"Vanishing" glioblastoma: A case report and review of the literature.

Contrast enhancement resolution induced by corticosteroids is a phenomenon primarily associated with primary central nervous system lymphoma, while malignant brain gliomas usually maintain a consistent radiological appearance during systemic steroid treatment. Although rare, a few primary and metastatic intracranial lesions have shown similar radiographic changes following corticosteroid therapy. In the case of glioblastomas, corticosteroid therapy is commonly used to alleviate pressure effects from peritumoral edema, but its impact on contrast enhancement is not well-established. A few reported cases in the literature describe reduced contrast enhancement in glioblastomas after corticosteroid treatment. We present a case of corticosteroid-induced regression on imaging of glioblastoma evaluated at our institutionwith the intention to explore the pathogenesis of this response and discuss the therapeutic and prognostic implications of this discovery.

Reactive hypoglycaemia during the OGTT after gestational diabetes mellitus: Metabolic implications and evolution.

AIMS: Gestational diabetes (GDM) presents an increased cardio-metabolic risk and is diagnosed with an oral glucose tolerance test (OGTT). Reactive hypoglycaemia (RH) during the OGTT in pregnancy is associated with adverse outcomes. Although postpartum OGTT after GDM is recommended, the occurrence and implications of RH are unknown. We investigated the prevalence, metabolic implications and longitudinal evolution of RH at 6-8 weeks postpartum in women with a history of GDM. METHODS: Between 2011 and 2021, we consecutively followed 1237 women with previous GDM undergoing an OGTT at 6-8 weeks postpartum. RH was defined as 2-h glucose <3.9 mmoL/L after the OGTT. Metabolic outcomes were compared in women with and without RH (RH+/RH-). We also included a subcohort of 191 women with data on insulin sensitivity/secretion indices (MATSUDA, HOMA-IR, insulin-adjusted-secretion ISSI-2). RESULTS: The postpartum prevalence of RH was 12%. RH+ women had a more favourable metabolic profile including a 2-5-times lower prevalence of glucose intolerance and metabolic syndrome at 6-8 weeks postpartum compared to RH- (all p ≤ 0.034). In the subcohort, women with RH+ had higher insulin sensitivity, higher ISSI-2 and an earlier glucose peak after OGTT (p ≤ 0.049) compared to RH- women at the same time point. Insulin resistance increased and ISSI-2 decreased over the first year postpartum in both groups. These changes were associated with a 50% reduction in overall RH prevalence at 1-year postpartum. Some of the favourable profiles of RH+ persisted at 1-year postpartum, without group differences in the longitudinal metabolic changes. CONCLUSIONS: At 6-8 weeks postpartum, RH was frequent in women after GDM and associated with a better metabolic profile including increased insulin sensitivity and higher insulin-adjusted-secretory capacity. RH might be a marker of favourable metabolic prognosis in women with a history of GDM.

[What is the place of a low carbohydrate or low glycemic index diet in gestational diabetes treatment?] / Quelle place pour une alimentation low-carb ou à index glycémique bas dans le diabète gestationnel ?

There is no real consensus on the ideal nutritional approach to recommend for gestational diabetes (GDM) treatment. A carbohydrates reduction (low-carb) is frequently suggested, although many studies have not found any consistent beneficial effects. On the other hand, according to recent meta-analyses, a low glycemic index (GI) diet would have favorable effects for the mother and the child. Although the clinical and practical value of GI is still being studied, a low GI diet seems to be the most appropriate approach in GDM. In addition, soluble fibers may have a beneficial metabolic impact in the short time of pregnancy. More evidence on the impact of these nutritional approaches in the short and long term for mother and child is needed.

Il n'y a pas de réel consensus concernant l'approche nutritionnelle idéale à recommander en cas de diabète gestationnel (DG). Une réduction des quantités de glucides (low-carb) est fréquemment mise en avant, alors que de nombreuses études n'y retrouvent pas d'effets bénéfiques notables. Toutefois, selon des méta-analyses récentes, une alimentation à index glycémique (IG) bas a des effets bénéfiques pour la mère et l'enfant. Même si la valeur clinique et pratique de l'IG fait encore l'objet d'études, cela semble être l'approche la plus appropriée en cas de DG. En complément, les fibres dites « solubles ¼ pourraient avoir un impact métabolique favorable dans le court délai imparti par la grossesse. Plus d'évidences sur l'impact de ces approches nutritionnelles à court et à long termes pour la mère et l'enfant sont indispensables.

