An alternatively activated macrophage marker CD163 in severely obese patients: the influence of very low-calorie diet and bariatric surgery.

CD163 is a marker of macrophages with anti-inflammatory properties and its soluble form (sCD163) is considered a prognostic predictor of several diseases including type 2 diabetes mellitus (T2DM). We explored sCD163 levels at baseline and after very low-calorie diet (VLCD) or bariatric surgery in 32 patients with obesity (20 undergoing VLCD and 12 bariatric surgery), 32 obese patients with T2DM (22 undergoing VLCD and 10 bariatric surgery), and 19 control subjects. We also assessed the changes of CD163 positive cells of monocyte-macrophage lineage in peripheral blood and subcutaneous adipose tissue (SAT) in subset of patients. Plasma sCD163 levels were increased in obese and T2DM subjects relative to control subjects (467.2+/-40.2 and 513.8+/-37.0 vs. 334.4+/-24.8 ng/ml, p=0.001) and decreased after both interventions. Obesity decreased percentage of CD163+CD14+ monocytes in peripheral blood compared to controls (78.9+/-1.48 vs. 86.2+/-1.31 %, p=0.003) and bariatric surgery decreased CD163+CD14+HLA-DR+ macrophages in SAT (19.4+/-2.32 vs. 11.3+/-0.90 %, p=0.004). Our data suggest that increased basal sCD163 levels are related to obesity and its metabolic complications. On the contrary, sCD163 or CD163 positive cell changes do not precisely reflect metabolic improvements after weight loss.

Fatty acid composition of adipose tissue triglycerides in obese diabetic women after bariatric surgery: a 2-year follow up.

Bariatric surgery is the most effective method in the treatment of obesity and type 2 diabetes (T2DM). The aim of this study was to evaluate the effects of different types of bariatric procedures on remission of T2DM and on the fatty acid composition in subcutaneous adipose tissue. Patients included obese diabetic women who underwent bariatric surgery: biliopancreatic diversion (BPD), n=8, laparoscopic gastric banding (LAGB), n=9 or laparoscopic greater curvature plication (LGCP), n=12. Anthropometric characteristics and fatty acid composition of adipose tissue (FA AT) were analyzed before surgery, then 6 months and 2 years after surgery. FA AT was analyzed by gas chromatography. Diabetes remission was estimated. BPD was most efficient in inducing a remission of diabetes (p=0.004). Significantly higher increases in lauric (12:0), myristoleic (14:1n-5) and palmitoleic (16:1n-7) acids and delta-9 desaturase were found two years after BPD, suggesting higher lipogenesis in adipose tissue. Docosatetraenoic acid (22:4n-6) increased significantly after BPD, while docosapentaenoic acid (22:5n-3) decreased 6 months after BPD and increased after 2 years. No changes were found after LAGB and LGCP after 2 years. Bariatric surgery led to significant changes in the fatty acid composition of subcutaneous adipose tissue in severely obese diabetic women after six months and two years, and was partly influenced by the type of surgery used.

Laparoscopic greater curvature plication (LGCP) for treatment of morbid obesity in a series of 244 patients.

BACKGROUND: Laparoscopic greater curvature plication (LGCP) is a new metabolic/bariatric surgical procedure that requires no resection, bypass, or implantable device. We report LGCP outcomes in 244 morbidly obese patients. METHODS: Between 2010 and 2011, patients underwent LGCP. Body mass index (BMI, kilogram per square meter) evolution, excess BMI loss (%EBMIL), excess weight loss (%EWL), complications, and type 2 diabetes mellitus (T2DM) changes were recorded. Repeated-measures analysis of variance (ANOVA) was used to assess weight change at 6, 12, and 18 months. Subgroup analyses were conducted to provide benchmark outcomes at 6 months. Logistic regression was used to identify characteristics predictive of suboptimal weight loss. RESULTS: Mean baseline BMI (±SD) was 41.4 ± 5.5 (80.7 % women, mean age 46.1 ± 11.0 years, 68 [27.9 %] patients had T2DM). Mean operative time was 70.6 min; mean hospitalization, 36 h (24-72). Sixty-eight patients (27.9 %) experienced postoperative nausea and/or vomiting that was controlled within 36 h. There was no mortality. Major complication rate was 1.2 % (n = 3). Repeated-measures ANOVA indicated significant weight loss across time points (p < 0.001). At 6 months (n = 105), BMI, %EBMIL, and %EWL were 36.1 ± 4.7, 34.8 ± 17.3, and 31.8 ± 15.9. Preoperative BMI was the only predictor of weight loss. Patients with BMI <40 lost more weight than those ≥40, although by 9 months, differences were no longer significant. In patients with preoperative BMI <40, 18-month %EWL approached 50 % and %EBMIL exceeded 50 %. At 6 months, 96.9 % of patients' T2DM was significantly improved/resolved. CONCLUSIONS: Over the short term, LGCP results in effective weight loss and significant T2DM reduction with a very low rate of complications.

