Patterns of ketamine use among people with substance use disorder in France: Multisource analysis of the data from the French Addictovigilance Network

BACKGROUND

Due to its psychoactive effects, ketamine has become a drug used for non-medical purpose.

OBJECTIVES

To assess the latest trends in ketamine use among people with substance use disorder and to characterize its clinical complications using complementary health data sources of the French Addictovigilance Network.

METHODS

First, we extracted all reports involving ketamine from 2012 to 2021 from the database of the OPPIDUM program (i.e., a multicentric program conducted in collaboration with hundreds of substance abuse treatment facilities that collects data on drugs used by subjects with substance use disorders). We described the reports globally and the changes from 2012 to 2021. Second, we extracted all cases involving ketamine from July 2020 to December 2022 from the French National Pharmacovigilance Database (BNPV). We identified the cases related to ketamine use among people with substance use disorder and described them.

RESULTS

There was a 2.5-fold increase in the number of ketamine users with substance use disorder in the OPPIDUM program, from 35 (0.7%) subjects in 2012 to 89 (1.7%) subjects in 2021. There was an increase in the proportion of subjects who were daily users, had distress upon discontinuation, and presented addiction. There were 238 cases related to ketamine use among people with substance use disorder in the French National Pharmacovigilance Database from July 2020 to December 2022. Among them, 94 (39.5%) cases involved ketamine use disorder, 20 (8.4%) cases involved urinary tract and kidney symptoms, and 13 (5.5%) cases involved hepatobiliary symptoms.

CONCLUSION

The trend observed over 10 years reflects the growth in ketamine use among people with substance use disorder, although it does not allow to estimate the rates of non-medical use of ketamine in the general population. Ketamine-induced uropathy and cholangiopathy are reported in ketamine users with substance use disorder, especially in case of repeated and/or prolonged use of high doses.

P13.10 Chemoattraction of glioma cells in a local hydrogel trap and immune control associated with improved survival and cognitive functions in a mouse model of glioblastoma resection

BACKGROUND

Glioblastoma (GB) is the most aggressive brain primary tumor. The prognosis remains poor mainly due to the invasiveness of glioma cells, radio and/or chemoresistance and GB-induced immunosuppressive environment. Here, we propose to use a local delivery system based on a biocompatible hydrogel containing the chemopeptide urotensin II (hUII) or a biased synthetic analog DAB8-hUII, to “trap” GB cells, and/or to control immune cells expressing its G protein-coupled receptor UT, leading to tumor regression and neurological benefit, in a mouse model of GB resection.

MATERIAL AND METHODS

In vitro, invasion towards UII/analog across different hydrogels or glue of human or murine GB-GFP cell lines was evaluated in Boyden chamber and cloning ring assays. In vivo GB cells were intrastriatally xenografted, then resected while hydrogel- or glue-containing UII/analog was injected in the cavity resection. Behavioral tests, brain immunohistochemical analyses and mouse survival were then investigated.

RESULTS

In vitro, invasive capacity of human U87 and 42MG or murine GL261 and CT2A GB cells was stimulated by UII loaded into hydrogel-based hyaluronic acid supplemented with collagen or other chemicals, PNIPAAm-PEG, or thrombin-fibrin glue. In vivo, injection of UII- or DAB8-hUII-loaded glue into the cavity resection of GL261 and CT2A GB in C57BL/6 mice significantly improved survival compared with tumor and resected experimental conditions. Neurological status was also tested before and after GB resection. We found that GL261 and CT2A cell-bearing mice expressed altered spontaneous activity, emotion and cognitive functions. Intracavity injection of the glue improved resignation and anxiety and increased motor activity and cognition with a best cognitive recovery with hUII and DAB-8-hUII-loaded glue groups. Ex vivo brain analyses revealed high expression of UT and UII in some GB GFP-positive cells and macrophages within GB core and at the interface with the normal brain, GB cells expressing UT migrating along tortuous podocalyxin+ vascular components. In brains bearing hydrogel/hUII glue, vascularization appears modified and GFAP+ astrocytes and F4/80+ macrophages were highly recruited in the border of the cavity, compared with the other conditions.

CONCLUSION

A local glue containing UII may trap GB cells and remodel the tumor microenvironment responsible for survival and cognitive improvements, providing new option in the therapeutic arsenal of GB.

