Large Weight Loss Research Articles

Protonthérapie des carcinomes épidermoïdes des voies aérodigestives supérieures : de la physique à la clinique

Intensity-modulated radiation therapy (IMRT) is presently the recommended technique for the treatment of locally advanced head and neck carcinomas. Proton therapy would allow to reduce the volume of irradiated normal tissue and, thus, to decrease the risk of late dysphagia, xerostomia, dysgeusia and hypothyroidism. An exhaustive research was performed with the search engine PubMed by focusing on the papers about the physical difficulties that slow down use of proton therapy for head and neck carcinomas. Range uncertainties in proton therapy (±3 %) paradoxically limit the use of the steep dose gradient in distality. Calibration uncertainties can be important in the treatment of head and neck cancer in the presence of materials of uncertain stoichiometric composition (such as with metal implants, dental filling, etc.) and complex heterogeneities. Dental management for example may be different with IMRT or proton therapy. Some uncertainties can be somewhat minimized at the time of optimization. Inter- and intrafractional variations and uncertainties in Hounsfield units/stopping power can be integrated in a robust optimization process. Additional changes in patient's anatomy (tumour shrinkage, changes in skin folds in the beam patch, large weight loss or gain) require rescanning. Dosimetric and small clinical studies comparing photon and proton therapy have well shown the interest of proton therapy for head and neck cancers. Intensity-modulated proton therapy is a promising treatment as it can reduce the substantial toxicity burden of patients with head and neck squamous cell carcinoma compared to IMRT. Robust optimization will allow to perform an optimal treatment and to use proton therapy in current clinical practice.

Abstract 609: Vitamin D binding protein and risk of renal cell carcinoma in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Abstract Introduction/Study purpose: Vitamin D binding protein (DBP) is the major carrier of vitamin D in circulation. In addition to its role in vitamin D transport, DBP has several other biologic mechanisms that may be relevant to cancer risk including macrophage activation, apoptosis, and angiogenesis. Although previous studies have demonstrated no association between vitamin D and RCC, our group has conducted two previous studies which found strong inverse associations between DBP and RCC. We undertook the current analysis to replicate our findings in a different study population. Methods: We conducted a nested case-control study in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Cases (n=323) were matched 1:1 to controls on age (+/- 1 year), race, date of blood collection (+/- 30 days) and sex. We performed conditional logistic regression to estimate the odds ratios and 95% confidence intervals for the association between quartiles of circulating DBP and risk of RCC. In addition to conditioning on the matching factors, multivariable models were further adjusted for history of diabetes or hypertension, family history of renal cancer, body mass index (BMI), and smoking status. Additionally, we performed stratified analyses by sex, family history of renal cancer, BMI, smoking status, and tumor stage at diagnosis. Results: We observed a statistically significant positive association between DBP and RCC that persisted after multivariable adjustment (mv-adj Q4 vs. Q1 OR=3.1, 95% CI=1.8-5.6; p-trend <0.0001). Sensitivity analyses were performed removing matched pairs where the case was diagnosed within 2 years of blood collection or experienced a large weight loss (>40 lbs), with little effect on the overall trend (Q4 vs. Q1 OR=2.5 CI=1.4-4.6 p-trend=<0.0001). Conclusions: In the present study, those with higher serum concentrations of DBP were at increased risk of RCC, which differs from previously-published findings. Further research is necessary to determine the true association between DBP and risk of RCC, and whether different DBP phenotypes via GC variation may have different associations with risk of RCC. Note: This abstract was not presented at the meeting. Citation Format: Tyler B. Kratzer, Alison M. Mondul, Stephanie J. Weinstein, Demetrius Albanes. Vitamin D binding protein and risk of renal cell carcinoma in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 609.

Predictors of successful weight loss with relative maintenance of fat-free mass in individuals with overweight and obesity on an 8-week low-energy diet.

