Risedronate to Prevent Bone Loss After Sleeve Gastrectomy: Study Design and Feasibility Report of a Pilot Randomized Controlled Trial

Mounting evidence implicates bariatric surgery as a cause of increased skeletal fragility and fracture risk. Bisphosphonate therapy reduces osteoporotic fracture risk and may be effective in minimizing bone loss associated with bariatric surgery. The main objective of this pilot randomized controlled trial (RCT; Clinical Trial No. NCT03411902) was to determine the feasibility of recruiting, treating, and following 24 older patients who had undergone sleeve gastrectomy in a 6 month RCT examining the efficacy of 150‐mg once‐monthly risedronate (versus placebo) in the prevention of surgical weight‐loss–associated bone loss. Feasibility was defined as: (i) >30% recruitment yield, (ii) >80% retention, (iii) >80% pills taken, (iv) <20% adverse events (AEs), and (v) >80% participant satisfaction. Study recruitment occurred over 17 months. Seventy participants were referred, with 24 randomized (34% yield) to risedronate (n = 11) or placebo (n = 13). Average age was 56 ± 7 years, 83% were female (63% postmenopausal), and 21% were black. The risedronate group had a higher baseline BMI than the placebo group (48.1 ± 7.2 versus 41.9 ± 3.8 kg/m²). The 10‐year fracture risk was low (6.0% major osteoporotic fracture, 0.4% hip fracture); however, three individuals (12.5%, all risedronate group) were osteopenic at baseline. Twenty‐one participants returned for 6‐month follow‐up testing (88% retention) with all (n = 3) loss to follow‐up occurring in the risedronate group. Average number of pills taken among completers was 5.9 ± 0.4 and 6.0 ± 0.0 in the risedronate and placebo groups, respectively (p = 0.21), with active participants taking >80% of allotted pills. Five AEs (3.7% AE rate) were reported; one definitely related, four not related, and none serious. All participants reported high satisfaction with participation in the study. Use of bisphosphonates as a novel therapeutic to preserve bone density in patients who had undergone a sleeve gastrectomy appears feasible and well‐tolerated. Knowledge gained from this pilot RCT will be used to inform the design of an appropriately powered trial.

Clinical Trial Registration

http://clinicaltrials.gov/show/NCT03411902. Weight Loss With Risedronate for Bone Health. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Effect of an Energy-Restricted, Nutritionally Complete, Higher Protein Meal Plan on Body Composition and Mobility in Older Adults With Obesity: A Randomized Controlled Trial

BACKGROUND

Increasing protein content of the diet might be an effective strategy to preserve muscle mass in older adults undergoing caloric restriction, thereby preserving muscle function.

METHODS

Ninety-six older adults (70.3 ± 3.7 years, 74% women, 27% African American) with obesity (35.4 ± 3.3 kg/m2; 47% total body fat) were randomized to a 6-month higher protein (providing 1.2-1.5 g/kg/d) weight loss (WL) program, utilizing the Medifast 4&2&1 Plan, or to weight stability (WS). Dual-energy x-ray absorptiometry-acquired total body mass and composition, and fast gait speed over 400 m was assessed at baseline, 3, and 6 months.

RESULTS

At baseline, dual-energy x-ray absorptiometry-acquired total body, fat, and lean masses were 95.9 ± 14.6, 44.6 ± 7.6, and 48.7 ± 9.5 kg, respectively, and 400-m gait speed was 1.17 ± 0.20 m/s. Total body mass was significantly reduced in the WL group (-8.17 [-9.56, -6.77] kg) compared with the WS group (-1.16 [-2.59, 0.27] kg), with 87% of total mass lost as fat (WL: -7.1 [-8.1, -6.1] kg; -15.9% change from baseline). A differential treatment effect was not observed for change in lean mass (WL: -0.81 [-1.40, -0.23] kg vs WS: -0.24 [-0.85, 0.36] kg). Four-hundred-meter gait speed was also unchanged from baseline although trends suggest slightly increased gait speed in the WL group [0.01 (-0.02, 0.04) m/s] compared with the WS group [-0.02 (-0.05, 0.01) m/s].

CONCLUSION

Intentional weight loss using a high-protein diet is effective in producing significant total body mass and fat mass loss, while helping preserve lean body mass and mobility, in relatively high-functioning older adults with obesity.