Signaling switch of the urotensin II vasosactive peptide GPCR: prototypic chemotaxic mechanism in glioma

Multiform glioblastomas (GBM) are the most frequent and aggressive primary brain tumors in adults. The poor prognosis is due to neo-angiogenesis and cellular invasion, processes that require complex chemotaxic mechanisms involving motility, migration and adhesion. Understanding these different cellular events implies identifying receptors and transduction pathways that lead to and promote either migration or adhesion. Here we establish that glioma express the vasoactive peptide urotensin II (UII) and its receptor UT and that UT-mediated signaling cascades are involved in glioma cell migration and adhesion. Components of the urotensinergic systems, UII and UT, are widely expressed in patient-derived GBM tissue sections, glioma cell lines and fresh biopsy explants. Interestingly, gradient concentrations of UII produced chemoattracting migratory/motility effects in glioma as well as HEK293 cells expressing human UT. These effects mainly involved the G13/Rho/rho kinase pathway while partially requiring Gi/o/PI3K components. In contrast, we observed that homogeneous concentrations of UII drastically blocked cell motility and stimulated cell-matrix adhesions through a UT/Gi/o signaling cascade, partially involving phosphatidylinositol-3 kinase. Finally, we provide evidence that, in glioma cells, homogeneous concentration of UII allowed translocation of Gα13 to the UT receptor at the plasma membrane and increased actin stress fibers, lamellipodia formation and vinculin-stained focal adhesions. UII also provoked a re-localization of UT precoupled to Gαi in filipodia and initiated integrin-stained focal points. Altogether, these findings suggest that UT behaves as a chemotaxic receptor, relaying a signaling switch between directional migration and cell adhesion under gradient or homogeneous concentrations, thereby redefining sequential mechanisms affecting tumor cells during glioma invasion. Taken together, our results allow us to propose a model in order to improve the design of compounds that demonstrate signaling bias for therapies that target specifically the Gi/o signaling pathway.

[Interaction between hypnotic agents and the hypothalamic-pituitary-adrenocorticotropic axis during surgery]

During stress, the relationship between the central nervous system and the immune system is essential to maintain homeostasis. The main neuroendocrine system involved in this interaction is the hypothalamic-pituitary-adrenal axis (HPA), which via the synthesis of glucocorticoids will modulate the intensity of the inflammatory response. Anaesthetic agents could be interacting with the HPA axis during surgery. Although etomidate currently remains in the center of the discussions, it seems, at least experimentally, that most hypnotics have the capacity to modulate the synthesis of adrenal steroids. Nevertheless, with the large literature on this subject, etomidate seems to be the most deleterious hypnotic agent on the HPA axis function. Its use should be limited when HPA axis is already altered.

Intravenous nutritional support in pregnancy. Experience following biliopancreatic diversion

11 pregnant women with protein malnutrition following biliopancreatic diversion for obesity were supported by parenteral nutrition (PN). In 2 cases high concentration glucose, lipid emulsions and standard aminoacid mixtures were infused via a central venous catheter; in the other subjects, because oral intake was normal or increased, only aminoacids with or without lipids were administered through a peripheral vein. PN promoted foetal growth and was very well tolerated and totally safe both for mother and infant.

Synthesis, conformational analysis and biological activity of cyclic analogs of the octadecaneuropeptide ODN. Design of a potent endozepine antagonist

The octadecaneuropeptide (ODN; QATVGDVNTDRPGLLDLK) and its C-terminal octapeptide (OP; RPGLLDLK), which exert anxiogenic activity, have been previously shown to increase intracellular calcium concentration ([Ca2+]i) in cultured rat astrocytes through activation of a metabotropic receptor positively coupled to phospholipase C. It has also been found that the [d-Leu5]OP analog possesses a weak antagonistic activity. The aim of the present study was to synthesize and characterize cyclic analogs of OP and [d-Leu5]OP. On-resin homodetic backbone cyclization of OP yielded an analog, cyclo1-8 OP, which was three times more potent and 1.4-times more efficacious than OP to increase [Ca2+]i in cultured rat astrocytes. Cyclo1-8 OP also mimicked the effect of both OP and ODN on polyphosphoinositide turnover. Conversely, the cyclo1-8 [d-Leu5]OP analog was totally devoid of agonistic activity but suppressed the effect of OP and ODN on [Ca2+]i and phosphoinositide metabolism in astrocytes. The structure of these cyclic analogs has been determined by two-dimensional 1H-NMR and molecular dynamics. Cyclo1-8 OP exhibited a single conformation characterized by a gamma turn comprising residues Pro2-Leu4 and a type III beta turn encompassing residues Leu5-Lys8. Cyclo1-8 [d-Leu5]OP was present as two equimolar conformers resulting from cis/trans isomerization of the Arg-Pro peptide bond. These pharmacological and structural data should prove useful for the rational design of non peptidic ODN analogs.

