Reduced Body Mass Research Articles

Efficacy of Somnodent® Appliance Therapy in Moderate to Severe Obstructive Sleep Apnea Patients Somnodent® OAs for Moderate to Severe OSAHS

Objective: Oral appliances are one of the treatments of obstructive sleep apnea hypopnea syndrome. The main objective of the study was to determine the efficacy of the Somnodent® oral appliance on Apnea-Hypopnea Index. The secondary objective was to measure the efficacy on other oxymetric parameters and to determine its tolerance and dropout rate. Methods: Efficacy results of the oral appliances based on the apnea hypopnea index, the oxygen desaturation index and the lower oxygen saturation reduction, appliance complications and dropout rates were retrospectively collected from 25 patients with a moderate to severe obstructive sleep apnea hypopnea syndrome treated by a Somnodent® oral appliance. The procedure was entirely performed by otolaryngologists. Results: The AHI with OA was more significantly reduced in patients with a higher initial apnea hypopnea index and a higher initial body mass index but reduction was not related to age and not proportional to degree of mandibular advancement. The 50%-AHI reduction rate after OA was 55.6%, the AHI ≤5/h rate after OA was 22.2%. The OA significantly reduced the mean apnea-hypopnea index (-14.3/h, p<10-5). No patient had his AHI increased with oral appliance. One patient stopped using OA mainly because of nausea. Conclusions: Somnodent® is an effective and well-tolerated treatment for moderate to severe obstructive sleep apnea hypopnea syndrome.

Electroacupuncture enhances resting-state functional connectivity between dorsal caudate and precuneus and decreases associated leptin levels in overweight/obese subjects.

Electroacupuncture (EA) is a safe and effective method for treating obesity. However, how it modulates reward-related brain activity/functional connectivity and gut hormones remains unclear. We employed resting-state functional magnetic resonance imaging (RS-fMRI) and resting-state functional connectivity (RSFC) to investigate EA induced changes in resting-state activity and RSFC in reward-related regions and its association with gut hormones in overweight/obese subjects who received real (n = 20) and Sham (n = 15) stimulation. Results showed reduced leptin levels was positively correlated with reduced body mass index (BMI) and negatively correlated with increased cognitive-control as measured with Three-Factor-Eating-Questionnaire (TFEQ). Significant time effects on RSFC between dorsal caudate (DC) and precuneus were due to significant increased RSFC strength in both EA and Sham groups. In addition, increased RSFC of DC-precuneus was negatively correlated with reduced BMI and leptin levels in the EA group. Mediation analysis showed that the relationship between increased DC-precuneus RSFC strength and reduced BMI was mediated by reduced leptin levels. These findings reflect the association between EA-induced brain reward-related RSFC and leptin levels, and decreased leptin levels mediated altered DC-precuneus RSFC strength and consequent weight-loss, suggesting the potential role of EA in reducing weight and appetite.

Weight Loss During Topiramate Treatment in a Severely Obese Adolescent with Congenital Adrenal Hyperplasia and Migraine

Youth with classical congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency exhibit an increased prevalence of obesity, early adiposity rebound, and increased abdominal adiposity compared to unaffected youth. Current obesity management in CAH largely focuses on lifestyle modifications. There is evidence that topiramate therapy is effective in reducing body mass index (BMI), as well as visceral adipose tissue (VAT), in unaffected adolescents with exogenous obesity. However, little is known about the efficacy of topiramate in patients with classical CAH. We report on a 17-year-old female with severe obesity and salt-wasting CAH due to 21-hydroxylase deficiency, who demonstrated reductions in BMI, as well as abdominal visceral and subcutaneous adipose tissue (SAT) while on topiramate therapy. The patient was diagnosed with classical CAH as a newborn with a 17-hydroxyprogesterone 11,000 ng/dL. She had a BMI over the 95th percentile at 3 years of age, followed by unremitting obesity. At 17 years old, she was started on topiramate to treat chronic migraines. Following three years of topiramate therapy, her BMI z-score decreased from +2.6 to +2.1. After four years of therapy, her waist circumference decreased from 110 to 101 cm, abdominal VAT decreased substantially by 34.2%, and abdominal SAT decreased by 25.6%. Topiramate therapy was associated with effective weight loss and reduced central adiposity in an adolescent with classical CAH and severe obesity, without any side effects. Further study is warranted regarding topiramate therapy in obese youth with classical CAH and increased central adiposity, who are at higher risk for significant morbidity.