Induced Lactation in Nonpregnant Cows: Profitability and Response to Bovine Somatotropin

Significant culling of high-producing cows with low fertility reduces profitability of dairy farms as those cows are replaced with heifers. Induced lactation of nonpregnant cows may be a management alternative to reduce culling and increase profits. The objectives of this study were to evaluate the efficacy of bovine somatotropin (bST) to increase milk production in cows induced into lactation with estrogen plus progesterone, and to determine the profitability of inducing cows into lactation vs. using replacement heifers entering the herd as first-lactation cows. Parity 1 or greater, nonpregnant, healthy Holstein cows (n = 28) were induced into lactation by administration of estradiol-17beta (0.075 mg/kg of body weight [BW] per d) and progesterone (0.25 mg/kg of BW per d) for 7 d. Milking began on d 18. Cows were randomly assigned to control or bST treatment groups on d 37 +/- 20 of milking, and milk production was compared for 70 d. After the 70-d comparison, all cows received bST for the duration of lactation. Cows receiving bST produced more milk (28.4 kg/d) than controls (24.1 kg/d), with variable yields among cows. For the economic analysis, induced cows were compared to first-lactation cows in the same herd using fair market value for costs and multiple component pricing for milk. Net present value for an induced cow (1966 dollars) was significantly greater than that for a first-lactation cow (1446 dollars). Our data suggest that bST use in induced cows is profitable. If a reliable method were developed and approved by the FDA, inducing nonpregnant cows into lactation could be used by dairy producers to increase profitability.

Anaphylactic or anaphylactoid reactions in patients undergoing cardiac surgery

OBJECTIVE

To examine the clinical features, treatment, and outcome of anaphylactic and anaphylactoid reactions during cardiac surgery.

DESIGN

Retrospective descriptive study.

SETTING

A specialized referral anesthetic allergy clinic at a university teaching hospital.

PARTICIPANTS

Twenty-three cardiac surgical patients referred after reactions resembling anaphylaxis.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The database of the anesthetic allergy clinic was examined, and the data for patients who developed anaphylactic or anaphylactoid reactions were collated and summarized. Twenty-three cardiac surgical patients who experienced signs of anaphylactic or anaphylactoid reactions during anesthesia and surgery from 8 cardiac surgical centers in a major city were referred to the clinic. Cephalosporin antibiotics (30%) and gelatin solutions (Hemaccel) (26%) were the most common (56%) causes of the reactions. Most reactions occurred before the start of cardiopulmonary bypass. Although metaraminol was the first vasopressor used in 18 of 23 patients, it was not effective in 14 patients. Response to epinephrine was immediate and effective in 88% of cases. Rapid placement onto cardiopulmonary bypass facilitated a good outcome and permitted all but one operation to proceed as planned. No intraoperative or postoperative deaths were recorded.

CONCLUSION

Of the anaphylactic and anaphylactoid reactions, 60% occurred before cardiopulmonary bypass, and these were caused by antibiotics and gelatin solution. The results from this limited database showed that cardiac surgery proceeded without complications after cardiovascular collapse caused by anaphylactic or anaphylactoid reactions. Rapid institution of cardiopulmonary bypass may be life-saving and should be considered.

Identification of jack-jumper ant (Myrmecia pilosula) venom allergens

Jack-jumper ant venom proteins were electrophoretically separated on SDS-polyacrylamide gels, transferred to nitrocellulose and probed with sera from subjects who had experienced an allergic reaction after being bitten by a jack-jumper ant. Ant venom components that bound IgE antibodies were detected by addition of 125I-anti-human IgE followed by autoradiography. Of the 17 polypeptides resolved by electrophoresis only three, of molecular weights approximately 14 kD, 12 kD and 10 kD, bound IgE antibodies from the panel of 50 sera examined. There was a marked similarity in the binding patterns by individual sera with almost all of the sera recognizing the 14kD and 12 kD components. IgE-binding profiles of separated ant venoms from ants collected in different regions of Australia appeared to be very similar if not identical. Identification of the ant allergens is a necessary prelude to the preparation of standardized venom sac extracts suitable for safe and effective diagnostic and therapeutic use.