The triakontatetraneuropeptide TTN increases [CA2+]i in rat astrocytes through activation of peripheral-type benzodiazepine receptors

Astrocytes synthesize a series of regulatory peptides called endozepines, which act as endogenous ligands of benzodiazepine receptors. We have recently shown that one of these endozepines, the triakontatetraneuropeptide TTN, stimulates DNA synthesis in astroglial cells. The purpose of the present study was to determine the mechanism of action of TTN on cultured rat astrocytes. Binding of the peripheral-type benzodiazepine receptor ligand [3H]Ro5-4864 to intact astrocytes was displaced by TTN, whereas its C-terminal fragment (TTN[17-34], the octadecaneuropeptide ODN) did not compete for [3H]Ro5-4864 binding. Microfluorimetric measurement of cytosolic calcium concentrations ([Ca2+]i) with the fluorescent probe indo-1 showed that TTN (10(-10) to 10(-6) M) provokes a concentration-dependent increase in [Ca2+]i in cultured astrocytes. Simultaneous administration of TTN (10(-8) M) and Ro5-4864 (10(-5) M) induced an increase in [Ca2+]i similar to that obtained with Ro5-4864 alone. In contrast, the effects of TTN (10(-8) M) and ODN (10(-8) M) on [Ca2+]i were strictly additive. Chelation of extracellular Ca2+ by EGTA (6 mM) or blockage of Ca2+ channels with Ni2+ (2 mM) abrogated the stimulatory effect of TTN. The calcium influx evoked by TTN (10(-7) M) or by Ro5-4864 (10(-5) M) was not affected by the N- and T-type calcium channel blockers omega-conotoxin (10(-6) M) and mibefradil (10(-6) M), but was significantly reduced by the L-type calcium channel blocker nifedipine (10(-7) M). Patch-clamp studies showed that, at negative potentials, TTN (10(-7) M) induced a sustained depolarization. Reduction of the chloride concentration in the extracellular solution shifted the reversal potential from 0 mV to a positive potential. These data show that TTN, acting through peripheral-type benzodiazepine receptors, provokes chloride efflux, which in turn induces calcium influx via L-type calcium channels in rat astrocytes.

The triakontatetraneuropeptide (TTN) stimulates thymidine incorporation in rat astrocytes through peripheral-type benzodiazepine receptors

Astrocytes and astrocytoma cells actively express the diazepam-binding inhibitor (DBI) gene, suggesting that DBI-processing products may regulate glial cell activity. In the present study, we have investigated the possible effect of one of the DBI-derived peptides, the triakontatetraneuropeptide (TTN), on [(3)H]thymidine incorporation in cultured rat astrocytes. Reversed-phase HPLC analysis of incubation media indicated that TTN is the major form of DBI-derived peptides released by cultured astrocytes. At very low concentrations (10(-14)-10(-11) M), TTN induced a dose-dependent increase in [(3)H]thymidine incorporation, whereas at higher concentrations (10(-10)-10(-5) M) the effect of TTN gradually declined. In the same range of concentrations, the specific peripheral-type benzodiazepine receptor (PBR) agonist Ro 5-4864 mimicked the bell-shaped stimulatory effect of TTN on [(3)H]thymidine incorporation. The PBR antagonist PK11195 (10(-6) M) suppressed the stimulatory action of both TTN and Ro 5-4864 on [(3)H]thymidine incorporation, whereas the central-type benzodiazepine receptor antagonist flumazenil (10(-6) M) had no effect. The present study demonstrates that the endozepine TTN stimulates DNA synthesis in rat glial cells through activation of PBRs. These data strongly suggest that TTN exerts an autocrine/paracrine stimulatory effect on glial cell proliferation.

The endozepine ODN stimulates [3H]thymidine incorporation in cultured rat astrocytes

High concentrations of diazepam-binding inhibitor (DBI) mRNA have been detected in astrocytoma, suggesting that DBI-derived peptides may play a role in glial cell proliferation. In the present study, we have investigated the effect of a processing product of DBI, the octadecaneuropeptide ODN, on DNA synthesis in cultured rat astrocytes. At very low concentrations (10(-14) to 10(-11) M), ODN caused a dose-dependent increase of [3H]thymidine incorporation. At higher doses (10(-10) to 10(-5) M), the effect of ODN gradually declined. The central-type benzodiazepine receptor antagonist flumazenil (10(-6) M) completely suppressed the stimulatory action of ODN whereas the peripheral-type benzodiazepine receptor ligand, PK11195 (10(-6) M) had no effect. The ODN-induced stimulation of [3H]thymidine incorporation was mimicked by methyl 6,7-dimethoxy-4-ethyl-beta-carboline-3-carboxylate (DMCM). The GABAA receptor antagonist bicuculline (10(-4) M) suppressed the effect of both ODN and DMCM on DNA synthesis. Exposure of cultured astrocytes to the specific GABAA agonist 3APS (10(-10) to 10(-4) M) also induced a dose-related increase of [3H]thymidine incorporation. The present study indicates that ODN, acting through central-type benzodiazepine receptors associated with the GABAA receptor complex, stimulates DNA synthesis in rat glial cells. These data provide evidence for an autocrine role of endozepines in the control of glial cell proliferation.