Incorporating the influent cellulose fraction in activated sludge modelling.

Cellulose represents a significant fraction of domestic wastewater, but it is not considered as a separate state variable in the conventional Activated Sludge Models (ASM). Cellulose is a very slowly degradable substrate that in traditional wastewater characterisation methods would be characterised partly as slowly biodegradable and partly as inert material. This can be problematic when the same model is used under different temperature conditions or different solid retention times. Also with the emerging attention for cellulose recovery, inclusion of this compound in models helps to assess the impact of cellulose recovery on operations and on operational costs. But also in membrane bioreactors, sieves are used in order to remove fibrous material, mainly cellulose. In this study a modification of ASM1 is proposed, where cellulose is introduced as a separate state variable and it is supposed to degrade with a first order hydrolysis rate. With the aid of this model, the effect of fine sieves is simulated using two alternatives, by either sieving the influent or the activated sludge. The model proved to be useful for operational purposes, and illustrates the need for including cellulose as separate state variable.

Subclinical hypothyroidism: new trials, old caveats.

The indications for levothyroxine replacement therapy for subclinical hypothyroidism (SH) remain a subject of debate, especially when prescribed for older adults. The results of the recent TRUST trial indicate that levothyroxine does not improve clinical symptom scores among elderly patients with SH. While there is much concern regarding the dilemma of introducing or withholding levothyroxine, less attention may be paid to the differential diagnosis of an elevated TSH level, which is the prerequisite for diagnosing SH. Herein, we review these issues facing endocrinologists and internists/generalists either in practice or in training. When a patient presents abnormal thyroid test results compatible with SH, a series of issues need to be addressed before the implementation of replacement therapy is considered: first, an isolated TSH elevation not linked to a primary thyroid pathology should be excluded; second, the persistent nature of the patient's TSH elevation and SH profile should be verified; third, SH symptoms and potential complications relevant for the specific patient should be documented; fourth, expectations from levothyroxine substitution therapy for SH in the specific patient should be clarified. Only then can the decision be made whether levothyroxine substitution should be introduced or not.

Monoacylglycerol-enriched oil increases EPA/DHA delivery to circulatory system in humans with induced lipid malabsorption conditions.

It was hypothesized that under induced lipid malabsorption/maldigestion conditions, an enriched sn-1(3)-monoacylglycerol (MAG) oil may be a better carrier for n-3 long-chain PUFAs (LC-PUFAs) compared with triacylglycerol (TAG) from fish oil. This monocentric double blinded clinical trial examined the accretion of EPA (500 mg/day) and DHA (300 mg/day) when consumed as TAG or MAG, into the erythrocytes, plasma, and chylomicrons of 45 obese (BMI ≥30 kg/m2 and ≤40 kg/m2) volunteers who were and were not administered Orlistat, an inhibitor of pancreatic lipases. Intake of MAG-enriched oil resulted in higher accretion of LC-PUFAs than with TAG, the concentrations of EPA and DHA in erythrocytes being, respectively, 72 and 24% higher at 21 days (P < 0.001). In addition, MAG increased the plasma concentration of EPA by 56% (P < 0.001) as compared with TAG. In chylomicrons, MAG intake yielded higher levels of EPA with the area under the curve (0-10 h) of EPA being 55% greater (P = 0.012). In conclusion, in obese human subjects with Orlistat-induced lipid maldigestion/malabsorption conditions, LC-PUFA MAG oil increased LC-PUFA levels in erythrocytes, plasma, and chylomicrons to a greater extent than TAG. These results indicate that MAG oil might require minimal enzymatic digestion prior to intestinal uptake and transfer across the epithelial barrier.

Effects of roux-en-Y gastric bypass surgery on postprandial fructose metabolism.