[Metabolic surgery--a new approach to the management of selected diseases]. / Metabolická chirurgie--nový smer v lécbe nekterých onemocnení.

Treatment options for type 2 diabetes have changed dramatically in the past few years. Experimental works followed by evidence based studies proved long-term efficacy of metabolic surgery in type 2 diabetes treatment. Moreover diabetes resolution is not directly correlated with weight loss and occurs independently to it. Large literature metaanalyses showed that type 2 diabetes can be subtantially improved with metabolic surgery in about 85% of all diabetic patients, out of which can be resolved in more than 75%. Metabolic surgery affects hormonal secretion on multiple levels namely in the small intestine. Restrictive as well as combined and malabsorptive surgical procedures have positive effect on type 2 diabetes improvement as well as on metabolic syndrome, sleep apnea syndrome and on other comorbidities.

Metabolic surgery for the treatment of type 2 diabetes in patients with BMI <35 kg/m2: an integrative review of early studies.

Type 2 diabetes mellitus (T2DM) resolution in morbidly obese patients following metabolic surgery suggests the efficacy of T2DM surgery in non-morbidly obese patients (body mass index [BMI] <35 kg/m(2)). This literature review examined research articles in English over the last 30 years (1979-2009) that addressed surgical resolution of T2DM in patients with a mean BMI <35. Weighted and simple means (95% CI) were calculated to analyze study outcomes. Sixteen studies met inclusion criteria; 343 patients underwent one of eight procedures with 6-216 months follow-up. Patients lost a clinically meaningful, not excessive, amount of weight (from BMI 29.4 to 24.2; -5.1), moving from the overweight into the normal weight category. There were 85.3% patients who were off T2DM medications with fasting plasma glucose approaching normal (105.2 mg/dL, -93.3), and normal glycated hemoglobin, 6% (-2.7). In subgroup comparison, BMI reduction and T2DM resolution were greatest following malabsorptive/restrictive procedures, and in the preoperatively mildly obese (30.0-35.0) vs overweight (25.0-25.9) BMI ranges. Complications were few with low operative mortality (0.29%). Novel and/or known mechanisms of T2DM resolution may be engaged by surgery at a BMI threshold

[Monitoring serum theophylline levels in children. Use of saliva for prediction]. / K monitorování sérových koncentrací teofylinu u detí. Vyuzití slin pro predikci.

In 28 children suffering from asthma--20 boys and 8 girls aged 3-19 years, weighing 18-79 kg--theophylline concentrations in serum and saliva were assessed. For detection the spectrophotometric method of Schack and Waxler and the fluoroimmunoassay TDA AMES were used. Under conditions of non stimulated salivary secretion the pH values of the secretion varied as a rule between 6.0 and 7.5 which did not influence significantly the amount of theophylline passing from blood into saliva. The authors found a very close correlation between the theophylline concentrations after administration of Syntophylline in saliva and serum (r = 0.9169, p less than 0.001) and Spophylline (r = 0.9369, p less than 0.001). Comparison of serum theophylline concentrations calculated from the salivary values on the one hand and the same serum theophylline concentrations actually assessed revealed that their difference varied up to 1 microgram.ml-1.

[Nonlinear theophylline kinetics in a boy on long-term theophylline therapy for bronchial asthma. Case report]. / Prípad nelineární kinetiky teofylinu u chlapce dlouhodobe léceného teofylinem pro astma bronchiale. Kasuistika.

On the case of a 13-year-old boy the authors demonstrate the possible non-linear relationship between long-term administration of theophylline and its serum concentrations which implies the danger of induction of limital to toxic concentrations of the drug in the blood stream when the doses are increased as required.

Phorbol myristate acetate-stimulated production of interleukin 2 by T-cell lymphoma and constitutive production by derived hybridomas.

To isolate a stable tumor cell line source of IL-2 (TCGF), 19 murine T-cell lines and their derivatives were screened for both constitutive and mitogen-stimulated IL-2 production. The cloned subline of a mouse thymic lymphoma EL-4 designated as EL-4TF could be stimulated with PMA to produce 80 U/ml of IL-2. A TK- EL-4TFR mutant line has been selected from the EL-4TF cell population by treatment with 5-BrdUrd. The EL-4-TFR cells were stimulated with PMA and fused with the cells of thymic lymphoma BW5147. The resulting BH3 hybrid cell population was repeatedly cloned and tested for constitutive IL-2 production: two of the BH3 hybridoma clones were found to produce IL-2 constitutively. The IL-2 of EL-4TF origin was found to support permanent in vitro growth of IL-2 dependent, tumor-specific T killer cell line CTLL when present in culture medium at a concentration of at least 0.1 U/ml. Since the EL-4TF-derived IL-2 preparations were contaminated with PMA, it was of interest whether PMA alone has a growth-promoting activity in CTLL cell cultures. Permanent cultivation of CTLL cells in an IL-2-free medium containing PMA was not possible. However, both mitogenic and co-mitogenic effects of PMA on CTLL cells were observed.