GABA inhibits endozepine release from cultured rat astrocytes

In the mammalian brain, the endogenous ligands for benzodiazepine receptors (also called endozepines) are predominantly synthesized by glial cells. It has recently been reported that rat astrocytes in primary culture release substantial amounts of endozepines. The aim of the present study was to investigate the possible involvement of GABA in the control of endozepine release. Exposure of cultured rat astrocytes to GABA (10(-7) to 10(-5) M) induced a dose-related inhibition of endozepine secretion. At higher doses (3 x 10(-5) to 10(-3) M), the effect of GABA gradually diminished. The inhibitory effect of GABA (10(-5) M) was mimicked by the GABA(B) receptor agonist baclofen (10(-5) M). In contrast, the GABA(A) receptor agonists 3APS and isoguvacine (10(-5) M each) did not modify endozepine release. The inhibition of endozepine secretion evoked by GABA and baclofen (10(-5) M each) was totally abrogated by the specific GABA(B) receptor antagonist phaclofen (10(-4) M). GABA and baclofen caused a significant inhibition of forskolin-evoked production of cAMP in astrocytes and this effect was abolished in the presence of phaclofen. In contrast, isoguvacine had no effect on cAMP production. Exposure of astrocytes to dbcAMP induced a time- and dose-dependent stimulation of endozepine release. These data indicate that GABA, acting through GABA(B) receptors negatively coupled to adenylyl cyclase, inhibits endozepine release from cultured rat astrocytes. The secretion of endozepines thus appears to be a valuable marker to monitor astrocyte activity.

Regulation of the expression of peripheral benzodiazepine receptors and their endogenous ligands during rat sciatic nerve degeneration and regeneration: a role for PBR in neurosteroidogenesis

Peripheral benzodiazepine receptors (PBR) and their endogenous ligands, the diazepam-binding inhibitor derived-peptides, are present in Schwann cells in the peripheral nervous system. The aim of this study was to determine the influence of reversible (freeze-injury) and permanent (transection and ligature) nerve lesion on PBR density and on the levels of their endogenous ligands, by autoradiography (using [3H]PK11195) and radioimmunoassay (using antisera directed against the octadecaneuropeptide (ODN), a diazepam-binding inhibitor fragment). The potential role of PBR on peripheral nerve steroidogenesis, was studied by investigating the effect of specific PBR agonists and antagonists on pregnenolone levels in the sciatic nerve. Sixteen to 30 days after nerve lesion, PBR density and ODN-LI level were highly increased. Their expression returned to normal level when regeneration was completed 60 days after freeze-injury, but remained elevated when regeneration did not occur in transected distal stumps. Reverse-phase HPLC analysis of ODN-LI showed that in control nerve extracts, the major immunoreactive peak co-elutes with triakontatetraneuropeptide (TTN). After freeze-injury, intermediate molecular forms eluting between ODN and TTN were predominant and remained elevated at day 60. The greater accumulation of intermediate forms when regeneration is allowed to occur may indicate a particular role of these forms in axonal elongation and myelination. Ro5-4864, a high affinity PBR agonist increased pregnenolone concentration in the sciatic nerve. This effect was antagonised by PK11195, a high affinity PBR antagonist, which had no effect on pregnenolone basal level, indicating a specific action of PBR in neurosteroid production. These results suggest a role for PBR and their endogenous ligands in peripheral nerve regeneration. A trophic effect could be exerted via stimulation of steroid synthesis.

Structure-activity relationships of a series of analogues of the octadecaneuropeptide ODN on calcium mobilization in rat astrocytes