Cypress (Cupressus sempervirens) pollen allergens: identification by protein blotting and improved detection of specific IgE antibodies

On the basis of results of an investigation of the effects of different treatments employed, a dialysed and reduced extract of Cupressus sempervirens was separated electrophoretically on sodium dodecylsulphate-polyacrylamide gels before being transferred and then fixed with glutaraldehyde to nitrocellulose membrane. Probing with sera from 91 subjects allergic to C. sempervirens pollen followed by detection of bound IgE antibodies with [125I]-labelled anti-human IgE revealed 17 IgE-binding proteins in the molecular weight range 14-96 kilodaltons (kDa). One component, of molecular weight approximately 42 kDa, reacted with IgE antibodies in the sera of 81.3% of the allergic subjects and, for each of the subjects, this component bound the greatest quantity of IgE. Almost 50% of the sera recognized only the approximately 42 kDa component, reinforcing the conclusion that this component is the major allergen of C. sempervirens pollen. A comparative study employing C. sempervirens pollen allergen discs prepared commercially or in the laboratory showed that values of the uptakes of [125I]-anti-IgE indicating the presence of pollen-reactive IgE antibodies obtained with the latter discs were consistently higher (means 4.5 vs. 0.88), and that false-negative results were obtained when many sera were used with the commercial discs. The results of this study provide an essential basis for the production of standardized, safe and effective C. sempervirens pollen extract applicable to diagnosis and therapy of cypress pollen allergy.

The spectrum of low molecular weight house dust mite (Dermatophagoides pteronyssinus) allergens with emphasis on Der p II

Analysis by protein blotting of sera from 96 different house dust mite-allergic subjects revealed previously unrecognized complexity of low molecular weight (MW) (less than 20 kD) IgE-binding proteins in extracts of whole bodies of Dermatophagoides pteronyssinus. Of 11 different IgE-binding components of MW less than 20 kD identified, two (MW approximately 16 kD and approximately 15 kD), showed both a high frequency (88% and 49% respectively) and a high intensity of IgE-binding. The approximately 16 kD component, identified as allergen Der p II, showed the highest frequency of IgE antibody reactivity of any of the major D. pteronyssinus allergens including Der p I and Der p III.

Detection of tumor-associated membrane proteins in prostate and bladder carcinomas by means of protein blotting

Analysis of membrane proteins by Western blotting has revealed both overexpression of proteins of molecular weight 10-200 kD (in particular, of proteins of MW less than 43 kD) and increased glycosylation in a xenografted human small cell undifferentiated prostatic carcinoma, and in two xenografted human bladder tumor cell lines compared with preparations from normal human tissue. Of potential functional significance were: a) a 43 kD protein in the bladder line, UCRU-BL-13, which demonstrated increased synthesis and a marked increase in the degree of glycosylation, and b), a 28 kD ConA-binding protein in prostatic tissue which was absent in normal tissue, present in intermediate quantity in a benign hyperplasia and greatly overexpressed in small cell carcinoma. This study demonstrates the utility of the protein blotting/autoradiography technique for the investigation of tumor membrane proteins.

Enhanced immunodetection of blotted house dust mite protein allergens on nitrocellulose following blocking with Tween 20

The effect of blocking nitrocellulose membranes with the nonionic detergent Tween 20 on the detection, by protein blotting, of IgE-binding to house dust mite Dermatophagoides pteronyssinus allergens has been investigated. Tween blocking led to enhanced immunodetection of allergens despite removal of proteins from the membrane when compared to protein blocking agents which did not displace transferred components. The enhancement varied with the different mite components and, for one in particular, antigen Der p II, an increase of more than 100-fold in IgE antibody binding occurred despite a concurrent loss of more than 90% of Der p II from the membrane. Both the enhancement of binding and loss of components from the membrane were dependent upon the time course of blocking and the concentration of Tween used.