OBJECTIVE: Fructose is partly metabolized in small bowel enterocytes, where it can be converted into glucose or fatty acids. It was therefore hypothesized that Roux-en-Y gastric bypass (RYGB) may significantly alter fructose metabolism. METHODS: We performed a randomized clinical study in eight patients 12-17 months after RYGB and eight control (Ctrl) subjects. Each participant was studied after ingestion of a protein and lipid meal (PL) and after ingestion of a protein+lipid+fructose+glucose meal labeled with (13) C-fructose (PLFG). Postprandial blood glucose, fructose, lactate, apolipoprotein B48 (apoB48), and triglyceride (TG) concentrations, (13) C-palmitate concentrations in chylomicron-TG and VLDL-TG, fructose oxidation ((13) CO2 production), and gluconeogenesis from fructose (GNGf) were measured over 6 hours. RESULTS: After ingestion of PLFG, postprandial plasma fructose, glucose, insulin, and lactate concentrations increased earlier and reached higher peak values in RYGB than in Ctrl. GNGf was 33% lower in RYGB than Ctrl (P = 0.041), while fructose oxidation was unchanged. Postprandial incremental areas under the curves for total TG and chylomicrons-TG were 72% and 91% lower in RYGB than Ctrl (P = 0.064 and P = 0.024, respectively). ApoB48 and (13) C-palmitate concentrations were not significantly different. CONCLUSIONS: Postprandial fructose metabolism was not grossly altered, but postprandial lipid concentrations were markedly decreased in subjects having had RYGB surgery.

[The person inside the patient: a qualitative research on the dignity of people assisted in hospital]. / La persona dentro il paziente: una ricerca qualitativa sulla dignità delle persone assistite in ospedale.

AIM: the dignity of the patient and the respect shown toward him are essential aspects of the nursing profession. Developing a qualified competence is possible only if healthcare professionals feel thoughtfully involved in their role. The purpose of this study is to understand, through actual patients' experiences of hospitalization, which are the key factors affecting patients dignity in order to recognize how to provide sensitive care. METHOD: The survey was conducted in Valcamonica's hospital, on a sample of 20 patients hospitalized here in August 2015, all corresponding to predefined inclusion criteria. The survey was carried out through semi-structured interviews including key questions, fundamental to survey purposes. RESULTS: dignity is regarded by everyone as an intrinsic value of every human being. Main survey's result is that the majority of interviewees feel their dignity maintained during hospitalization. Factors that may affect patients dignity can be summarized in three main categories: factors related to healthcare professionals behavior, hospital environment and patients personal condition. CONCLUSIONS: dignity is today an undefined and ambiguous concept; nevertheless it is something that every human being is aware of and the importance to safeguard it is recognized by all of us. However, hospital itself and the conditions of weakness and dependence that often come along with the disease, can easily harm patient's dignity. Polite and accommodating behavior of healthcare providers is the best way to respect patients' dignity. In conclusion, the clinical approach which takes into account only the disease and not the individuality of the person is inadmissible for every category of patient.

Long-term effects of Roux-en-Y gastric bypass on postprandial plasma lipid and bile acids kinetics in female non diabetic subjects: A cross-sectional pilot study.

BACKGROUND AND AIMS: Formerly obese patients having undergone Roux-en-Y gastric bypass (RYGB) display both an accelerated digestion and absorption of carbohydrate and an increased plasma glucose clearance rate after meal ingestion. How RYGB effects postprandial kinetics of dietary lipids has yet not been investigated. METHODS: Plasma triglyceride (TG), apoB48, total apoB, bile acids (BA), fibroblast growth factor 19 (FGF19), and cholecystokinin (CCK) were measured in post-absorptive conditions and over 4-h following the ingestion of a mixed test meal in a cross-sectional, pilot study involving 11 formerly obese female patients 33.8 ± 16.4 months after RYGB surgery and in 11 weight- and age-matched female control participants. RESULTS: Compared to controls, RYGB patients had faster (254 ± 14 vs. 327 ± 7 min, p < 0.05) and lower (0.14 ± 0.04 vs. 0.35 ± 0.07 mM, p < 0.05) peak TG responses, but their peak apoB48 responses tended to be higher (2692 ± 336 vs. 1841 ± 228 ng/ml, p = 0.09). Their postprandial total BA concentrations were significantly increased and peaked earlier after meal ingestion than in controls. Their FGF19 and CCK concentrations also peaked earlier and to a higher value. CONCLUSIONS: The early postprandial apoB48 and BA responses indicate that RYGB accelerated the rate of dietary lipid absorption. The lower postprandial peak TG strongly suggests that the RYGB simultaneously increased the clearance of TG-rich lipoproteins. CLINICAL TRIAL REGISTRATION: NCT01891591.