A low-energy diet (LED) is an effective approach to induce a rapid weight loss in individuals with overweight. However, reported disproportionally large losses of fat-free mass (FFM) after an LED trigger the question of adequate protein content. Additionally, not all individuals have the same degree of weight loss success. After an 8-week LED providing 5020 kJ/d for men and 4184 kJ/d for women (84/70 g protein/d) among overweight and obese adults, we aimed to investigate the relationship between protein intake relative to initial FFM and proportion of weight lost as FFM as well as the individual characteristics associated with weight loss success. We assessed all outcomes baseline and after the LED. A total of 286 participants (sixty-four men and 222 women) initiated the LED of which 82 % completed and 70 % achieved a substantial weight loss (defined as ≥8 %). Protein intake in the range 1·0-1·6 g protein/d per kg FFM at baseline for men and 1·1-2·2 g protein/d per kg FFM at baseline for women was not associated with loss of FFM (P = 0·632). Higher Three-Factor Eating Questionnaire (TFEQ) hunger at baseline and reductions in TFEQ disinhibition and hunger during the LED were associated with larger weight loss (all P ≤ 0·020); whereas lower sleep quality at baseline predicted less successful weight loss using intention to treat analysis (P = 0·021), possibly driven by those dropping out (n 81, P = 0·067 v. completers: n 198, P = 0·659). Thus, the protein intakes relative to initial FFM were sufficient for maintenance of FFM and specific eating behaviour characteristics were associated with weight loss success.

Влияние транспортировки и хранения на потерю массы и влаги экзотических фруктов

Every year, hundreds of thousands of tons of fruits and vegetables are supplied to the territory of the Russian Federation by exporting producers from different countries. During transportation and storage, the supplied fruits and vegetables undergo various physical and biochemical changes, leading to weight loss and changes in quality indicators. Loss of moisture during transportation is one of the main causes of damage to fruits and vegetables. The relevance of the research topic is determined by the need to minimize the loss of mass and moisture of exotic fruits during transportation and storage in warehouse conditions.Objective: to establish the rates of loss of 10 samples of exotic fruits. The samples included Thai pineapple, Thai watermelon, guava, cantaloupe melon, carambola, Thai mango, papaya of Holland variety, green papaya, passionflower (passion fruit, pitaya). The fruits were transported by air from Thailand (Bangkok) to Krasnoyarsk. The flight duration was 8 hours, flight altitude – 10,000 m. The storage conditions were as follows: temperature – 5–8°C, humidity – 47%, storage time – 10 days in winter period. The paper presents the results obtained for the dynamics of mass and humidity during transportation by air of samples of exotic fruits and during storage in warehouse conditions. It was established that the loss of mass and moisture of exotic fruits in the process of transportation and storage occurred in all samples. The highest percentage of weight loss was observed in Thai mango and amounted to 2.93%. The greatest loss of moisture during storage in warehouses was observed in Thai watermelon (3.5%), the smallest – in Thai pineapple (0.5%). The largest weight loss was set for guava (4.6%), the smallest – for Thai watermelon (0.5%).

1917-P: Primary Weight Loss Failure after Gastric Bypass Is Characterized by Impaired Gut-Hormone-Mediated Suppression of Food Intake

Roux-en-Y gastric bypass (RYGB) induces large and sustained weight loss in most patients. However, a minority of patients (5-10%) never obtain a successful weight loss after RYGB. The aim of this study was to characterize the role of gut hormones for appetite regulation in patients with primary weight loss (WL) failure defined as maximal excess BMI loss (EBLmax= ΔBMIpreoperative-postoperative/ΔBMIpreoperative-25) <50% compared with patients with successful WL (EBLmax >60%) after RYGB. Twenty women with primary WL failure (EBL 24% [9;27], median [IQR]) were matched to 20 women with successful WL (EBL 74% [70;83]) on age (51±9 vs. 51±9 years, mean ± sd), preoperative BMI (43.1±4.0 vs. 43.0±3.6 kg/m2) and time from RYGB (4.8±2.0 vs. 4.8±1.4 years). On separate days, a patient blinded subcutaneous injection of the somatostatin analogue Octreotide (Oct) 1 µg/kg bodyweight (max 100 µg) or saline (placebo) was given in randomized order followed by a mixed meal test at T=30 min and an ad libitum meal with measurement of food intake at T=270 min. The WL failure group had similar GLP-1 (tAUC, median [IQR], 4039 [3336;6018] vs. 4669 [3006;5891] pM·min, p=0.30) and PYY secretion (tAUC, 1935 [1493;2783], 1778 [1163;2756] pM·min, p=0.65) on the placebo day compared with the successful WL group. Injection of Oct diminished GLP-1 and PYY secretion in both groups. Oct had no effect on ad libitum food intake in the WL failure group (-0.5% [-13, 12], mean [95% CI]), while food intake was increased after Oct in the successful WL group (+23% [1.6, 44]) (ANOVA Group x Oct p=0.04). In conclusion, primary WL failure after RYGB was not explained by lower secretion of GLP-1 or PYY. However, inhibition of hormone secretion with octreotide increased food intake only in patients with successful WL, whereas the effect was absent in patients with primary WL failure. These results support that an impaired gut-hormone mediated suppression of appetite could contribute to primary weight loss failure after RYGB. Disclosure K.N. Bojsen-Moller: None. M.S. Svane: None. C. Martinussen: None. C. Dirksen: None. N.B. Jørgensen: Stock/Shareholder; Self; Novo Nordisk A/S. V. Kristiansen: None. B. Hartmann: None. J.J. Holst: Advisory Panel; Self; Novo Nordisk A/S. S. Madsbad: None. Funding Danish Council for Independent Research