Effect of reduction and heat on the detection of house dust mite (Dermatophagoides pteronyssinus) allergen Der p I by protein blotting

Employment of reducing conditions during sample preparation alters the mobility of the house dust mite (Dermatophagoides pteronyssinus) allergen Der p I as determined by sodium dodecylsulphate-poly-acrylamide gel electrophoresis (SDS-PAGE) from an apparent MW of approximately 25 kD (unreduced) to an apparent MW of approximately 30 kD. Probing of nitrocellulose transfers with sera from subjects allergic to D. pteronyssinus showed that reduction of Der p I was accompanied by a substantial loss of IgE-antibody-binding capacity by this allergen. An important consequence of the effect of reduction on Der p I is that the electrophoretic mobility of this protein becomes very similar to a closely spaced pair of protein-staining bands, probably Der p III, of MWs 30-31 kD. These bands bind IgE antibodies strongly and with high frequency and exhibit the same electrophoretic mobilities under both reducing and non-reducing conditions. Thus, for the clear resolution of allergen Der p I from other IgE-binding components in the same MW region, including Der p III, house dust mite samples for analysis by SDS-PAGE and blotting should not be reduced.

Identification of Bermuda grass (Cynodon dactylon)--pollen allergens by electroblotting

Bermuda grass-pollen proteins were electrophoretically separated on polyacrylamide gels and transferred to nitrocellulose where IgE-binding components were detected by reaction with individual patient's serum and 125I-labeled antihuman IgE. Seventeen pollen components (in the molecular weight (MW) range of 8000 to 94,000 daltons), separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, bound IgE antibodies from a panel of 44 sera from allergic patients. The spectrum of Bermuda grass-pollen IgE-binding components detected is greater in number and wider in MW range than has previously been described. A component of MW 34,000 daltons (fraction 9) bound IgE from 100% of atopic sera tested. This component also bound the greatest quantity of IgE. Electrophoresis and transfer under nondissociating conditions revealed a component of MW 100,000 daltons that also bound IgE antibodies in all 44 sera tested. This component may be an aggregated form of fraction 9. A comparison of the electroblotting results obtained under dissociating and nondissociating conditions suggests once again that allergenic proteins in crude extracts may aggregate or associate during in vitro studies. Electrophoretic transfer analysis with sodium dodecyl sulfate-polyacrylamide gel electrophoresis may thus be the method of choice for allergen separation and identification.

Protein blotting on nitrocellulose: some important aspects of the resolution and detection of antigens in complex extracts

The resolution and detection of individual components in complex extracts by protein blotting have been investigated. By probing nitrocellulose transfers with monospecific and multispecific antisera, it was demonstrated that dissociating conditions were required for the maximum resolution of antigens by polyacrylamide gel electrophoresis, a conclusion reinforced by results from 2-D electrophoresis. The dissociating and reducing treatments employed, however, were both shown to be responsible for some loss of total antigenicity and included the complete loss of at least one important antigen. Assays with nitrocelluloses of different pore sizes demonstrated that both higher protein-binding capacities and higher backgrounds were associated with the use of the smallest pore size, while the sensitivity of the assay was greatest when a non-ionic detergent, and not proteins, were used for blocking. Nitrocellulose-bound proteins may be stained with amido black, India ink, toluidine blue, Ponceau S or a gold sol, but these agents do not always give identical staining patterns. While detection of components with immuno-enzyme staining methods had some advantages, problems with non-specific binding were encountered. These did not occur with affinity purified radiolabelled second antibodies, which in combination with scanning of autoradiographs allowed a quantitative approach to be adopted.

Comparison of different blocking agents and nitrocelluloses in the solid phase detection of proteins by labelled antisera and protein A

Five different brands of nitrocellulose (NC), each of pore size 0.45 micron and without adsorbed antigen, bound different amounts of two labelled antisera and labelled protein A. Experiments with some non-ionic surface active agents and proteins showed that milk powder and bovine serum albumin were the most effective agents for blocking non-specific binding of labelled protein to NC. With some of the NCs, Nonidet P-40 (NP-40) and Tween 20 were almost as effective as milk powder. The protein-binding capacity of unblocked NC and the level of protein binding after blocking were found to be inversely proportional to the pore size of the NC. A comparison of blocking agents in an immunoassay with pollen proteins adsorbed to NC discs revealed that the highest specific uptakes of antiserum occurred with NP-40 and Tween and not with any of the protein blocking agents such as milk powder. Hence, for the detection of proteins using NC-based assays (but not necessarily following electroblotting), the best choices would appear to be: NC of pore size 0.45 micron; a brand of NC that provides a suitable balance between protein binding capacity and non-specific uptake of protein after blocking; a non-ionic detergent such as NP-40 or Tween 20.