The octadecaneuropeptide ODN (QATVGDVNTDRPGLLDLK), originally characterized as an endogenous ligand for central-type benzodiazepine receptors, increases intracellular calcium concentration ([Ca2+]i) in rat astroglial cells. A series of ODN analogues was synthesized, and each compound was studied for its ability to induce Ca2+ mobilization in cultured rat astrocytes. Replacement of each amino acid by an L-alanine residue (AlaScan) showed that the N-terminal region of the molecule was relatively tolerant to alanine substitution (2-8, 10), except for the Ala9-substituted analogue (9) which was totally devoid of activity. Pyroglutamization (21) and acetylation (22) of the Gln1 residue reduced the Ca2+ response suggesting that a free N-terminal amine function is required for full activity of ODN. Alanine substitution of the residues in the C-terminal region of the molecule (11-14, 16-18) significantly reduced the biological activity of ODN. In particular, modifications of the Leu15 residue (15, 20) abolished the Ca2+-mobilizing activity. The analogues [Ala9]ODN (9), [Ala15]ODN (15), [D-Thr9]ODN (19), and [D-Leu15]ODN (20) partially antagonized the Ca2+ response evoked by ODN. Most importantly, the octapeptide ODN11-18 (OP, 24) produced a dose-response curve that was superimposable to that obtained with ODN, indicating that the C-terminal region of the molecule possesses full biological activity. Finally, the AlaScan of OP revealed that replacement of the Leu5 residue by Ala (29) or D-Leu (33) totally suppressed the calcium response, confirming the crucial contribution of the Leu15 residue of ODN to the biological activity of the neuropeptide.

Body image and body weight in obese patients

OBJECTIVE

To evaluate the influence of body weight on body image.

METHODS

The study was carried out in severely obese patients and in postobese subjects, having attained and maintaining a normal or nearly normal weight following biliopancreatic diversion; body image was assessed by self-report questionnaires.

RESULTS

The obese patients' scores were different from those of postobese subjects. In postobese individuals with adult-onset obesity, body image was very similar to that of controls, whilst in those with early-onset obesity it was abnormal.

DISCUSSION

In the adult-onset obese patients, since the weight normalization causes a sharp improvement of body image, its alterations could be accounted for by a body shape far different from that socially acceptable. In the early-onset obese patients, being the postoperative findings similar to those of the obese patients and different from those of never-obese controls, the body image disparagement might reflect inner feelings, independent of body weight.

Body image in early-onset obese patients

In a group of early-onset-obesity obese patients eating behaviour, body image and psychological condition were assessed by the Eating Disorder Inventory, the Three Factor Eating Questionnaire, the Body Shape Questionnaire and the Body Attitude Questionnaire. These evaluations were carried out prior to and at long-term follow-up after biliopancreatic diversion when body weight had steadily fallen towards normal values. The aim was to establish the influence of actual body weight and shape over body image. A notable improvement in eating behaviour and overall psychological conditions was observed, while the parameters assessing body image remained substantially unchanged, indicating that early-onset-obesity postobese subjects, despite having obtained normal or nearly normal weight conditions, are still much more dissatisfied with their body weight and somatic morphology than never-obese subjects with very similar actual body weights.

The stimulatory effect of the octadecaneuropeptide (ODN) on cytosolic Ca2+ in rat astrocytes is not mediated through classical benzodiazepine receptors

Diazepam-binding inhibitor has been initially isolated from the rat brain from its ability to compete with benzodiazepines for their receptors. We have recently shown that the octadecaneuropeptide (diazepam-binding inhibitor-(33-50) or ODN) induces an increase in cytosolic free Ca2+ concentration ([Ca2+]i) in astroglial cells. The purpose of the present study was to determine whether central-type benzodiazepine receptors or peripheral-type benzodiazepine receptors are involved in the response of cultured rat astrocytes to ODN. The mixed central-/peripheral-type benzodiazepine receptor ligand flunitrazepam (10(-10) to 10(-6) M), the specific peripheral-type benzodiazepine receptor agonist Ro5-4864 (10(-10) to 10(-6) M) and the peripheral-type benzodiazepine receptor 'antagonist' PK 11195 (10(-9) to 10(-6) M) all induced a dose-dependent increase in [Ca2+]i. At high doses (10(-7) to 10(-5) M), the central-type benzodiazepine receptor agonist clonazepam also mimicked the stimulatory effect of ODN on [Ca2+]i. However, the [Ca2+]i rise induced by ODN was blocked neither by PK 11195 nor by the central-type benzodiazepine receptor antagonist flumazenil (10(-6) M each). Binding of [3H]flunitrazepam to intact astrocytes was displaced by low concentrations of the peripheral-type benzodiazepine receptor ligands flunitrazepam, Ro5 4864 and PK 11195, and by high concentrations of clonazepam. In contrast, ODN did not compete for [3H]flunitrazepam binding in intact cells. These data indicate that the effect of ODN on Ca2+ mobilization in rat astrocytes is mediated by high affinity receptors which are not related to classical benzodiazepine receptors.

Binge eating in obesity: a longitudinal study following biliopancreatic diversion

OBJECTIVE

Evaluating the influence of dieting and of being overweight on binge-eating episodes and on psychological traits in severely obese patients.