Effect of different moxibustion interventions on hepatic histomorphology and PD-1 expression in immunosuppressed rabbits: 不同灸法干预对免疫抑制兔肝脏组织形态学及PD-1表达的影响

Objective To observe the changes in hepatic histomorphology and the differences in the expression of PD-1 after different moxibustion interventions in the immunosuppressed rabbits caused by cyclophosphamide and analyze the intervention effects of different moxibustion therapies.Methods A total of 40 big-ear white rabbits were randomized into 4 groups, i.e. a blank group, an immunosuppressed model group, a moxibustion group and a herbal-paste isolated moxibustion group, 10 rabbits in each one. In the immunosuppressed model group, the moxibustion group and the herbal-paste isolated moxibustion group, the intraperitoneal injection with cyclophosphamide was administered consecutively for 7 days, 60 mg/kg, and then, the immunosuppressed models were prepared. After the models were established successfully, in the moxibustion group and the herbal-paste isolated moxibustion group, moxibustion was administer at “Shénquè (神阙CV 8)” “Guānyuán (关元CV 4)” “Zúsānlĭ (足三里ST 36)” “Píshū (脾俞BL20)” and “Shènshū (肾俞BL23)”, once every other day, 10 times in total. In the blank group and the immunosuppressed model group, the rabbits were restricted on the rabbit platform at the same time periods, without intervention. On the second day after the end of intervention, the animals were weighed and anesthetized, and the livers were extracted. After routine HE staining, the changes of hepatic histomorphology were observed under the microscope and the morphometric analysis was conducted in each group. Besides, PD-1 expression was observed with immunohistochemical method.Result Compared with the blank group, after modeling of each animal in three groups, the body mass decreased obviously (all P < 0.01), the hepatocyte count decreased (all P < 0.01), the inflammatory cellular infiltration area was increased obviously (all P < 0.01), necrosis appeared in hepatic tissue and the positive expression of PD-1 in hepatic tissue was significantly increased (all P < 0.01). After moxibustion intervention, compared with the immunosuppressed model group, the body masses of the animals were increased obviously (P < 0.05, P < 0.01), the hepatocyte count was increased obviously (both P < 0.01), the infiltration area of inflammatory cells decreased significantly (both P < 0.01) and the expression of the PD-1 decreased in the hepatic tissue (both P < 0.05) in both the moxibustion group and the herbal-paste isolated moxibustion group. Compared with the moxibustion group, the animal body mass was higher obviously (P < 0.01), the hepatocyte count was raised apparently (P < 0.01) and the infiltration area of inflammatory cells were reduced obviously (P < 0.05) in the herbal-paste isolated moxibustion group.Conclusion The intervention with different moxibustion therapies improves the condition of body mass reduction and hepatic tissue damage of the immunosuppressed rabbits caused by cyclophosphamide. The effect of herbal-paste isolated moxibustion therapy is better than that of simple moxibustion therapy.

Ramadan Fasting Improves Body Composition without Exacerbating Depression in Males with Diagnosed Major Depressive Disorders.

Background: Ramadan fasting (RF) is a form of intermittent fasting that generally improves body composition and related metabolic profiles. Whether RF exacerbates depressive symptomatology in individuals diagnosed with major depressive disorder (MDD) is undetermined. Methods: 100 men, who lived in Bahrain and were between the ages of 18 and 64 years with an established diagnosis of MDD, participated in this 4-week study. Based on preference, participants were assigned to a fasting group (FG, n = 50) and a non-fasting group (NFG, n = 50). The FG engaged in fasting from 03:40 to 18:10 (dawn and dusk timings). Changes in depressive symptoms, body mass, body composition, and components of metabolic syndrome were measured. Results: There were no significant changes in depressive symptoms within the FG vs. NFG after controlling for baseline covariates: mean difference 0.49 (SE = 0.63), p = 0.43. No adverse effects were reported in either group. The FG experienced significant reductions in body mass, 1.87 kg, p = 0.001; body mass index, 0.69 kg/m2, p = 0.001; body fat, 0.87%, p = 0.001; body surface area, 0.03 m2, p = 0.001; and lean mass, 0.77 kg, p = 0.001. Conclusions: RF did not negatively affect depressive symptoms and improved body composition, suggesting short-term intermittent fasting may be a safe dietary practice for adult males with MDD.

