Metagenomic sequencing of the human gut microbiome before and after bariatric surgery in obese patients with type 2 diabetes: correlation with inflammatory and metabolic parameters.

Roux-en-Y gastric bypass (RYGB) has become a prominent therapeutic option for long-term treatment of morbid obesity and type 2 diabetes mellitus (T2D). Cross talk and pathogenetic consequences of RYGB-induced profound effects on metabolism and gut microbiome are poorly understood. The aim of the present study therefore was to characterize intra-individual changes of gut microbial composition before and 3 months after RYGB by metagenomic sequencing in morbidly obese patients (body mass index (BMI)>40 kg m(-)(2)) with T2D. Subsequently, metagenomic data were correlated with clinical indices. Based on gene relative abundance profile, 1061 species, 729 genera, 44 phyla and 5127 KO (KEGG Orthology) were identified. Despite high diversity, bacteria could mostly be assigned to seven bacterial divisions. The overall metagenomic RYGB-induced shift was characterized by a reduction of Firmicutes and Bacteroidetes and an increase of Proteobacteria. Twenty-two microbial species and 11 genera were significantly altered by RYGB. Using principal component analysis, highly correlated species were assembled into two common components. Component 1 consisted of species that were mainly associated with BMI and C-reactive protein. This component was characterized by increased numbers of Proteobacterium Enterobacter cancerogenus and decreased Firmicutes Faecalibacterium prausnitzii and Coprococcus comes. Functional analysis of carbohydrate metabolism by KO revealed significant effects in 13 KOs assigned to phosphotransferase system. Spearmen's Rank correlation indicated an association of 10 species with plasma total- or low-density lipoprotein cholesterol, and 5 species with triglycerides. F. prausnitzii was directly correlated to fasting blood glucose. This is the first clinical demonstration of a profound and specific intra-individual modification of gut microbial composition by full metagenomic sequencing. A clear correlation exists of microbiome composition and gene function with an improvement in metabolic and inflammatory parameters. This will allow to develop new diagnostic and therapeutic strategies based on metagenomic sequencing of the human gut microbiome.

Postexercise left ventricular function: a comparative assessment by different noninvasive imaging modalities.

The variety of noninvasive imaging modalities now available permits assessment of different aspects of left ventricular function in the postexercise state. Some of these modalities, such as first-pass radionuclide ventriculography, permit a nearly instantaneous assessment of left ventricular function in the early postexercise state. These modalities indicate that most exercise-induced left ventricular wall motion abnormalities resolve quickly after exercise. Resting wall motion abnormalities may also improve in the postexercise period; this response indicates the presence of hibernating myocardium capable of improving in response to myocardial revascularization procedures. On the other hand, all imaging techniques indicate that a certain percentage of exercise-induced wall motion abnormalities may persist into the postexercise period, and this finding signifies that severe coronary disease subtends the region of persisting wall motion abnormality. Further, if there is increased left ventricular size after exercise, both extensive and severe coronary disease are present. A conceptual framework for unifying these disparate findings is provided. These results underscore the importance of postexercise imaging in enhancing clinical assessment and imply that there are important technical considerations to contemplate when performing certain tests such as postexercise echocardiography.

Reflection intensity optical fiber sensors for the mid-infrared.

Two kinds of reflection intensity sensor made of chalcogenide glass fiber for the mid-IR region are demonstrated. One is a double-fiber reflection sensor based on two tied fibers with a gold-coated hollow metal waveguide connected to the far end of the fibers. The other is a single-fiber reflection sensor based on contact couplers. These reflectance sensors were coupled to a Fourier-transform IR spectrometer by a unique accessory based on nonimaging concentrators. This setup was built to measure absorption spectra of a polymer coating of an aluminum can and a sheet of drafting paper. A theoretical model treating the ratio between the signal from the target and the background is introduced. This model was helpful in deriving the sensitivity characteristics of the sensors from experimental absorption peak heights. Hence, the absorption peaks heights that we obtained using a single-fiber reflection sensor with a symmetric coupler were nearly 50% relative to those obtained with a double-fiber reflection sensor.

Familial cutaneous malignant melanoma and tumors of the nervous system. A hereditary cancer syndrome.

BACKGROUND: Excessive risk of cutaneous melanoma as a second cancer has been associated with benign or malignant tumors of the nervous system. Cutaneous melanoma and nervous system tumors may independently aggregate in families. There are, however, no previous reports of increased likelihood of tumors of the nervous system in families of patients with cutaneous melanoma or--of cutaneous melanoma in families with tumors of the nervous system. METHODS: The occurrence of nervous system tumors as second cancers was examined in a series of 904 patients with cutaneous melanoma and/or their family members. RESULTS: Fifteen families with 17 members with cutaneous melanoma from this series had one or more additional relatives with tumors of the nervous system, including astrocytoma, medulloblastoma, glioblastoma multiforme, ependymoma, glioma, meningioma, and acoustic neurilemmoma. Another subgroup of 10 patients with cutaneous melanoma had either a meningioma (n = 9) or acoustic neurilemmoma (n = 1) as a second tumor. The pattern of atypical melanocytic nevi occurring in the majority (20/25) of cutaneous melanoma patients in our series and in additional first degree relatives of 9 of 11 of the affected families, has been previously associated with the Familial Atypical Multiple Mole-Melanoma syndrome. CONCLUSIONS: This unusual familial and personal occurrence of tumors, showing differentiation toward tissues of the neural crest, neuroepithelium, and/or mesenchymal derivation, supports a putative association with a hereditary cancer susceptibility trait.

Quantitative evaluation of chalcogenide glass fiber evanescent wave spectroscopy.

