Investigation of liver-targeted peripheral focused ultrasound stimulation (pFUS) and its effect on glucose homeostasis and insulin resistance in type 2 diabetes mellitus: a proof of concept, phase 1 trial

BACKGROUND

Mechanical waves produced by ultrasound pulses have been shown to activate mechanosensitive ion channels and modulate peripheral nerves. However, while peripheral ultrasound neuromodulation has been demonstrated in vitro and in pre-clinical models, there have been few reports of clinical tests.

AIM

We modified a diagnostic imaging system for ultrasound neuromodulation in human subjects. We report the first safety and feasibility outcomes in subjects with type 2 diabetes (T2D) mellitus and discuss these outcomes in relation to previous pre-clinical results.

DESIGN

The study was performed as an open label feasibility study to assess the effects of hepatic ultrasound (targeted to the porta hepatis) on glucometabolic parameters in subjects with T2D. Stimulation (peripheral focused ultrasound stimulation treatment) was performed for 3 days (i.e. 15 min per day), preceded by a baseline examination and followed by a 2-week observation period.

METHODS

Multiple metabolic assays were employed including measures of fasting glucose and insulin, insulin resistance and glucose metabolism. The safety and tolerability were also assessed by monitoring adverse events, changes in vital signs, electrocardiogram parameters and clinical laboratory measures.

RESULTS AND CONCLUSION

We report post-pFUS trends in several outcomes that were consistent with previous pre-clinical findings. Fasting insulin was lowered, resulting in a reduction of HOMA-IR scores (P-value 0.01; corrected Wilcoxon signed-rank test). Additional safety and exploratory markers demonstrated no device-related adverse impact of pFUS. Our findings demonstrate that pFUS represents a promising new treatment modality that could be used as a non-pharmaceutical adjunct or even alternative to current drug treatments in diabetes.

Hydrotalcite based Ni–Fe/(Mg, Al)Ox catalysts for CO2 methanation – tailoring Fe content for improved CO dissociation, basicity, and particle size

Advantages of hydrotalcite-like precursors and the synergistic effect of bimetallic Ni–Fe alloys are combined and the most appropriate amount of Fe identified with respect to activity, selectivity and stability.

Trichinellosis surveillance in wildlife in northeastern argentine patagonia

Trichinellosis is a food-borne parasitic disease produced by different nematodes of the genus Trichinella. In Argentina, it is an endemic zoonosis and an important public health problem. The infection has been detected in domestic and wild animals. Trichinella spp. muscle larvae have anaerobic metabolism, which allows their survival in decaying tissues. The aim of this study was to evaluate the presence of Trichinella spp. in carnivorous and/or scavenger wild vertebrates - birds, mammals and reptiles - in northeastern Argentine Patagonia. Skeletal muscle samples from 141 animals, which were found killed on northeastern Argentine Patagonia roads, were analyzed by the artificial digestion method. None of the 141 samples were positive for larvae of Trichinella. These results suggest that Trichinella does not use these species to complete its cycle in this region of the continent and the absence of a significant alteration in the study area makes it difficult to transmit parasitic diseases. However, due to the limited number of samples assessed for some species, this could not be confirmed. The relevance of this study resides in the fact that it is the first systematic study in South America that considers birds, reptiles and mammals as potential hosts for Trichinella.

Disruptive catalysis by zeolites

Emerging concepts and novel possibilities in catalysis by zeolites for a new scenario in chemical and energy vector production.

Comparison of specimens for detection of porcine reproductive and respiratory syndrome virus infection in boar studs

Porcine reproductive and respiratory syndrome virus (PRRSV)-contaminated semen from boars is a route of transmission to females, and early detection of PRRSV infection in boars is a key component in sow farm biosecurity. The purpose of this study was to determine the optimum diagnostic specimen(s) for the detection of acute PRRSV infection in boars. Individually housed boars (n = 15) were trained for semen and oral fluid collection and then vaccinated with a commercial PRRSV modified live virus vaccine. Starting on the day of vaccination and for 14 days thereafter, oral fluid specimens were collected daily from all boars. The 15 boars were subdivided into three groups of 5, and serum, blood swabs and 'frothy saliva' were collected at the time of semen collection on a 3-day rotation. Frothy saliva, derived from the submandibular salivary gland, is produced by aroused boars. Semen was centrifuged, and semen supernatant and cell fractions were tested separately. All samples were randomly ordered and then tested by PRRSV real-time quantitative reverse-transcription polymerase chain reaction assay (rRT-PCR) and PRRSV antibody ELISA. In this study, a comparison of serum, blood swab, and oral fluid rRT-PCR results found no statistically significant differences in the onset of detection or proportion of positives, but serum was numerically superior to oral fluids for early detection. Serum and oral fluid provided identical rRT-PCR results at ≥ 5 day post-vaccination. Likewise, the onset of detection of PRRSV antibody in serum, oral fluid and frothy saliva was statistically equivalent, with serum results again showing a numerical advantage. These results showed that the highest assurance of providing PRRSV-negative semen to sow farms should be based on rRT-PCR testing of serum collected at the time of semen collection. This approach can be augmented with oral fluid sampling from a random selection of uncollected boars to provide for statistically valid surveillance of the boar stud.