Identification of Parietaria judaica pollen allergens

Parietaria judaica pollen allergens, fractionated by SDS-polyacrylamide gel electrophoresis and transferred to nitrocellulose membranes, were identified using 52 sera collected in Australia and Sicily from P. judaica pollen-allergic patients. IgE-binding pollen components transferred to nitrocellulose were detected by reaction with 125I-anti-human IgE and autoradiography. Nine pollen components, ranging in molecular weight (MW) from approximately 10,000 to 80,000 daltons, bound IgE antibodies but the two fastest migrating components sometimes each separated into two very closely migrating bands. The faster of the two components exhibiting doublet formation (MW approximately 10,000 daltons) showed by far the highest frequency of IgE binding, being recognised by 50 of the 52 sera examined. Although patients' IgE reaction patterns to P. judaica allergens were heterogeneous, the degree of heterogeneity was much less than that observed with house dust mite and other pollen extracts studied by electrophoretic transfer analysis. Results with gradient gel-nitrocellulose transfer experiments which showed no IgE-binding components with MWs less than 70,000 daltons, and comparisons of our electroblotting results with crossed radioimmunoelectrophoresis results of others, suggested that the doublet proteins with MWs of approximately 10,000 probably bind to higher MW proteins in P. judaica pollen extracts.

A re-examination of ryegrass (Lolium perenne) pollen allergens

Electroblotting of crude ryegrass pollen extracts and purified group I, II and III allergens identified 14 IgE-binding components, 8 of which were previously unrecognized. In addition to allergen groups I, II and III, which are already regarded as clinically important, and on the basis of the frequencies and intensities of IgE binding with sera from 42 ryegrass pollen-allergic patients, proteins with molecular weights (MWs) of 60, 32, 30 and 28 kD were identified as allergens of possible major clinical importance. Six other pollen components with MWs ranging from 23 to 80 kD and which reacted with IgE antibodies in the sera of 33-50% of patients, should also be viewed as proteins with potential clinical relevance for at least a proportion of the patients. The electrophoretic separation patterns of ryegrass pollen extracts in both alkaline and acid gels and IgE-probed membrane transfers produced in this study should serve as useful reference patterns for standardization purposes. In addition, the identification of the complete allergen recognition pattern by individual patients will permit safer and more effective diagnosis and therapy of ryegrass pollen sensitivities.

Identification of orchard grass (Dactylis glomerata) pollen allergens following electrophoretic transfer to nitrocellulose

Orchard grass (cocksfoot) pollen extracts, fractionated by polyacrylamide gradient electrophoresis or SDS gel electrophoresis were electroblotted onto nitrocellulose membranes and probed with sera from orchard grass pollen-allergic patients and 125I-anti-human IgE. The IgE-binding components of the pollen were detected by autoradiography. Elution studies showed that allergens could be extracted immediately and continuously over a 3-hour period. Two fractions of MWs 28,000 and 30,000 could be detected only after 20 min extraction. SDS-PAGE separations gave the better resolution revealing 19 electrophoretically-separate components, 13 of which bound human IgE. All of the IgE-binding components had MWs in the range 14,000 - 70,000. Three of the bands bound IgE from more than 85% of the serum samples. Following gradient gel electrophoresis, IgE binding was exhibited by 10 bands in the range MW 5,000 to greater than 669,000. The technique used allows one to quantitatively examine patients' sera for allergen-specific IgE antibodies and to identify the clinically important allergens. Results revealed numerous allergenic components over a wide MW range while patterns of IgE binding with different patients' sera demonstrated a great diversity of IgE antibody responses. This study demonstrates the suitability of the electroblotting technique combined with autoradiography for the investigation of allergenic components of grass pollen extracts and hence has application to extract standardization and immunotherapy. Such studies can be carried out rapidly, economically and with a high degree of sensitivity.