BCAAs and Di-Alanine supplementation in the prevention of skeletal muscle atrophy: preclinical evaluation in a murine model of hind limb unloading

Skeletal muscle atrophy occurs in response to various pathophysiological stimuli, including disuse, aging, and neuromuscular disorders, mainly due to an imbalance of anabolic/catabolic signaling. Branched Chain Amino Acids (BCAAs: leucine, isoleucine, valine) supplements can be beneficial for counteracting muscle atrophy, in virtue of their reported anabolic properties. Here, we carried out a proof-of-concept study to assess the in vivo/ex vivo effects of a 4-week treatment with BCAAs on disuse-induced atrophy, in a murine model of hind limb unloading (HU). BCAAs were formulated in drinking water, alone, or plus two equivalents of L-Alanine (2 ALA) or the dipeptide L-Alanyl-L-Alanine (Di-ALA), to boost BCAAs bioavailability. HU mice were characterized by reduction of body mass, decrease of soleus – SOL – muscle mass and total protein, alteration of postural muscles architecture and fiber size, dysregulation of atrophy-related genes (Atrogin-1, MuRF-1, mTOR, Mstn). In parallel, we provided new robust readouts in the HU murine model, such as impaired in vivo isometric torque and ex vivo SOL muscle contractility and elasticity, as well as altered immune response. An acute pharmacokinetic study confirmed that L-ALA, also as dipeptide, enhanced plasma exposure of BCAAs. Globally, the most sensitive parameters to BCAAs action were muscle atrophy and myofiber cross-sectional area, muscle force and compliance to stress, protein synthesis via mTOR and innate immunity, with the new BCAAs + Di-ALA formulation being the most effective treatment. Our results support the working hypothesis and highlight the importance of developing innovative formulations to optimize BCAAs biodistribution.

Physiological Effects and Inter-Individual Variability to 12 Weeks of High Intensity-Interval Training and Dietary Energy Restriction in Overweight/Obese Adult Women.

Background: Human adaptive response to exercise interventions is often described as group average and SD to represent the typical response for most individuals, but studies reporting individual responses to exercise show a wide range of responses.Objective: To characterize the physiological effects and inter-individual variability on fat mass and other health-related and physical performance outcomes after 12 weeks of high-intensity interval training (HIIT) and dietary energy restriction in overweight/obese adult women.Methods: Thirty untrained adult overweight and obese women (age = 27.4 ± 7.9 years; BMI = 29.9 ± 3.3 kg/m2) successfully completed a 12-week supervised HIIT program and an individually prescribed home hypocaloric diet (75% of daily energy requirements) throughout the whole intervention. High and low responders to the intervention were those individuals who were able to lose ≥ 10 and < 10% of initial absolute fat mass (i.e., kilograms), respectively.Results: The prevalence for high and low responders was 33% (n = 11) and 66% (n = 19), respectively. At the whole group level, the intervention was effective to reduce the absolute fat mass (30.9 ± 7.2 vs. 28.5 ± 7.2 kg; p < 0.0001), body fat percentage (39.8 ± 4.3 vs. 37.8 ± 4.9%; p < 0.0001), and total body mass (76.7 ± 10.1 vs. 74.4 ± 9.9 kg; p < 0.0001). In addition, there were improvements in systolic blood pressure (SBP; Δ% = −5.1%), diastolic blood pressure (DBP; Δ% = −6.4%), absolute VO2peak (Δ% = +14.0%), relative VO2peak (Δ% = +13.8%), peak power output (PPO; Δ% = +19.8%), anaerobic threshold (AT; Δ% = +16.7%), maximal ventilation (VE; Δ% = +14.1%), and peak oxygen pulse (O2 pulse; Δ% = +10.4%). However, at the individual level, a wide range of effects were appreciated on all variables, and the magnitude of the fat mass changes did not correlate with baseline body mass or fat mass.Conclusion: A 12-week supervised HIIT program added to a slight dietary energy restriction effectively improved fat mass, body mass, blood pressure, and cardiorespiratory fitness (CRF). However, a wide range of inter-individual variability was observed in the adaptative response to the intervention. Furthermore, subjects classified as low responders for fat mass reduction could be high responders (HiRes) in many other health-related and physical performance outcomes. Thus, the beneficial effects of exercise in obese and overweight women go further beyond the adaptive response to a single outcome variable such as fat mass or total body mass reduction.