METHODS

Clinical interviews and self-report questionnaires prior to and 2 years following biliopancreatic diversion (BPD) when subjects adopt a completely free eating style and achieve in maintaining a normal or nearly normal body weight.

RESULTS

At two years following the operation, the prevalence of binge-eating episodes sharply fell and the subjects' overall psychological conditions improved; only a few patients started binging.

DISCUSSION

These results point out the importance of dieting and of overweight itself in determining eating behavior disturbances or psychopathology. The fact that only a very small number of patients continue or start binging following BDP suggests that a minority of obese bingers should be considered as true eating-disordered patients.

Binge eating in obesity

OBJECTIVE

To investigate the influence of dieting and of body shape dissatisfaction on binge eating.

DESIGN

Longitudinal study following billiopancreatic diversion (BPD), when the body shape has become normal or nearly normal, and any worries over weight, dieting and food have probably been abandoned completely.

SUBJECTS

65 severely obese patients, evaluated by clinical semistructured interview for occurrence of binge eating episodes prior to, and at one and at two years following BPD.

RESULTS

Whereas preoperative binge eating had been reported by 65% of the obese individuals, at two years following BPD binge eating occurred only in 9.2% of them.

CONCLUSIONS

Weight stabilisation following BPD is associated with a sharp improvement in control over food intake, and this suggests the central role of dieting and/or of body dissatisfaction in causing binge eating episodes.

Body composition and energy expenditure in obese patients prior to and following biliopancreatic diversion for obesity

Body composition and resting energy expenditure (REE) were assessed in 69 obese patients prior to and 1 year following biliopancreatic diversion (BPD). Fat-free mass (FFM) and body fat sizes were very similar to those of nonoperated subjects closely matched for body weight and FFM size. In the BPD subjects, the REE data were high, thus excluding a dilatation of non-energy-consuming extracellular spaces and suggesting an increase in the ratio between the organs and the less metabolically active muscle mass within the FFM.

Food- and weight-related attitudes in obese persons: a longitudinal study over two years following biliopancreatic diversion

Food- and weight-related attitudes were assessed in obese subjects prior to biliopancreatic diversion (BPD) and at 1 and 2 years after BPD, when any preoccupation with dieting and body weight and shape should have been abandoned. A decrease in the number of subjects whose food attitudes suggested some loss of control over food consumption, such as snacking, nibbling, getting hungry and eating in response to non-alimentary stimuli or arousal conditions was observed, confirming the role of dieting in leading to loss of control over food intake. The stable weight loss correlated with changes in the body attitudes and in the overall psychological status. The changes observed in obese persons after BPD suggest that 1) the food-related attitudes are influenced by the preoccupation with food and with dieting; 2) the weight-related attitudes are accounted for more by dissatisfaction with a body shape that is very different from the socially accepted one than by an individual's psychological traits.

Preoperative Eating Behavior and Weight-loss Following Gastric Banding for Obesity

BACKGROUND AND METHODS: The relationships between cognitive restraint and the tendency to disinhibition, as assessed by the Three Factor Eating Questionnaire (TFEQ), and the weight loss at 1 year following gastric banding are evaluated. RESULTS: A significant predictability of the TFEQ Disinhibition score on the postoperative weight reduction was observed, while the amount of weight lost was negatively related to the preoperative TFEQ Cognitive Restraint score. CONCLUSION: It must then be hypothesized that the operated subjects feel a strong aversive stimulus and then they are led to reduce their food consumption only when they lose control and tend to overeat. The discomfort due to proximal gastric pouch distention facilitates the development of food aversion and then both the decrease of food intake and a change in eating behavior. The subjects must therefore be encouraged to adopt an eating style that cannot allow them to avoid such a feeling.

[Preoperative eating behavior and weight loss after gastric banding for obesity]

The relationships between the cognitive restraint and the tendency to disinhibition prior to gastric banding for obesity, as assessed by the Three Factor Eating Questionnaire, and the weight loss at one year following the operation were investigated. The amount of overall weight loss was correlated positively to the disinhibition and negatively to the cognitive restraint score. When the food consumption overtakes the proximal gastric pouch capacity, the patient feels a strong aversive stimulus, thus stopping eating. Therefore, more is the patient's tendency to lose the control on food intake more is the postoperative weight loss. On the contrary, the high restraint patient only seldom feels such an aversive stimulus, and only seldom stops eating, thus the weight loss is smaller. Except for the overeating due to the disinhibition, the aversive stimulus arising from the gastric restriction cannot influence by itself any other aspect of eating behavior.