The action of (S)-alpha-chlorohydrin and 6-chloro-6-deoxyglucose on the metabolism of guinea pig spermatozoa

(S)-alpha-Chlorohydrin inhibits the conversion of fructose to lactate by mature guinea pig spermatozoa in vitro. At a concentration of 2mM, there is a specific inhibition of glyceraldehyde-phosphate dehydrogenase resulting in the accumulation of fructose-1,6-bisphosphate, dihydroxyacetone phosphate and glyceraldehyde-3-phosphate and a concomitant decrease in the concentration of endogenous lactate. (R,S)-[3-36Cl]-alpha-Chlorohydrin is metabolised by the spermatozoa to 3-chlorolactaldehyde of unknown configuration. Exogenous (R,S)-3-chlorolactaldehyde (2mM) is an inhibitor of glyceraldehyde-phosphate dehydrogenase in guinea pig spermatozoa, whereas (R)-alpha-chlorohydrin (10mM) has no significant effect on the metabolism of fructose. 6-Chloro-6-deoxyglucose (10mM) inhibits glyceraldehyde-phosphate dehydrogenase in guinea pig spermatozoa in vitro and is metabolised to 3-chlorolactaldehyde which is presumably the (S)-isomer. The anti-glycolytic actions of (S)-alpha-chlorohydrin and 6-chloro-6-deoxyglucose in guinea pig spermatozoa are suggested to be due to the action of a common metabolite, (S)-3-chlorolactaldehyde.

The effect of alpha-chlorohydrin on the oxidation of fructose by rabbit spermatozoa in vitro

(R,S)-alpha-Chlorohydrin inhibits the oxidative metabolism of fructose in mature rabbit spermatozoa in vitro. This effect is not noticeable at concentrations of the compound up to 10 mM, is evident at 50 mM but at 100 mM is apparently accompanied by cell damage. At a concentration of 50 mM, (R,S)-alpha-chlorohydrin causes the specific inhibition of the enzyme glyceraldehyde 3-phosphate dehydrogenase and is metabolised by the spermatozoa to 3-chlorolactaldehyde of unknown configuration. Exogenous (R,S)-3-chlorolactaldehyde (5 mM and 10 mM) appears to inhibit glyceraldehyde 3-phosphate dehydrogenase in rabbit spermatozoa as well as affecting other metabolic pathways. The ineffectiveness of (R,S)-alpha-chlorohydrin as an anti-fertility agent in male rabbits may be due to the inability of the spermatozoa to produce a sufficient amount of the inhibitory metabolite (S)-3-chlorolactaldehyde.

National study of chlorinated hydrocarbon insecticide residues in human milk, USA. I. Geographic distribution of dieldrin, heptachlor, heptachlor epoxide, chlordane, oxychlordane, and mirex

Human milk samples obtained from 1436 women residing in the United States were analyzed by gas-liquid chromatography for the chlorinated hydrocarbon insecticides--dieldrin, chlordane, heptachlor, heptachlor epoxide, oxychlordane and Mirex. Dieldrin was found above the detection limit (1.0 ppb) in over 80% of all the samples collected. Chlordane was not found in any of the 1436 milk samples but its metabolite, oxychlordane, was found above the detection limit in 74% of the samples. Although heptachlor was recovered in less than 2% of the samples, its metabolite, heptachlor epoxide, was found above the detection limit in 63% of the samples. It was of considerable interest that Mirex was not positively identified in any of the samples. The proportion of samples with values above the detection limit for dieldrin, heptachlor epoxide and oxychlordane varied significantly among the five geographic regions with the southeastern United States having the highest mean residue level for each of these three contaminants. For the United States the mean fat adjusted residue levels of those samples above the detection limit were 164.2 ppb for dieldrin, 91.4 ppb for heptachlor epoxide, and 95.8 ppb for oxychlordane.

Suspected foodborne carbamate pesticide intoxications associated with ingestion of hydroponic cucumbers

In the period April 1--15, 1977, nine residents of one Nebraska town experienced violent illnesses with short duration following ingestion of locally grown hydroponic cucumbers. Despite a thorough investigation, the etiologic agent of illness was not determined. From July 16--25, 1978, a second similar outbreak occurred in an adjacent city. Five individuals experienced illness similar to that which occurred in 1977, also following ingestion of hydroponic cucumbers grown at the same greenhouse involved in the 1977 outbreak. The carbamate insecticide, aldicarb, was detected in some cucumbers grown at the hydroponic greenhouse. The source of this chemical in the greenhouse could not be determined.