1995-P: Optimization of DACRA Dosing Frequency—The Balance between Efficacy and Tolerability

Potent dual amylin and calcitonin receptor agonists (DACRAs) are novel candidates for treatment of T2D and obesity due to their beneficial effects on body weight, blood glucose and insulin sensitivity. Notably, DACRAs activate the receptors for a prolonged time period resulting in metabolic effects superior to those of amylin. This indicates that a less frequent dosing could be feasible, although the tolerability is a question mark. In this study, we compared daily dosing to dosing every other day to characterize the tolerability and efficacy of these regimens. High fat fed Sprague Dawley rats were treated 9 weeks by s.c. injections of the DACRA KBP in two different dosing intervals corresponding to a daily dose of 1.5 nmol/kg. KBP was dosed either daily (q.d., 1.5 nmol/kg) or every other day (q.a.d, 3 nmol/kg). After 3 and 8 weeks of treatment oral glucose tolerance tests were performed 24 hours post injection of treatment. Both treatments resulted in an initial reduction in food intake. KBP q.d. resulted in a transient reduction in food intake that normalized within the first 10 days of treatment, while KBP q.a.d resulted in fluctuating food intake throughout the study. The fluctuations reflected the dosing intervals resulting in a marked suppression of food intake following dosing, however food intake normalized on non-dosing days. This difference is reflected in the accumulated food intake, where KBP q.a.d tended to have a lower food intake than KBP q.d. Both treatments resulted in sustained and significant weight loss as well as reductions in the overall adiposity. Interestingly, KBP q.a.d tended to induce a larger weight loss than KBP q.d., albeit with fluctuations reflecting the dosing intervals. In addition, KBP dose dependently improved oral glucose tolerance with significant reduced insulin levels both after 3 and 8 weeks of treatment. In conclusion, dosing KBP every other day positively affects the efficacy confirming that less frequent dosing with KBP could be feasible. Disclosure A.T. Larsen: None. K.V. Andreassen: Employee; Self; Nordic Bioscience. N. Sonne: None. M.A. Karsdal: Employee; Self; Nordic Bioscience. K. Henriksen: Employee; Self; Nordic Bioscience. Employee; Spouse/Partner; Novo Nordisk A/S. Stock/Shareholder; Self; Nordic Bioscience. Other Relationship; Self; Nordic Bioscience.

Improving thermal durability and mechanical properties of poly(ether ether ketone) with single-walled carbon nanotubes

In this study, adding carbon nanotubes (CNTs) to poly (ether ether ketone) (PEEK) not only improved the mechanical properties, but also improved the thermal resistivity of PEEK owing to the CNTs’ function as an antioxidant. The PEEK–CNT composite did not show large weight loss at 450 °C. The stabilization energies (ΔG) of CNTs for 1,4-diphenoxybenzene radical and 4-phenoxyphenol radical, which are decomposition products of PEEK at 450 °C, were calculated by density functional theory, and they were estimated to be −80.3 and 150.2 kJ mol−1, respectively. It was confirmed that 1,4-diphenoxybenzene radical could be trapped in a high-temperature environment of 450 °C by the CNTs. The addition of CNTs yielded almost no change in formability, but the mechanical properties such as tensile strength and bending strength were greatly improved. The PEEK–CNT composite is expected to have improved heat resistivity and mechanical properties, as well as higher reliability, so that it can be used in the future in various fields such as aerospace and automotive.