Binge eating following biliopancreatic diversion for obesity

The prevalence of binge eating disorder (BED) was assessed in 68 massively obese patients prior to and following biliopancreatic diversion (BPD) for obesity. The eating behavior and the psychological traits were evaluated by the Three Factor Eating Questionnaire and the Eating Disorder Inventory. Since after BPD the body weight regulation is substantially dependent on intestinal absorption, the individuals operated on have to be considered as absolutely free eaters. In this population, 30 patients were affected by BED and in 24 of them binge eating disappeared spontaneously following BPD, highlighting the main role of preoccupation with food, diet and overweight in causing or in maintaining BED.

The endozepine ODN stimulates polyphosphoinositide metabolism in rat astrocytes

Astrocytes synthesize a series of peptides called endozepines which act as endogenous ligands of benzodiazepine receptors. The present study demonstrates that the endozepine ODN causes a dose-dependent increase in inositol trisphosphate and a parallel decrease in phosphatidylinositol bisphosphate in cultured rat astrocytes. Pre-incubation of astrocytes with the phospholipase C inhibitor U 73122 or with pertussis toxin totally blocked polyphosphoinositide metabolism. These data show that, in rat astrocytes, ODN stimulates a phospholipase C coupled to a pertussis toxin-sensitive G protein.

Binge eating in massively obese patients undergoing bariatric surgery

Data on the prevalence of binge eating in a series of 92 massively obese patients undergoing bariatric surgery are presented. A semistructured clinical interview demonstrated that 63 individuals had problems with binge eating, 43 of these reporting episodes of binge eating more than twice a week and then meeting the diagnostic criteria for binge eating disorder. By comparison with their nonbinge eating counterparts, binge eaters demonstrated higher body weight, greater weight fluctuation due to reducing diets in their past lifetime, higher Three-Factor Eating Questionnaire Disinhibition and Hunger score, and an overall higher psychopathology as assessed by the Eating Disorder Inventory. The great prevalence of binge eating in these patients could be accounted for by the high body weight, by the characteristics of the patients, or by the context in which the eating behavior assessment was carried out.

Obese binge eaters: metabolic characteristics, energy expenditure and dieting

The study was carried out in two groups of massively obese women with BMI values who were to undergo bariatric surgery. The patients were evaluated for weight variability and for the presence and the frequency of binge eating. Body composition, resting energy expenditure (REE) and metabolic parameters were also measured. When non-bingeing individuals were compared with patients who met Binge Eating Disorder criteria, no differences in body composition, fat distribution, REE values and concentrations of serum lipids, insulin and thyroid hormones were found. On the other hand, weight variability due to reduced diet in the subjects' lifetime was significantly higher. This study does not support the hypothesis that in massively obese women binge eating is somehow induced by a reduced energy expenditure.

Eating disorder inventory in the assessment of psychosocial status in the obese patients prior to and at long-term following biliopancreatic diversion for obesity

Psychological traits of obese patients, assessed with the Eating Disorder Inventory (EDI), were compared to those of subjects in the long-term following biliopancreatic diversion for obesity (BPD), when body weight has been steadily normal for over 1 year and any preoccupation with dieting and weight has been completely abandoned. The overall results suggest that the stable body weight normalization on a completely free diet does confer considerable psychological benefit on obese individuals. On the basis of the EDI results, post-BPD subjects were divided into weight-preoccupied and not-weight-preoccupied individuals. In the not-weight-preoccupied subjects, the psychosocial status and emotional rectivity were closely similar to those observed in lean control persons, whereas the few weight-preoccupied subjects, in spite of completely normal body weight, showed residual body dissatisfaction and personality traits very similar to those of eating-disordered patients.

Resting Energy Expenditure in Long-Term Postobese Subjects after Weight Normalization by Dieting or Biliopancreatic Diversion

Resting energy expenditure (REE) was measured by Indirect calorimetry in three groups of subjects closely matched for body weight (BW) and body composition. Five subjects had reduced from lO3 kg (129-90) to normal BW by dieting. Fourteen subjects had normalized their weight (preop 120 kg, from 168 to 100) following biliopancreatic diversion (BPD). All subjects in both groups had essentially maintained a stable weight for at least 2 years before the study. Ten healthy volunteers who had never been obese served as controls. No differences in REE were observed between post-BPD and control subjects, while lower (p < 0.05) values of REE were found in post-diet subjects. A long-lasting reduction of REE, in spite of a normal body composition, might partly account for the very poor long-term results of conventional dietary treatment. The unreduced REE following BPD may contribute, along with the permanent intestinal malabsorption, to the excellent long-term weight maintenance caused by this surgical procedure.