[High resolution vascular ultrasonography. Personal experience]

Personal experience in the use of two-dimensional echography (B-scan) in vascular diagnosis is reported, stress being laid on its advantages with respect to other non-invasive investigations (rheography, photoplethysmography, Doppler measurement) and conventional arteriography. The importance of the technique is considered and special attention paid to the system of Biosound for defining small and initial parietal changes whose consequences, particularly if located in the carotid district, can be very serious. The result of an 18-month study using real-time Doppler ultrasonography is reported. 147 carotids and 88 lower extremities were involved and percentages were matched against conventional arteriography where the latter was carried out.

Survival and locations of recurrence following abdomino-perineal resection for rectal cancer

Records of 134 patients treated by abdomino-perineal resection (1971-1979) were reviewed. One hundred and thirteen had curative operations. Mortality was 2.6% and morbidity was 51%. Ninety-three were evaluable and were followed for 5 to 8 years; they were evaluated for survival and pattern of recurrence. Five-year survival for Dukes' A, B, C, and D lesions was 86, 62, 31, and 0%, respectively. Thirty-seven had recurrence: Four pelvic, nine pelvic and distant, and 24 only distant lesions. The overall incidence of failures was 47%, failure rates by stage were 11% for stage A, 27% for B, 48% for C, and 70% for D. Incidence of local recurrence was significantly higher in stage C compared to stage B. Irrespective of stage, after detection of local or distant recurrence, survival did not differ. Furthermore, radiotherapy for local recurrence and chemotherapy for distant lesions did not improve survival time.

[Validity of diagnostic studies in thyroid pathology. Retrospective study]

In view of the growing number of examinations proposed and employed for the diagnosis of diseases of the thyroid, a retrospective evaluation was made of their validity in a series of 2500 patients (1500 operated). Attention was paid to scintiscanning, oncotropic indicators, echography, needle biopsy, thyrolymphography and thyroid hormones as aids to determining the nature of thyroid lesions and the planning of their treatment. Scintiscanning and needle biopsy proved of primary importance in determination of the nature of a lesion. Echography supplied additional, though not necessarily indispensable information. Oncotropic indicators and thyrolymphography do not appear to be useful. They do not provide data enabling a diagnostic problem to be solved, but can only help to increase any doubts that may exist. Determination of thyroid hormones is clearly indicated when planning the management of hot lesions (single, multiple or disseminated nodes), in cold lesions where thyroiditis is suspected, and in all cases where the clinical evidence suggests hypothyroidism. In euthyroid subjects requiring surgery with no objective signs of hypofunction, preoperative determinations appear to be unnecessary, where as post-operative values are of assistance in assessing the functional efficiency of the residual thyroid tissue. The conclusion to be drawn, therefore, is that diagnostic examinations should be employed in a more selective and discriminating manner.

Auranofin in juvenile rheumatoid arthritis. An open label, non-controlled study

An open label, non-controlled trial of six-month duration was designed to determine the safety and efficacy of auranofin in the treatment of 13 children with polyarticular JRA. Adverse reactions were observed in 5 of the 13 patients (38%) but only in one was it serious enough to discontinue treatment. None of the patients developed diarrhea or hematologic abnormalities. Therapeutic response was evaluated in the 11 patients who completed the six-month treatment. According to the final overall assessment 9 of the 11 children had improved, one remained unchanged and one worsened. After four months of treatment serum gold levels in 11 patients ranged between 28 and 59 micrograms/dl, with a mean value of 34 micrograms/dl. There was no correlation between serum gold levels and the frequency and severity of side effects.

Enhancement of colonic cancer by indomethacin treatment in dimethylhydrazine pretreated rats

Indomethacin treatment to rats bearing dimethylhydrazine-induced colonic cancer resulted in increased mortality (p less than 0.01) and a greater incidence of metastases compared to untreated animals with the same stage of disease. It is postulated that indomethacin might have a promotional effect on the spread of autochthonous experimental colon cancer.

Effects of CO2 laser on the healing of experimental colon anastomoses

Anastomotic leakage after colonic resection still remains a troublesome complication of major clinical significance. Systemic (nutritional status, blood viscosity) or local factors (contamination by local germs, suture technique) seems to be implicated in the healing process of the suture line. The CO2 laser as a cutting procedure in colonic resection should provide a useful tool for its accuracy and the bactericidal properties. We have tested the strength of an end-to-end anastomosis of rat colon resected by CO2 laser, scalpel and diathermy, respectively, by measuring the bursting pressures at different postoperative days. The present study shows that the use of CO2 laser resulted in a significant increase of colonic bursting pressure at the anastomotic site.