Surgical obesity treatment and the risk of heart failure.

Obesity is associated with increased risk for heart failure. We analysed data from the Swedish Obese Subjects (SOS) study, a prospective matched cohort study, to investigate whether bariatric surgery reduces this risk. From the total SOS population (n = 4047), we identified 4033 obese individuals with no history of heart failure at baseline, of whom 2003 underwent bariatric surgery (surgery group) and 2030 received usual care (control group). First-time principal diagnoses of heart failure were identified by crosschecking the SOS database with the Swedish National Patient Register and the Swedish Cause of Death Register using diagnosis codes. During a median follow-up of 22 years, first-time heart failure occurred in 188 of the participants treated with surgery and in 266 of those receiving usual care. The risk of developing heart failure was lower in the surgery group than in the control group [sub-hazard ratio 0.65, 95% confidence interval (CI) 0.54-0.79; P < 0.001]. After pooling data from the two study groups, the quartile of subjects with the largest weight loss after 1 year (mean -41 kg) displayed the greatest risk reduction (sub-hazard ratio 0.51, 95% CI 0.30-0.70; P < 0.001). This association remained statistically significant after adjustment for surgical intervention and potential baseline confounders (sub-hazard ratio 0.60, 95% CI 0.36-0.97; P = 0.038). Compared with usual care, bariatric surgery was associated with reduced risk of heart failure among persons being treated for obesity. The risk of heart failure appeared to decline in parallel with a greater degree of weight loss. NCT01479452.

Weight loss at your fingertips: personalized nutrition with fasting glucose and insulin using a novel statistical approach.

Precision medicine is changing the way people are diagnosed and treated into a more personalized approach. Using a novel statistical approach, we demonstrate how two diets cause differential weight loss depending on pre-treatment fasting plasma glucose (FPG) and fasting insulin (FI) levels. One hundred and eighty-one overweight people with increased waist circumference were randomly assigned to receive an ad libitum New Nordic Diet (NND) high in dietary fiber and whole grain or an Average Danish (Western) Diet (ADD) for 26 weeks. All foods were provided free of charge. Body weight was measured throughout the study and blood was drawn before randomization from where FPG and FI were analyzed. Weight was described by linear mixed models including biomarker (FPG or FI) diet group interactions. Individualized predictions were estimated as contrasts of intercepts and slopes of pre-treatment biomarkers. Every mmol/L increase in baseline FPG predicted a between-diet difference of 3.00 (1.18;4.83, n = 181, P = 0.001) kg larger weight loss from choosing NND over ADD. For instance, a baseline FPG level of 4.7 mmol/L would lead to an average of 1.42 kg larger weight loss on NND vs. ADD (above 0.41 kg with 95% certainty), whereas the average effect size would be 8.33 kg (above 5.50 kg with 95% certainty) among subjects with FPG level of 7.0 mmol/L. Among individuals with FPG <5.6 mmol/L, each pmol/L lower baseline FI predicted a 0.039 (95% CI 0.017;0.061, n = 143, P < 0.001) kg larger weight loss from choosing NND over ADD. Use of pre-treatment FPG and FI led to truly individualized predictions of treatment effect of introducing more fiber and whole grain in the diet on weight loss, ranging from almost no effect to losing >8 kg. These findings suggest that this novel statistical approach has great potential when re-evaluating data from existing randomized controlled trials.

To Text or Not to Text: Electronic Message Intervention to Improve Treatment Adherence Versus Matched Historical Controls.