Metabolic fate of fructose ingested with and without glucose in a mixed meal.

Ingestion of pure fructose stimulates de novo lipogenesis and gluconeogenesis. This may however not be relevant to typical nutritional situations, where fructose is invariably ingested with glucose. We therefore assessed the metabolic fate of fructose incorporated in a mixed meal without or with glucose in eight healthy volunteers. Each participant was studied over six hours after the ingestion of liquid meals containing either 13C-labelled fructose, unlabeled glucose, lipids and protein (Fr + G) or 13C-labelled fructose, lipids and protein, but without glucose (Fr), or protein and lipids alone (ProLip). After Fr + G, plasma 13C-glucose production accounted for 19.0% ± 1.5% and 13CO2 production for 32.2% ± 1.3% of 13C-fructose carbons. After Fr, 13C-glucose production (26.5% ± 1.4%) and 13CO2 production (36.6% ± 1.9%) were higher (p < 0.05) than with Fr + G. 13C-lactate concentration and very low density lipoprotein VLDL 13C-palmitate concentrations increased to the same extent with Fr + G and Fr, while chylomicron 13C-palmitate tended to increase more with Fr + G. These data indicate that gluconeogenesis, lactic acid production and both intestinal and hepatic de novo lipogenesis contributed to the disposal of fructose carbons ingested together with a mixed meal. Co-ingestion of glucose decreased fructose oxidation and gluconeogenesis and tended to increase 13C-pamitate concentration in gut-derived chylomicrons, but not in hepatic-borne VLDL-triacylglycerol (TG). This trial was approved by clinicaltrial. gov. Identifier is NCT01792089.

The energy balance positively regulates the levels of circulating TNF-related apoptosis inducing ligand in humans.

BACKGROUND & AIMS: Although decreased levels of circulating TRAIL have been associated to cardiovascular risk and overall mortality, the mechanisms controlling TRAIL levels in physiopathological conditions are currently unknown. The aim of the present study was to investigate whether changes in the energy intake and insulin sensitivity may influence circulating TRAIL, and to analyze potential relationships between circulating TRAIL and changes in fat mass in healthy subjects receiving hypocaloric or hypercaloric diets. METHODS: Three distinct groups of participants were studied, at the end of a 14-day (n = 9), 35-day (n = 30) or 60-day (n = 16) period of experimental bed rest to induce insulin resistance and during controlled ambulation, after receiving eucaloric, hypocaloric or hypercaloric diets. RESULTS: After bed rest conditions, energy restriction significantly decreased circulating TRAIL, while overfeeding significantly increased TRAIL levels with respect to eucaloric control subjects. Moreover, a positive correlation was found between levels of circulating TRAIL and energy intake as well as between circulating TRAIL and energy balance, as determined by changes in fat mass in these subjects. CONCLUSIONS: Circulating levels of TRAIL exhibit a clear-cut positive correlation with the energy intake and balance in healthy subjects during experimental physical inactivity.

Household waste prevention--a review of evidence.

