overview describes the study of obesity issues over the last 8 years in Mainland China. A disease risk-based body mass index classification for Chinese adults was developed and verified by the results of the 2002 China Nationwide Nutrition and Health Survey. Age and gender-specific BMI cut-offs for Chinese children and adolescents aged 7-18 years were also developed. As the first step in the obesity control effort, the public health implications of the prevalence of overweight and obesity were set out and publicized by the government of China. The overweight prevalence in 2002 was 22.8% and for obesity 7.1%, these having increased by 40.7% and 97.2%, respectively, since 1992. In children, dramatic increases in overweight/obesity have occurred with a two- to threefold increase in Beijing and Shanghai between 1985 and 1995; the prevalence of overweight plus obesity in 7- to 12-year-old boys approached 29% in 2000 and in girls 15-17%. The rapid development of overweight/obesity in China will undoubtedly push up the prevalence of chronic disease. The relative risk for adult hypertension and diabetes in the overweight and obese populations was 2-5 in 2002. In adolescents, the relative risk of hypertension in the overweight was 3.3 and in the obese 3.9, with a clustering of cardiovascular risk factors in the obese Chinese children of whom 90.5% had evidence of abdominal obesity. Even the overweight group had 15.8% with abdominal obesity. Based on the population attributable risks of overweight and obesity in 2002 and data on the direct medical costs of hypertension, diabetes, stroke and coronary heart disease, 25% of these comorbidity costs could be attributed to overweight and obesity. As the improvement in linear growth of young children is usually slower than their improvements in weight during the economic development of China, the long-term adult implications of having a problem of 'Stunted obesity' rather than simple obesity in young children are raised. Analysis of the associations between adult obesity with the individuals' fetal and early nutrition highlights the need for further investigation.

Winner-take-all neural networks using the highest threshold

In this paper, we propose a fast winner-take-all (WTA) neural network by dynamically accelerating the mutual inhibition among competitive neurons. The highest-threshold neural network (HITNET) with an accelerated factor is evolved from the general mean-based neural network (GEMNET), which adopts the mean of active neurons as the threshold of mutual inhibition. When the accelerated factor is optimally designed, the ideal HITNET statistically achieves the highest threshold for mutual inhibition. Both theoretical analyzes and simulation results demonstrate that the practical HITNET converges faster than the existing WTA networks for a large number of competitors.

Pelvic actinomycosis masquerading as an acute abdomen from a small bowel perforation

Pelvic actinomycosis is an extremely rare disease which may complicate long-term intrauterine contraceptive device (IUCD) use. Its timely recognition is important as clinical and radiological signs may mimic other intra-abdominal pathology and lead to radical and unnecessary surgery. We report a 50-year-old woman with pelvic actinomycosis resulting from a neglected intrauterine device, which was left in place for 20 years. The signs and symptoms at presentation were consistent with acute peritonitis from a perforated viscus. A perforated segment of the small bowel was suspected intraoperatively and resection was performed. The diagnosis was only revealed on subsequent histopathological examination of the surgical specimen. A high index of suspicion for this rare but devastating condition must be maintained in any woman with an IUCD and who presents with a surgical abdomen. Diligence in replacing IUCDs at recommended intervals and adherence to "missing threads" protocols may prevent these sequelae.