Body Temperature and Activity Adaptation of Short Photoperiod-Exposed Djungarian Hamsters (Phodopus sungorus): Timing, Traits, and Torpor.

To survive the Siberian winter, Djungarian hamsters (Phodopus sungorus) adjust their behavior, morphology, and physiology to maintain energy balance. The reduction of body mass and the improvement of fur insulation are followed by the expression of spontaneous daily torpor, a state of reduced metabolism during the resting phase to save additional energy. Since these complex changes require time, the upcoming winter is anticipated via decreasing photoperiod. Yet, the extent of adaptation and torpor use is highly individual. In this study, adaptation was triggered by an artificially changed light regime under laboratory conditions with 20°C ambient temperature and food and water ad libitum. Two approaches analyzed data on weekly measured body mass and fur index as well as continuously recorded core body temperature and activity during: (1) the torpor period of 60 hamsters and (2) the entire adaptation period of 11 hamsters, aiming to identify parameters allowing (1) a better prediction of torpor expression in individuals during the torpor period as well as (2) an early estimation of the adaptation extent and torpor proneness. In approach 1, 46 torpor-expressing hamsters had a median torpor incidence of 0.3, covering the spectrum from no torpor to torpor every day within one representative week. Torpor use reduced the body temperature during both photo- and scotophase. Torpor was never expressed by 14 hamsters. They could be identified by a high, constant body temperature during the torpor period and a low body mass loss during adaptation to a short photoperiod. Already in the first week of short photoperiod, approach 2 revealed that the hamsters extended their activity over the prolonged scotophase, yet with reduced scotophase activity and body temperature. Over the entire adaptation period, scotophase activity and body temperature of the scoto- and photophases were further reduced, later accompanied by a body mass decline and winter fur development. Torpor was expressed by those hamsters with the most pronounced adaptations. These results provide insights into the preconditions and proximate stimuli of torpor expression. This knowledge will improve experimental planning and sampling for neuroendocrine and molecular research on torpor regulation and has the potential to facilitate acute torpor forecasting to eventually unravel torpor regulation processes.

Effects of Tai Chi Softball Exercises on Physical Fitness Level and Cardiovascular Health-Related Factors among Older Females.

Tai Chi softball was voted as one of the most popular health-promoting exercises and can also develop manipulative skill and hand-eye coordination. The purpose of this study was to explore changes in the physical fitness level and cardiovascular health-related factors after the 16-week Tai Chi softball (TCSB) training program among older females. One hundred healthy older females were assessed at the baseline before TCSB training, and then, they conducted intervention experiments. Through the 16-week TCSB intervention training, a control group and a physical exercise group showed significant differences. The physical exercise group significantly reduced body mass index, systolic blood pressure, and diastolic blood pressure from all the results studied. It also reduces total cholesterol, triglycerides, low-density lipoprotein cholesterol (∗p < 0.05), and waist-to-hip ratio (∗∗p < 0.01), whereas handgrip, sit and reach, single leg stance, vital capacity (∗p < 0.05), and high-density lipoprotein cholesterol (∗∗p < 0.01) were significantly increased. TCSB training may improve physical fitness ability and decrease the risk of cardiovascular disease among older females.

Commentaries on Viewpoint: Fragile bones of elite cyclists: to treat or not to treat?

Commentaries on Viewpoint: Fragile bones of elite cyclists: to treat or not to treat?