Male sexual function after abdominoperineal resection for rectal cancer

In a series of 26 male patients undergoing abdominoperineal resection of the rectum for malignant disease, a detailed history of sexual function was obtained, using a questionnaire before and 12 months after the operation. The overall incidence of sexual dysfunction was 61.5 per cent, total and partial erectile impotence being, respectively, both 27 per cent. Taking age into account, among men of the youngest age group (41-48 yrs), incidence of complete and partial erectile impotence was 14 per cent. In the middle age group (49-57 yrs), 22 per cent reported total and 33 per cent reported partial erectile impotence, whereas in patients of the oldest group (58-65 yrs), total erectile impotence was present in 40 per cent and partial in an additional 30 per cent. The extent of the disease (Dukes' stage) was found to be of no value as a prognostic index of postoperative sexual dysfunction. It is concluded that the age of the patients is the most important factor related to sexual activity after abdominoperineal resection for cancer.

[Sequential hepato-biliary scintigraphy and percutaneous cholangiography in the diagnosis of benign diseases of the biliary tract Indications and limits]

Attention is drawn to the results of a study of 45 patients with bile duct calculosis designed to assess the soundness and the limits of two diagnostic examinations (HIDA and PTC) in determining the morphological and functional characteristics of the hepatoenteric tract. The results indicated that HIDA is a useful first step in average to serious cases of icterus as a means of evaluating the functional state of liver cells and the bile ducts by determination of activity-time curves for preselected areas, whereas PTC is more important in cases of serious icterus, since it also enables the patient to be suitably prepared for surgery.

[Hyperthyroidism as a rare cause of "false acute abdomen"]

4 patients affected by hyperthyroidism presenting a feature of "false acute abdomen" as main clinical sign are presented. The low incidence of that association, according to the literature, and the difficulties of a correct diagnosis, which could lead to a useless laparotomy is pointed out. The conclusion is drawn that tests of thyroid functions should be done whenever the feature of acute abdomen presents without any past history of gastro-enteric lesions.

Propranolol-induced reverse vascular steal in arteriopathic patients

The vascular steal phenomenon, i.e., the shunting of blood from ischemic to normally perfused areas, has been described in the affected limbs of arteriopathic patients after taking vasodilating drugs. This study was per formed to ascertain whether the reverse situation can be induced, i.e., whether vasoconstriction of the vessels supplying the nonischemic zone could increase the amount of blood reaching the ischemic area. Accordingly, 49 arteriopathic subjects were selected on the basis of the plethysmographic evidence of a reduction of blood flow in the affected limb following an IV injection of xanthinol-nicotinate. In a first group of 10 patients, the reduction of blood supply to the affected limb induced by xanthinol-nicotinate was inhibited when this drug was administered in combination with 5 mg of propranolol. In another 22 patients, the plethysmographic response observed after xanthinol-nicotinate alone was reversed when this drug was injected after 10 mg of propranolol. Actually, the blood perfusion to the affected limb rose significantly at all times of recording as compared to basal values. Finally, in a third group of 10 patients in whom xanthinol-nicotinate induced a significant reduction of blood flow, propranolol did not modify it. The angiographic studies performed in 3 patients confirm the plethysmographic results. Xanthinol-nicotinate alone induces a reduction of the vascular filling in the affected limb, while the combination of the vasodilating drug with 10 mg of propranolol is able to improve the vascular filling in the affected area. These results indicate that the overwhelming action of α-adrenoceptors obtained in the normal area by the β-receptors' blockade favors a beneficial redistribution of blood flow which might be considered a reverse vascular steal.

[Compression of the celiac tripod by the arcuate ligament of the diaphragm]

A case of external compression of the coeliac trunk on the part of the lateral arcuate ligament is reported. A brief account of the questions still posed by Dunbar's syndrome is followed by the assertion that dynamic, not static, aortography must be performed since it is in itself sufficient to clinch the diagnosis. It is suggested that pain is not an expression of reduced arterial flow, but of compression of the coeliac plexus, with the results that surgical management must associate adventitiectomy with section of the arcuate ligament. This will ensure displacement of the plexus, and prevent possible postoperative periarterial fibrosis from causing the reappearance of pain by involving the nerve fibres.

[Primary leiomyosarcoma of the mesentery]

A case of primary leiomyosarcoma of the mesentery is described. Only seven other cases have been reported in the literature, which means that this was an accidental finding. The histological features of the case are illustrated. It is suggested that this tumour originates in the muscle cells of the mesenteric vessels. The view that surgical management is incapable of improving the fatal prognosis is expressed.