BackgroundEnsuring treatment adherence is important for the internal validity of clinical trials. In intervention studies where touch points decrease over time, there is even more of an adherence challenge. Trials with multiple cohorts offer an opportunity to innovate on ways to increase treatment adherence without compromising the integrity of the study design, and previous cohorts can serve as historical controls. Electronically delivered nudges offer low-cost opportunities to increase treatment adherence.ObjectiveThis study aimed to evaluate the effectiveness of electronic messages (e-messages) on treatment adherence to the last cohort of a parent weight loss intervention during the second half of a year-long trial, when intervention checkpoint frequency decreases. Treatment adherence is measured by intervention class attendance and adherence to the intervention diet.MethodsAll participants in the last cohort (cohort 5, n=128) of a large randomized weight loss study were offered an e-message intervention to improve participant adherence during the last 6 months of a 1-year weight loss program. Overall, 3 to 4 electronic weekly messages asked participants about intervention diet adherence. A propensity score model was estimated using 97 participants who opted to receive e-messages and 31 who declined in cohort 5 and used to pair match cohort 5 e-message participants to a historical control group from cohorts 1 to 4. Moreover, 88 participants had complete data, yielding 176 participants in the final analyses. After matching, intervention and matched control groups were compared on (1) proportion of class attendance between the 6 and 12 month study endpoints, (2) diet adherence, as measured by total carbohydrate grams for low-carbohydrate (LC) and total fat grams for low-fat (LF) diets at 12 months, and (3) weight change from 6 to 12 months. The dose-response relationship between the proportion of text messages responded to and the 3 outcomes was also investigated.ResultsCompared with matched controls, receiving e-messages had no effect on (1) treatment adherence; class attendance after 6 months +4.6% (95% CI −4.43 to 13.68, P=.31), (2) adherence; LC −2.5 g carbohydrate, 95% CI −29.9 to 24.8, P=.85; LF +6.2 g fat, 95% CI −4.1 to 17.0, P=.26); or on (3) the secondary outcome of weight change in the last 6 months; +0.3 kg (95% CI −1.0 to 1.5, P=.68). There was a positive significant response correlation between the percentage of messages to which participants responded and class attendance (r=.45, P<.001).ConclusionsAlthough this e-message intervention did not improve treatment adherence, future studies can learn from this pilot and may incorporate more variety in the prompts and more interaction to promote more effective user engagement. Uniquely, this study demonstrated the potential for innovating within a multicohort trial using propensity score–matched historical control subjects.Trial RegistrationClinicalTrials.gov NCT01826591; https://clinicaltrials.gov/ct2/show/NCT01826591International Registered Report Identifier (IRRID)RR2-10.1016/j.cct.2016.12.021

Primary Care Interventions for Obesity: Review of the Evidence.

This review describes the results of randomized controlled trials that have evaluated the efficacy of behavioral interventions for obesity in primary care settings. Most studies have found that high-intensity behavioral counseling (providing 12 or more sessions per year, as defined by the US Preventative Services Task Force), when delivered in-person, by phone, or electronically, produced clinically meaningful weight loss (4 to 7kg). Low- to moderate-intensity behavioral counseling and counseling that did not include behavioral strategies (e.g., motivational interviewing) produced modest losses of 1 to 2kg. The addition of weight loss medication increased mean losses relative to behavioral treatment alone. Consistent with national guidelines, the largest weight losses were achieved with high-intensity counseling, either alone or in combination with obesity pharmacotherapy. Primary care providers can support their patients by inviting them to discuss their weight concerns and referring interested individuals to appropriate interventions.

Partial replacement of pork backfat with konjac gel in Northeastern Thai fermented sausage (Sai Krok E-san).

ObjectiveThe influence of konjac gel level on fermentation process and product qualities were assessed to evaluate the feasibility of using it as fat analog in Northeastern Thai fermented sausage (Sai Krok E-san).MethodsFive treatments of fermented sausages were formulated by replacing pork backfat with 0%, 7.5%, 22.5%, and 30% konjac gel. The changes in lactic acid bacteria (LAB) and important physicochemical properties of samples were assessed during 3 days of fermentation. After the end of fermentation at day 3, water activity (aw), instrumental texture, color, microbial counts, and sensory evaluation were compared. The best product formulation using konjac for replacing pork back fat were selected and used to compare proximate composition and energy value with control sample (30% pork backfat).ResultsAn increase in konjac gel resulted in higher values of LAB, total acidity, and proteolysis index with lower pH and lipid oxidation during 3 days of product fermentation (p< 0.05). It was noted that larger weight loss and product shrinkage during fermentation was observed with higher levels of konjac gel (p<0.05). The resulting sausage at day 3 with 15% to 30% konjac gel exhibited higher hardness, cohesiveness, gumminess, springiness, and chewiness than control (p<0.05). The external color of samples with 22.5% to 30% konjac gel were redder than others (p<0.05). Mold, Salmonella spp., Staphylococcus aureus, and Escherichia coli in all finished products were lower than detectable levels. Product with 15% konjac gel had the highest scores of sourness linking and overall acceptability (p<0.05).ConclusionThe product with 15% of konjac gel was the optimum formulation for replacing pork backfat. It had higher sensorial scores of sourness and overall acceptability than control with less negative impact on external appearance (product shrinkage) and weight loss. Moreover, it provided 46% fat reduction and 32% energy reduction than control.