Replacing native mammal assemblages with livestock in African savannahs, impacts dung beetle diversity and reduces body size

Replacement of complex assemblages of native mammal fauna with livestock species reduces niche heterogeneity. This negatively affects taxa such as dung beetles, which depend on them and can, in turn, affect ecosystem functioning. We assessed the response of dung beetle diversity, biomass and body condition to cattle-farming pressures in protected areas (PAs) and adjacent farms in the savannah biome of northern Namibia. We hypothesized that rich native mammal assemblages are essential to maintain dung beetle diversity and overall biomass. We further explored whether the low-quality dung resources on farms would lead to a decrease in individual body size for species found on both farms and PAs. Overall dung beetle richness increased with higher mammal richness but not relative abundance, demonstrating that a rich native vertebrate assemblage promotes dung beetle richness. Overall dung beetle biomass was lower on farms, but abundance showed no difference. Large-bodied dung specialist species, which are known to be functionally superior, were absent on farms while smaller generalist species proliferated. Furthermore, a large proportion of individuals of species common to both farms and PAs were physically smaller on farms, indicating reduced body condition. Our results show that a high diversity of native mammals maintains dung beetle diversity and higher biomass on PAs. A decrease in native dung on farms leads to reduced body mass, likely negatively impacting ecological function. These results suggest that the conservation of dung beetles and their functions in the expansive African savannah ecosystems is dependent on a complex mix of native mammal species.

Nutritional Considerations for Female Athletes in Weight Category Sports

ABSTRACT Weight making can be described as the process of reducing body mass in events where aesthetics, propulsion or the requirement to meet a specific weight category limit, are considered to be of competitive importance. Cross sectional research specifically focussed on weight category sports, has highlighted behaviours and practices that are similar in athletes of both sexes. Regardless of this and despite parallel participation in weight category sporting events, females are drastically underrepresented in studies examining body mass loss interventions across both chronic and acute timeframes. However, it has been well characterised that these types of body mass loss strategies can be causative of low energy availability, leading to consequences of female athlete triad and relative energy deficiency in sports. Furthermore, female-specific body composition and physiological systems modulated by the anterior pituitary and ovarian hormones within the menstrual cycle or use of hormonal contraception, can lead to potential outcomes which need to be considered carefully, particularly when employing acute weight loss strategies that are often utilised by weight making athletes. Therefore, the aim of this article serves to review the aforementioned issues, whilst offering practical recommendations via initial assessment, chronic/acute interventions and refeeding/recovery plans to help support the implementation of body mass loss strategies in the context of weight making specifically with female athletes.

Impact of contraceptive hormones on the reproductive potential of male and female commensal black rats (Rattus rattus).

The black rat is considered one of the world's top pests. With increased restrictions on rodenticides, new alternatives to manage rats are urgently needed. Research on the use of contraceptive hormones, levonorgestrel (LE), and quinestrol (QU), have been evaluated against some rodent species, and this research is the first study to assess these on black rats. Hormones were incorporated into rodent bait at 10 and 50 ppm concentrations singly and in combination (EP-1). Groups of 10 animals of each sex were fed the baits over 7days. Lower bait consumption was observed with slight body mass reductions. On dissection, it was observed that the uterus was in a state of edema and male reproductive organs weighed less with reduced sperm counts/motility. The 2 most promising baits, 50 ppm QU and EP-1, were used to assess impact on pregnancy and litter size. Pregnancy was reduced from 70% success when both males and females consumed untreated bait, down to 30% when males had consumed contraceptive bait but females had not, and down to 0% when females had consumed contraceptive bait, regardless of whether they had paired with a treated or untreated male. Litter size in the untreated pairs was 8 pups, but only 4 pups in those cases where the male only had consumed the contraceptive. Further studies should investigate how long the effect lasts and its reversibility. Field studies at the population level may also shed light on the practicality of using contraceptive baits for black rats in different habitats.

Quantitative Parameters of the Body Composition Influencing Host Seeking Behavior of Ixodes ricinus Adults.