The use of bioelectrical impedance analysis for monitoring body composition changes during nutritional support

Body composition was measured with bioelectric impedance analysis (BIA) in 30 patients with protein malnutrition following biliopancreatic diversion. Determinations were carried out prior to, during, and at the completion of intravenous nutritional support when the nutritional parameters had completely reverted to normal. Before treatment, body weight (BW), lean body mass (LBM), and body fat (BF) values were similar to those of controls, whereas the total body sodium/total body potassium (TBNa/TBK) and extracellular mass/body cell mass (ECM/BCM) ratios were considerably higher. During the support, no changes in BW, LBM, and BF were demonstrated, although a sharp decrease of TBNa/TBK and ECM/BCM was observed, thus demonstrating improved LBM composition. At the end of parenteral feeding, the BW, LBM, and BF values were similar to those observed before the support, while a further decrease in TBNa/TBK and ECM/BCM demonstrated a recovery towards normal of body composition. The full correspondence between clinical and BIA findings therefore suggests that this method may be valuable for monitoring body composition changes during nutritional support.

[Eating behavior and energy expenditure]

The relationships between the resting energy expenditure (REE), measured by indirect calorimetry, and eating behavior, assessed by the "Three Factor Eating Questionnaire" were evaluated. The study was carried out in a group of healthy never-obese subjects and in two groups of formerly obese people, who have maintained a normal weight for more than two years. The subjects of the first formerly obese group had brought their body weight to normal by dieting. The second one comprised subjects following biliopancreatic diversion for obesity (BPD) in the long term, who maintain a normal weight because of the intestinal malabsorption due to the operation regardless of food consumption. In comparison with the other subjects, significantly higher cognitive restraint score values were observed in the post-diet subjects. Furthermore, a negative significant correlation between cognitive restraint and REE was found in the non operated subjects, while such correlation was not present in the BPD subjects. Therefore, in normal people cognitive restraint has to be considered to be related to behavioral-cognitive factors rather than biologically driven by energy requirements.

Eating behavior following biliopancreatic diversion for obesity: study with a three-factor eating questionnaire

The eating behavior of obese patients and of subjects who had normalized their body weight following biliopancreatic diversion (BPD) was assessed by a three-factor eating questionnaire (TFEQ), constructed to measure cognitive dietary restraint, the tendency to disinhibition, and susceptibility to hunger. In the obese patients higher values of both disinhibition and hunger score were found than in normoweight persons. In BPD subjects a negative association between the time elapsed from the operation and both the disinhibition and hunger score values was observed. In patients operated more than 2 years before, the eating behavior, as assessed by the TFEQ, was similar to that of normoweight persons. After BPD the operated subjects do not have to respect any dietary advice, the loss of weight and the maintenance of a normal body weight occurring in spite of an absolutely free food consumption. Similarity to the control values of disinhibition and hunger score following BPD suggests that in the long term, when the preoccupation with food and diet is abandoned, a normal eating pattern can be achieved.

Enteral nutrition following total laryngectomy

Body composition was measured in patients who underwent total laryngectomy for carcinoma and who were enterally fed throughout the postoperative period with full liquid artificial mixtures. The intestinal complications were very mild and required no changes in the nutritional program. Body sector sizes remained essentially unchanged until the end of the support, malnutrition did not occur and the postoperative local infection rate was very low. On the contrary, in patients fed with blenderized food, the amount of enteral infusion had to be reduced because of poor tolerance or abdominal discomfort; in this case caloric intake was largely inadequate. Fall in BW and BCM size and increase of TBNa/TBK ratio demonstrated a postoperative impairment of the nutritional status. Furthermore, the postoperative infection rate, the number of days with fever and the length of antibioticotherapy were higher than those observed in patients fed with full liquid mixtures.

[A new approach to gastric restriction surgery in treatment of obesity. Preliminary data]

Following gastric surgery for obesity, a satisfactory weight loss and, above all, long-term weight maintenance can only be achieved in patients who have succeeded in radically changing their preoperative eating habits. In this preliminary study gastric banding is associated with rehabilitative training which was carried out using similar methods to the programs used for eating disorders. One year after surgery the results were substantially the same as those reported in the literature, with an overall weight loss of approximately 50%. The lack of correlation between weight loss and the degree of gastric banding underlines, even after a short interval, the efficacy and importance of postoperative re-educational training. The utility of this integrated approach will only be more fully evaluated after a longer period.

Orally-administered Serum Ranitidine Concentration after Biliopancreatic Diversion for Obesity

Stomal ulcer occurs in about 5% of patients after biliopancreatic diversion (BPD). Seven females were given 150 or 300 mg of ranitidine orally. Blood samples found a pharmacologically effective concentration from 0.5 to 8 h after both doses. Intestinal absorption of ranitidine is maintained after BPD.