No effect of weight intervention on perinatal outcomes in obese women scheduled for in vitro fertilization treatment.

Large observational studies have shown that obstetric and perinatal outcomes are negatively affected in obese women. In contrast, a recent Dutch randomized trial of infertile women and lifestyle weight intervention found no difference between the weight intervention group and the control group in obstetric or neonatal outcomes. We have recently published a large Nordic randomized trial where obese women scheduled for in vitro fertilization (IVF) treatment went through an intensive weight intervention treatment before IVF. No significant effect on live birth rate was found, despite large weight loss in the intervention group. The present study was conducted primarily to find out the effect of weight intervention in obese women scheduled for IVF on mean birthweight and mean deviation from expected birthweight, and secondarily the effect on other perinatal and maternal outcomes. A secondary analysis of a prospective, randomized controlled trial performed between 2010 and 2016 in the Nordic countries was performed. In all, 317 women were randomized either to weight reduction and IVF treatment (n=160) or IVF only (n=157) and the primary end-point was live birth. From this study, all births were analyzed for perinatal and maternal outcomes. Nine infertility clinics participated, including women <38years of age planning for IVF, and having a body mass index ≥30 and <35kg/m2 . Data concerning perinatal and maternal outcomes were gathered from maternal health-care and delivery records for mother and child. All analyses were performed on singletons only. There were 87 live births, 45 singletons in the intervention group and 41 singletons and one twin birth in the control group. The maternal characteristics for the women having a live birth were comparable in the two groups. The primary outcomes, mean birthweight, in the weight intervention and IVF group and the IVF only group were; 3486g (standard deviation [SD] 523) vs 3584g (SD 509) (P=0.46), mean difference -98.6g (95% confidence interval [CI] -320.3 to 123.2); deviation from expected birthweight 0.25% (SD 10.4) vs 0.87% (SD 12.9), mean difference 1.1% (95% CI -6.1 to 3.9). The estimates of the secondary perinatal and maternal outcomes in the 2 groups were: preterm birth <37weeks 2 (4.4%) vs 1 (2.4%) (odds ratio [OR] 1.95; 95% CI 0.17-22.36), small-for-gestational-age 0 (0%) vs 1 (2.4%), mean gestational age (days) 278 vs 280 (P=0.95), preeclampsia 5 (11.1%) vs 4 (9.8%) (OR 1.19; 95% CI 0.30-4.76), cesarean section 13 (28.9%) vs 10 (24.4%) (OR 1.14; 95% CI 0.45-2.94). The outcomes in both groups were generally good. There are no indications that weight intervention in this setting, in infertile women with obesity WHO class 1 undergoing IVF, has a negative impact on mean birthweight and deviation from expected birthweight. However, the data are not sufficiently robust to draw firm conclusions concerning other outcomes.

Obesity is Only a Risk Number for Secondary Prevention – Failure of Randomised Weight Loss Trials

Introduction: Obesity is linked to a number of metabolic conditions which are risk factors for cardiovascular disease. An increasing number of weight loss medications have become available as an adjunct treatment of obesity along with recommendations for diet and exercise. None have been shown to have effect on mortality or cardiovascular outcomes. Overweight and obesity are increasing and correlated with first but not necessarily recurrent cardiovascular events (CVE). This study assesses the safety and efficacy of weight loss as measured in the large prospective randomised weight loss trials for secondary prevention. Methods: PubMed search for trials measuring the specific effect of obesity reduction on cardiovascular events up to March 2019. Results:Tabled 1TrialLOOK-AHEADSCOUTCRESCENDOLIGHTCONVENECAMELLIASOSSLEEVE-PASSNumber5100107441869589108800120004047264OutcomeCVECVECVECVECVECVECVECV RiskHR0.95 p = 0.511.16 p = 0.020.97 p = 0.680.88n/a0.97 p = 0.550.76 p = 0.01n/aDuration10 yrs3.4 yrs13.8 mths2.9 yrs5 mths3.3 yrs15 yrs5 yrsStatusTerminatedWithdrawnTerminatedTerminatedTerminatedNo effect on CVEPrimary objective successful Secondary under-poweredWeight loss benefit shown with decrease in comorbidities. Open table in a new tab Conclusion: Deliberate weight loss in patients with baseline CVD do not prevent recurrent CVD and in fact may increase risk. Current guidelines need revision.