This paper reports a synthesis of policy-relevant evidence on household waste prevention, based on a UK portfolio of primary research and a broad international review. Waste prevention was defined as strict avoidance, reduction at source (e.g. home composting) and reuse (for the product's original purpose) - recycling was excluded. A major focus was on consumers. Waste prevention is not one but many behaviours; the review revealed a general hierarchy in their popularity, from donating goods to charity at the top; through small reuse behaviours around the home; to activities involving changes in consumption habits at the bottom; one estimate is that 60% of the public does at least one of these activities, some of the time. Barriers to engaging householders include both modern consumer culture and a genuine confusion that waste prevention is equivalent to recycling. The public can be engaged through local or national campaigns, with a wide range of interventions and communications approaches available. On the products and services side, the primary opportunity within the scope of the review was identified as increasing reuse. The barriers included operational difficulties (funding, capacity, logistics) and consumer attitudes towards second-hand goods. The main opportunities are to ensure more strategic planning for reuse by local authorities and better co-ordination and joint working with the third sector. The review examined the impact or potential of various policy measures designed to influence household behaviour directly or the products and services provided to them. Overall, the international evidence suggests that waste prevention benefits will be derived from a 'package' of measures, including, for example, prevention targets, producer responsibility, householder charging, funding for pilot projects, collaboration between the public, private and third sectors, and public intervention campaigns. UK evidence suggests that the greatest tonnage diversions can be achieved on food waste, home composting and bulky waste. The principal evidence gaps relate to robust and comprehensive quantitative data. Better evidence is needed of what actually works, and what outcomes (weight, carbon and costs) can be expected from different measures. More sensitive and effective monitoring and evaluation is needed to provide the evidence required to develop the necessary basket of future policy measures at local and national level.

Delivery and impact of household waste prevention intervention campaigns (at the local level).

This paper presents one strand of the findings from a comprehensive synthesis review of policy-relevant evidence on household waste prevention. Understanding what is achievable in terms of local household waste prevention intervention campaigns enables policy makers, local authorities and practitioners to identify optimum approaches to deliver effective behaviour change. The results of the evidence have been assembled and are discussed in two contexts: (1) the delivery of intervention campaigns as a package of measures used to 'enable', 'engage' and 'encourage' householders to change their behaviour; and (2) the impact of local household waste prevention intervention campaigns in terms of tonnage data. Waste prevention measures adopted include home composting, reducing food waste, smart shopping, donating items for reuse, small changes in the home, reducing junk mail and using cloth/reusable nappies. In terms of diverting biodegradable municipal waste from landfill, the biggest impacts can be attributed to food waste prevention (1.5 kg household(- 1) week(-1)) and home composting (2.9 kg household( -1) week(-1)). Projects providing a package of other waste prevention interventions have shown a very wide range of impacts: a broad indication is that such a package could achieve around 0.5 to 1 kg household(-1) week(- 1) reduction at source. Disaggregating which waste prevention measures influenced uptake is generally not possible, but the evidence suggests that this does not matter: behaviour change has been supported by integrating a range of intervention tools and campaign promotions which have made a collective rather than isolated difference: it is a collection and an accumulation of measures that will have impact.

Methods to monitor and evaluate household waste prevention.

This paper presents one strand of the findings from a comprehensive synthesis review of the policy-relevant evidence on household waste prevention. The focus herein is on how to measure waste prevention: it is always difficult to measure what is not there. Yet reliable and robust monitoring and evaluation of household waste prevention interventions is essential, to enable policy makers, local authorities and practitioners to: (a) collect robust and high quality data; (b) ensure robust decisions are made about where to prioritize resources; and (c) ensure that waste prevention initiatives are being effective and delivering behaviour change. The evidence reveals a range of methods for monitoring and evaluation, including self-weighing; pre- and post-intervention surveys, focusing on attitudes and behaviours and/or on participation rates; tracking waste arisings via collection data and/or compositional analysis; and estimation/modelling. There appears to be an emerging consensus that no single approach is sufficient on its own, rather a 'hybrid' method using a suite of monitoring approaches - usually including surveys, waste tonnage data and monitoring of campaigns - is recommended. The evidence concurs that there is no benefit in trying to further collate evidence from past waste prevention projects, other than to establish, in a few selected cases, if waste prevention behaviour has been sustained beyond cessation of the active intervention campaign. A more promising way forward is to ensure that new intervention campaigns are properly evaluated and that the evidence is captured and collated into a common resource.