A quantitative theoretical model that describes the amount of evanescent field that is absorbed by an infinite cladding has been developed. The validity of this model has been confirmed by a series of experiments to determine the typical dependence of the abosrption on each parameter (fiber length, fiber diameter, light beam launching condition, and wavelength) separately, and the total amount of absorption as a function of all the parameters combined. The results show that this model can predict the amount of absorbed radiation with an error range of 5%. It is therefore possible to analyze the infrared spectrum by quantitative data such as the ratio between two absorption lines or by deriving the absorbance coefficient of the absorption curve.

Experimental evaluation of a hollow glass fiber.

Very high interest in making a low-loss fiber for the infrared has been stimulated by important applications in optical communication, surgery, cutting, welding, and heat treatment. The leaky waveguide is one of the most promising types of future fiber in the infrared region where low-loss materials are not available or not suitable for making fibers (i.e., CO2 laser light lambda = 10.6 microm). In this paper a comparative model of a He-Ne laser beam and an oxide glass leaky hollow fiber for a CO2 laser light beam and a chalcogenide glass leaky hollow fiber are studied. Measurements of attenuation, dependence of output power on diameter and angle, and the angular dependence of output angle vs input angle were made. The experimental data were compared with theoretical calculations, and the critical value of the wall thickness for minimum attenuation is given.

Acute myocardial infarction in a thirty-six year old postpartum female.

A thirty-six year old woman who had an acute myocardial infarction during the early postpartum period is described. Review of literature on the incidence of postpartum myocardial infarction, the possible mechanisms and its clinical implications are summarized.

Assessment of the cardiac effects of hemodialysis with systolic time intervals and echocardiography.

The acute effects of hemodialysis on left ventricular (LV) function were studied with the use of externally recorded LV systolic time intervals and echocardiography; 10 patients with normal or near-normal predialysis LV function and no circulatory congestion were studied. Hemodialysis significantly decreased the LV ejection time (LVET) from 270 +/- 9 ms to 237 +/- 10 ms (p less than 0.001); no significant change was noted in the preejection period (PEP). The PEP/LVET ratio increased from 0.41 +/- 0.05 to 0.45 +/- 0.06 (p less than 0.05). The LV end-diastolic dimension decreased from 5.3 +/- 0.3 cm to 4.8 +/- 0.3 cm (p less than 0.001). Fractional shortening and ejection fraction did not change significantly, but hemodialysis slightly increased mean VCF from 1.2 +/- 0.1 s-1 to 1.4 +/- 0.1s-1 (p less than 0.005). Hemodialysis was associated with a 17% decrease (87 +/- 8 ml to 72 +/- 7 ml; p less than 0.001) in LV stroke volume as calculated from echocardiographic data. Small changes in heart rate and blood pressure were insignificant. We conclude that the postdialysis reduction in stroke volume was due primarily to an acute decrease in LV preload; dialysis also appears to be associated with a small increase in the LV contractile state.

Fracture of pacing electrode mimicking failure of pulse generator.

To our knowledge, this is the first reported case of spontaneous fracture of a pacing electrode with decreased amplitude of the pacing artifact, failure to capture, and intact sensing. We postulate that the difference in impedance of the pacemaker for sensing and stimulation may account for this phenomenon.

An unusual complication associated with blepharoplasty.

The usual complications associated with blepharoplasty are well known. This report presents a case of second-degree burns of the face which occurred while oxygen was being administered to a patient undergoing blepharoplasty and a heat-producing cautery was being used for hemostasis. A possible cause for the complication is suggested. Surgeons are warned of the potential problem that may occur when this combination of factors are present.

Cardiac effects of hemodialysis: noninvasive monitoring by systolic time intervals.

The effects of hemodialysis on cardiac performance were evaluated by systolic time intervals measured blindly in 15 chronic renal failure patients maintained free of circulatory congestion. After a mean dialysis of 8.7 hours, levels of blood urea nitrogen, serum creatinin, and potassium and body weight showed statistically significant decreases and serum calcium and hematocrit values increased; heart rate and both diastolic and systolic blood pressure did not change significantly. Left ventricular ejection time (LVET) and ejection time index (ETI) were significantly shorter, falling from within normal limits to below normal. Pre-ejection period (PEP) rose significantly. These changes are consistent with a two-fold immediate effect of hemodialysis: (1) reduction of stroke volume as reflected by decreased ETI; and (2) reduced Starling effect, with or without decreased contractility, as reflected by increased PEP.

The young child in Yemen.

PIP: 4 surveys were undertaken in Yemen through interviews with women in their homes in an effort to obtain information on the sociological and psychological aspects of young children and their mothers, the conditions of working mothers with young children, and traditional midwives and midwifery practices. The survey on child socialization and upbringing included 30 families. The survey on working mothers included 54 women selected at random among more than 300 women employed in a textile factory. 40 midwives were also interviewed; most were of the traditional type but the group also included 6 with 4 years of nursing school training and some hospital and midwifery experience. Focus is on ecological and economic background; social organization; housing, water supply and sanitation; the role of women; family planning; pregnancy and delivery; infant feeding and care; childhood; attitude of parents to education; weaning foods; swaddling babies; working mothers; health conditions and services; education; and the future for families in Yemen. There is a marked preference for sons in Yemen which is explained by the patriarchal character of the society and the place of defense in tribal unity and integration. Childbearing and rearing are heavy physical burdens for women. Among the families interviewed, 70% of the mothers did not want more children after the 4th child. During pregnancy mothers did not receive supplementary nutrition nor did they change their pattern of work or take any other special precautions. The social environment for child bearing is favorable, but conditions of delivery are primitive and even dangerous in the event of complications.^ieng