Oxidation resistance of a Mo-W-Si-B alloy at 1000–1300 °C: The effect of a multicomponent Mo-Si-B coating

The oxidation behavior and microstructures of a three phase Mo50W20Si15B15 alloy containing (Mo, W) solid solution, (Mo, W)5Si3 and (Mo, W)5SiB2 were investigated over the 1000–1300 °C temperature range. At 1300 °C, the alloy exhibited a large initial mass loss and eventually transitioned to a steady state behavior associated with the development of an amorphous borosilica scale. The oxidation resistance at lower temperature was unsatisfactory due to the pesting of Mo and W. Grazing Incident Angle X-ray Diffraction (GIXRD) measurements during the initial transient stage of oxidation identified the evolution of surface oxide products that were responsible for the large weight loss and pesting behavior. In order to address the large initial weight loss and the low temperature pesting behavior, the alloy was coated with a Mo-Si-B based coating by employing the pack cementation process followed by a conditioning treatment at 1450 °C. The microstructures of the coatings and the interlayer between the base alloy and the coating were studied, and the oxidation resistance of the coated alloys was evaluated over the 800–1300 °C temperature range. The coated alloy showed improved oxidation resistance with nearly zero mass change for extended period of time over the entire range of temperatures studied.

Ten Years After Bariatric Surgery: Bad Quality of Life Promotes the Need of Psychological Interventions.

Background: This study aims to evaluate long-term quality of life (QoL) and primary clinical outcomes, 10 years after biliointestinal bypass (BIB) surgery. It was expected that, although BIB might show encouraging primary outcomes, long term QoL could be significantly impaired.Methods: Ninety patients were contacted for a phone interview [age 41.0 ± 10.6 (mean ± SD) years, age-range 31-65 years]. QoL (by SF-36) and the clinical situation (by ad hoc questionnaire) were collected. Data were analyzed with SPSS 22. SF-36 scores were compared with Italian normative data from general and healthy population. We also compared primary clinical outcomes and SF-36 scores between patients who reported high and low levels of satisfaction with BIB.Results: Considering SF-36 results, patients showed significant impairments in QoL compared to general and healthy populations. Sixty-five percent would repeat the BIB. All patients showed at least one chronic adverse event. It occurred a significant decrease in pre-post co-occurrence rates of diabetes (χ2 = 18.41; p < 0.001) and hypertension (χ2 = 50.27; p < 0.001). Large and significant weight loss indexes (i.e., percent excess weight loss (%EWL); body mass index) were observed between pre-post intervention.Conclusion: BIB showed promising primary clinical outcomes (i.e., hypertension, diabetes, and weight loss). However, subjects reported a significant impairment in all SF-36 domains. Ad hoc psychological interventions should be implemented to ameliorate the quality of life of these patients.

Alumina hollow sphere-based ceramics bonded with preceramic polymer-filler derived ceramics

In this study, alumina hollow sphere-based ceramics were successfully prepared using the dimethyl silicone rubber, a kind of preceramic polymer, as the forming binder. A mixture of inorganic fillers, including SnO-SiO2-P2O5 (SSP) glass powder, boron carbide (B4C) powder, silicon (Si) powder and aluminum (Al) powder, were introduced into the silicone rubber to compensate for the weight loss caused by the ceramization of the silicone rubber. The green body exhibited an excellent flexibility and machinability due to the formation of the Si-O-Si polymeric network in the green sample. During the sintering process, the silicone rubber decomposed and transformed into the amorphous silica, occurring a large weight loss, while the oxidization reaction of the introduced inorganic fillers (B4C, Al and Si powders) could effectively compensate for this large weight loss to some content. The addition of SSP and B4C powders could decrease the melting point of the binder, and therefore improve the strength of the sample sintered at low temperatures (lower than 1300 °C); the addition of Si and Al powders could promote the formation of mullite phased, consequently introducing a high bonding strength between the alumina spheres. The sample with the addition of the mixed inorganic filler after sintered at 1500 °C exhibited a low density of 1.18 g/cm3, low thermal conductive of 0.83 W/mK and high compressive strength of 23.32 MPa and could be used as the high temperature thermal insulation materials in various thermal protection systems.