Ixodes ricinus, a hematophagous arthropod species with great medical importance in the northern hemisphere, is characterized by an ability to survive prolonged periods of starvation, a wide host spectrum, and high vector competence. The aim of the present study was to determine the quantitative parameters of questing I. ricinus ticks collected in eastern Poland during the spring peak of their activity. The study consisted in the determination of quantitative parameters characterizing I. ricinus females and males, i.e., fresh body mass, reduced body mass, lipid-free body mass, water mass, and lipid mass and calculation of the lipid index. A statistically significant difference was observed between the mean values of the lipid index in females collected during the first and last ten days of May, which indicates the progressive utilization of reserve materials in the activity period. Higher activity of I. ricinus female ticks was observed during the last ten days of May despite the less favorable weather conditions, indicating their strong determination in host-seeking behaviors accompanying a decline in the lipid content and the use of the “now or never” strategy.

Instrumental and anthropometric studies in physical rehabilitation of patients with rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease of unknown etiology, characterised by pain, stiffness, and swelling in the joints of the hands and feet, but the disease can also affect other joints. The disease is quite common among rheumatological pathologies and is observed in an average of 1% of the population. A thorough examination of a patient with rheumatoid arthritis, early detection of the main radiological signs of the disease, the level of functional and organic disorders, and the establishment of a rehabilitation diagnosis are essential, which is the basis for building a further personalised physical rehabilitation programme. The purpose of the paper is to determine the severity of the disease in patients with rheumatoid arthritis using instrumental and anthropometric methods of research to form an individual approach to rehabilitation. Materials and methods: the study was conducted on the basis of the Rheumatology Department and the Department of Rehabilitation Treatment with Traditional and Alternative Methods of the Rivne Regional Clinical Hospital named after Yuriy Semenyuk. The study involved 216 patients with rheumatoid arthritis, including 178 women (82%) and 38 men (18%). The patients were aged 25 to 59 years (mean age – 46±0.24). The following research methods were used: questionnaire, history taking, objective examination, instrumental methods of research (radiography), anthropometric methods (Ketle index), statistical methods. Results. Clinical and radiological stage I was diagnosed in 50 (23 %) patients, stage II – in 102 (47 %) patients, and stage III – in 64 patients (30 %). It was found that most patients had radiological stage II with characteristic radiological symptoms (periarticular osteoporosis with minor destruction of the subchondral bone; slight narrowing of the joint gaps, single usurps). Average body mass index values indicate that patients are generally overweight, which is a negative factor in the onset and progression of rheumatoid arthritis. Body mass index is an important indicator in determining the indications for treatment and rehabilitation. Conclusion. As a result of the examination, we found that most patients with rheumatoid arthritis were diagnosed with clinical and radiological stage II. The average BMI values indicate that, in general, patients are overweight, which is a negative factor in the progression of rheumatoid arthritis. The above data give grounds for the development and implementation of the concept of physical rehabilitation of patients with rheumatoid arthritis aimed at reducing clinical symptoms of the disease, reducing body mass index and improving the quality of life of patients.

MO207END-OF-LIFE CARE IN NEPHROLOGY INPATIENTS - ARE WE GETTING IT RIGHT?

Abstract Background and Aims Average life expectancy have been continuously increasing within the general population and, equally so, within Nephrology patients. End-of-life (EOL) care is part of non-oncologic palliative care provided by Nephrology. The aim of our study is to evaluate the quality of EOL care provided in Nephrology, and to determine potential areas of improvement. Method Retrospective single-centre analysis of all nephrology and kidney transplant inpatients dying between January 2019 and June 2020. Clinical records were reviewed for evidence of recognition of end of life, resuscitation plans, acute interventions in the 48 hours previous to death, comfort care plans and symptoms evaluation. Results A total of 83 patients were included. 19.6% of patients had chronic kidney disease, 60.2% were in haemodialysis, 14.5% were kidney transplanted patients and 3.6% had acute kidney injury. 89.2% of the admissions were for acute events, 5% for symptom control and 4.8% for diagnosis. In 72.3% of admissions, EOL was recognised. Most patients were unable to discuss EOL plans (67.5%), and the family was informed of the prognosis in only 61.4% of the cases. At the time of dead: only 62.7% of patients had a clear resuscitation plan, 44.6% were on antibiotics and 26.5% died with nasogastric tube. Within 48h of death: invasive interventions were still being given in 42.2%, blood samples were taken in 69.9%; imaging was performed in 36.1% and 48.2% had a haemodialysis session. Comfort measure were provided to 53% and only 60.2% had evidence of symptom evaluation. 44.6% stopped invasive measures in the last 48h. Recognition of EOL was associated with having a clear resuscitation plan (p&amp;lt;0.001), comfort measures (p&amp;lt;0.001), evidence of symptom evaluation (p=0.004), stopping invasive measures (p&amp;lt;0.001), having less imaging (p=0.270) and discussing prognosis with the family (p&amp;lt;0.001). Despite recognition of EOL, there was no difference in dying with nasogastric tube (p=0.404) or dying on antibiotics (p=0.134). In a multivariable analysis (binary logistic regression), EOL recognition was associated with a clear resuscitation plan (Exp(B) 0.088, (CI 95%: 0.018-0.419) p=0.002), with discussion of prognosis with family ( Exp(B) 0.061 (CI 95%: 0.011-0.337) p=0.001), and with reduced body mass index (Exp(B) 0.870, (CI 95%: 0.763-0.991), p=0.037,); in a model adjusted to the age. Conclusion In our cohort, patient for whom EOL was recognized had better EOL care. In conclusion, there are still areas in which EOL care can be improved. Palliative care should be an investment area for training within the Nephrology core curriculum and awareness for EOL care is needed.

Small Intestinal Tuft Cell Activity Associates With Energy Metabolism in Diet-Induced Obesity.

Little is known about the involvement of type 2 immune response-promoting intestinal tuft cells in metabolic regulation. We here examined the temporal changes in small intestinal tuft cell number and activity in response to high-fat diet-induced obesity in mice and investigated the relation to whole-body energy metabolism and the immune phenotype of the small intestine and epididymal white adipose tissue. Intake of high fat diet resulted in a reduction in overall numbers of small intestinal epithelial and tuft cells and reduced expression of the intestinal type 2 tuft cell markers Il25 and Tslp. Amongst >1,700 diet-regulated transcripts in tuft cells, we observed an early association between body mass expansion and increased expression of the gene encoding the serine protease inhibitor neuroserpin. By contrast, tuft cell expression of genes encoding gamma aminobutyric acid (GABA)-receptors was coupled to Tslp and Il25 and reduced body mass gain. Combined, our results point to a possible role for small intestinal tuft cells in energy metabolism via coupled regulation of tuft cell type 2 markers and GABA signaling receptors, while being independent of type 2 immune cell involvement. These results pave the way for further studies into interventions that elicit anti-obesogenic circuits via small intestinal tuft cells.

New approaches to prophylaxis of endometrium hyperplasia relaps in premenopausal women

Research aim: to evaluate the effectiveness of therapy aimed at preventing endometrial hyperplasia recurrence in premenopausal women.Materials and methods. Clinical and paraclinical examinations of 76 premenopausal women were carried out. Transvaginal ultrasound was performed, levels of estradiol, progesterone, homocysteine, folic acid, serum HOMA index evaluated, body mass index and blood pressure assessed. Women were divided into two groups after histological results obtained: the main group included 40 women who received oral progestins (dydrogesterone 10 mg) twice a day in combination with Depapilin® 395 mg twice a day; the comparison group included 36 women who received only oral progestins (dydrogesterone 10 mg) twice a day. Comparison of the therapy effectiveness was performed 6 and 9 months after the start of treatment.Results. Endometrial thickness stabilized within 9 months in women of the main group, and was within the physiological norm (before treatment – 22 ± 3.1 mm, 6 months after the start of treatment – 8,3 ± 0.46 mm, after 9 months – 9,7 ± 0.31 mm, p &lt;0.05). The positive treatment effect consisted in a significant decrease in the frequency of endometrial hyperplasia recurrence, which was 17 (17.5%) cases in the main group and 16 (44.4%) cases in the comparison group (p &lt;0.05). Women of the main group also showed stable normalization of the level of estrogen and progesterone, a steady decrease in the level of homocysteine and a synergistic increase in the level of folic acid, normalization of blood pressure and reduction of body mass index.Conclusions. Depapilin® inclusion in the basic therapy of endometrial hyperplasia in premenopausal aged women is pathogenetically justified due to the complex effect of the drug components on the extragonadal estrogens synthesis and the antiproliferative effect on the endometrium.