Weight-Independent Mechanisms of Glucose Control After Roux-en-Y Gastric Bypass.

Roux-en-Y gastric bypass results in large and sustained weight loss and resolution of type 2 diabetes in 60% of cases at 1–2 years. In addition to calorie restriction and weight loss, various gastro-intestinal mediated mechanisms, independent of weight loss, also contribute to glucose control. The anatomical re-arrangement of the small intestine after gastric bypass results in accelerated nutrient transit, enhances the release of post-prandial gut hormones incretins and of insulin, alters the metabolism and the entero-hepatic cycle of bile acids, modifies intestinal glucose uptake and metabolism, and alters the composition and function of the microbiome. The amelioration of beta cell function after gastric bypass in individuals with type 2 diabetes requires enteric stimulation. However, beta cell function in response to intravenous glucose stimulus remains severely impaired, even in individuals in full clinical diabetes remission. The permanent impairment of the beta cell may explain diabetes relapse years after surgery.

Role of gut peptide in diabetes remission after Roux-en-Y gastric bypass surgery

Roux-en-Y gastric bypass surgery results in the resolution of type 2 diabetes in ∼60% of cases. Pre-surgery beta-cell function, with the large and sustained weight loss resulting from the surgery, are the main predictors of diabetes remission. However, enteric mechanisms, independent of weight loss, have been identified as important players. They include, among others, changes in intestinal metabolism, the gut hormones, the bile acids and the microbiome. The enhanced release of glucagon-like peptide 1 (GLP-1) contribute to the improvement of the incretin effect on insulin secretion during meals. GLP-1 and other gut peptides such as peptide YY and oxyntomodulin, may also contribute to the increased satiety and the decreased reward power of food observed after bypass, both contributing to decreased food intake and sustained weight loss. Although enteric factors are key for the full recovery of beta cell function during meals, the recovery of beta cell function in response to an IV glucose stimulus is more modest in magnitude, even in individual in diabetes remission. This may explain, in part, the long-term diabetes relapse in some patients. With the improvement of gut-mediated improved insulin secretion, RYGB results in large increase in insulin sensitivity and clearance, both contributors to improved glucose metabolism.

The Effects of Laparoscopic Sleeve Gastrectomy on Obesity-Related Hypertriglyceridemia-Induced Acute Pancreatitis.

Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is a significant clinical problem and is characterized by high recurrence rate compared with non-HTG-AP. The objective of this study was to investigate the effects of laparoscopic sleeve gastrectomy (LSG) on obesity-related HTG-AP. Twenty-nine patients with obesity-related HTG-AP were admitted to our hospital and treated with the conventional therapy or LSG surgery according to the wishes of patients. Clinical data and the recurrence rate of AP were collected at baseline and at four different time points (3, 6, 9, and 12months) after the treatments for all patients. Of the 29 patients, 28 patients (19 patients with conventional therapy and 9 patients with LSG surgery) completed the 12-month follow-up. Clinical data and the severity scores of AP were comparable at baseline when the patients were admitted to the intensive care unit. The LSG group experienced a large weight loss (percent total weight loss, 26.87 ± 1.44%; percent excess weight loss, 79.56 ± 1.37%) and triglyceride reduction (from 15.77 ± 1.02 to 1.36 ± 0.09mmol/L), and no recurrence was observed at 12months after the surgery. In the conventional treatment group, however, body weight was not changed although triglyceride was significantly decreased (from 17.34 ± 1.29 to 8.25 ± 1.12mmol/L), and more importantly, 47.4% of the patients had at least one recurrence of AP in 12months after the treatment. LSG might be an effective way to cure obesity-related HTG-induced AP since it prevents the recurrence of this disease. Further randomized studies will be needed to standardize this way of treatment.