Physical Activity, Sleep, and Sedentary Behavior among Successful Long-Term Weight Loss Maintainers: Findings from a U.S. National Study.

Despite adults’ desire to reduce body mass (weight) for numerous health benefits, few are able to successfully lose at least 5% of their starting weight. There is evidence on the independent associations of physical activity, sedentary behaviors, and sleep with weight loss; however, this study provided insight on the combined effects of these behaviors on long-term body weight loss success. Hence, the purpose of this cross-sectional study was to evaluate the joint relations of sleep, physical activity, and sedentary behaviors with successful long-term weight loss. Data are from the 2005–2006 wave of the National Health and Examination Survey (NHANES). Physical activity and sedentary behavior were measured with an accelerometer, whereas sleep time was self-reported. Physical activity and sleep were dichotomized into meeting guidelines (active/not active, ideal sleep/short sleep), and sedentary time was categorized into prolonged sedentary time (4th quartile) compared to low sedentary time (1st–3rd quartiles). The dichotomized behaviors were combined to form 12 unique behavioral combinations. Two-step multivariable regression models were used to determine the associations between the behavioral combinations with (1) long-term weight loss success (≥5% body mass reduction for ≥12-months) and (2) the amount of body mass reduction among those who were successful. After adjustment for relevant factors, there were no significant associations between any of the independent body weight loss behaviors (physical activity, sedentary time, and sleep) and successful long-term weight loss. However, after combining the behaviors, those who were active (≥150 min MVPA weekly), regardless of their sedentary time, were significantly (p < 0.05) more likely to have long-term weight loss success compared to the inactive and sedentary referent group. These results should be confirmed in longitudinal analyses, including investigation of characteristics of waking (type, domain, and context) and sleep (quality metrics) behaviors for their association with long-term weight loss success.

Healthy eating and lifestyle in pregnancy (HELP): a cluster randomised trial to evaluate the effectiveness of a weight management intervention for pregnant women with obesity on weight at 12 months postpartum

ObjectiveTo assess whether a weight management intervention for pregnant women with obesity was effective in reducing body mass index (BMI) 12 months after giving birth.MethodsPragmatic, cluster randomised controlled trial (RCT) with embedded cost-effectiveness analysis. 598 women with a BMI of ≥30 kg/m2 (between 12 and 20 weeks gestation) were recruited from 20 secondary care maternity units in England and Wales. BMI at 12 months postpartum was the primary outcome. A range of clinical and behavioural secondary outcomes were examined.InterventionsWomen attending maternity units randomised to intervention were invited to a weekly weight management group, which combined expertise from a commercial weight loss programme with clinical advice from midwives. Both intervention and control participants received usual care and leaflets on diet and physical activity in pregnancy.ResultsMean (SD) BMI at 12 months postpartum was 36.0 kg/m2 (5.2) in the control group, and 37.5 kg/m2 (6.7) in the intervention group. After adjustment for baseline BMI, the intervention effect was −0.02 (95% CI −0.04 to 0.01). The intervention group had an improved healthy eating score (3.08, 95% CI 0.16 to 6.00, p < 0.04), improved fibre score (3.22, 1.07 to 5.37, p < 0.01) and lower levels of risky drinking at 12 months postpartum compared to the control group (OR 0.45, 0.27 to 0.74, p < 0.002). The net incremental monetary benefit was not statistically significantly different between arms, although the probability of the intervention being cost-effective was above 60%, at policy-relevant thresholds.ConclusionsThere was no significant difference between groups on the primary outcome of BMI at 12 months. Analyses of secondary outcomes indicated improved healthy eating and lower levels of risky drinking.Trial registration: Current Controlled Trials ISRCTN25260464.