Efficacy of liraglutide 3.0 mg treatment on weight loss in patients with weight regain after bariatric surgery.

PURPOSE: Bariatric surgery, as Roux-en-Y gastric bypass (RYGB), laparoscopic gastric banding (LGB), and laparoscopic sleeve gastrectomy (LSG), is considered the gold standard treatment to achieve long-term weight loss in severe obesity. In patients who fail to maintain the achieved weight, pharmacological treatment may be required. Here, we reported our real-life experience on the efficacy of liraglutide therapy in 62 patients who regained weight after bariatric surgery. METHODS: We retrospectively evaluated 62 (60 F-2 M; mean age: 43.6 ± 9.9 years) patients received liraglutide for weight loss after bariatric surgery (17 RYGB, 22 LGB, and 23 LSG). Body mass index (BMI) before and after surgery was, respectively, of 45.4 ± 5.5 kg/m2 and 29.5 ± 4.9 kg/m2. Patients were followed up from 2016 until 2021. Liraglutide was administered after weight regain once-daily subcutaneously at starting dose of 0.6 mg and with weekly increases up to 3.0 mg. Treatments were administered when a weight regain of 10-15% occurred after reaching a minimum weight loss from bariatric surgery or if weight loss after bariatric surgery was unsatisfactory. RESULTS: After a mean of 70.7 ± 43.7 months from any bariatric surgery, all patients started liraglutide therapy. At this time, mean BMI was 34.2 ± 4.8 kg/m2 (mean increased BMI: 4.7 ± 2.8 kg/m2). After a mean of 10.5 ± 4.4 months from the beginning of liraglutide, 9 patients achieved normal weight (BMI 24.1 ± 0.9 kg/m2), and 28 were overweight (BMI 26.9 ± 1.6 kg/m2). Twenty patients achieved grade I (BMI 32.1 ± 1.5 kg/m2), 5 grade II (BMI 37.3 ± 2.0 kg/m2) obesity, and none had grade III obesity (mean BMI change: - 5.1 ± 2.5 kg/m2). The treatment was well tolerated, and no serious adverse events were recorded. CONCLUSION: These data confirm the efficacy and safety of liraglutide in patients who experienced weight regain after bariatric surgery. Considering the long-term follow-up, patients should be followed up regularly and the pharmacological treatment should be adapted to the weight fluctuations observed during the clinical history. LEVEL OF EVIDENCE: V. Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Persistent B lymphocyte depletion after an ultralow dose of rituximab for pemphigus vulgaris

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Accuracy and reliability of the RGB-D camera for measuring walking speed on a treadmill.

AIM: RGB-D cameras (Red Green Blue+Depth) are widely employed in exergames designed to physically stimulate elderly people. Nevertheless, the intensity of the physical activity reached with the existing solutions is rarely sufficient to obtain a real impact on the physical fitness and thus on the health status of this population. In this context, a Point Cloud Based System (PCBS) has been developed to interface ordinary motorized treadmills with exergames through a simple RGB-D camera, to induce players to perform physical activities at higher intensities. The goal of this study was to assess the accuracy and reliability of PCBS to measure the walking speed of a subject on a standard motorized treadmill based on the image streams of an RGB-D camera. METHODS: 36 participants performed three 10min walking exercises, divided in 5 blocks of 2min at the following constant ordered speeds: 0.42, 0.69, 0.97, 1.25 and 1.53ms(-1). The measured walking speeds are compared to those obtained through a Marker Based Control System (MBCS). RESULTS: Results showed a high system accuracy (bias: 0.013±0.015ms(-1)), a good reliability (ICC=0.63-0.91) and a low variability (SEM=1-5%; MD=2.7-14%). DISCUSSION: Accuracy and reliability of PCBS are consistent with those obtained in similar existing systems measuring gait parameters. CONCLUSION: Within the context of the development of exergames, PCBS may be combined with exergames to perform physical activities at sufficiently high intensities in the elderly population, in order to improve their physical health and possibly prevent/delay cognitive impairment.

Influence of Genetic Background on Apathy-Like Behavior in Triple Transgenic AD Mice.

Apathy is an early and common neuropsychiatric syndrome in Alzheimer's disease (AD) patients. In clinical trials, apathy is associated with decreased motor activity that can be monitored by actigraphy. The triple transgenic mouse AD model (3xTgAD) has been shown to recapitulate the biochemical lesions as well as many of the synaptic and cognitive alterations associated with AD. In the present work we found that these mice also develop an early and consistent apathy-like behavior as evidenced by a drastic decrease in spontaneous activity measured by actimetry. We recently established that these mice also display an intraneuronal accumulation of the ß-secretase-derived ßAPP fragment (C99) appearing early, in absence of Aß. Interestingly, we found that the apathy-like behavior observed in 3xTgAD mice was temporally associated with C99 accumulation and synaptic alterations. Since it is well known that the genetic background can strongly influence behavior and can induce transcriptional variability in animal models, we decided to determine the influence of genetic background on the above-described alterations. We backcrossed 3xTgAD mice to C57BL/6 and found that the genetic background had no influence on either C99 accumulation or synaptic plasticity alterations, but strongly affected the apathy-like behavior.

Inertial sensors as measurement tools of elbow range of motion in gerontology.

BACKGROUND AND PURPOSE: Musculoskeletal system deterioration among the aging is a major reason for loss of autonomy and directly affects the quality of life of the elderly. Articular evaluation is part of physiotherapeutic assessment and helps in establishing a precise diagnosis and deciding appropriate therapy. Reference instruments are valid but not easy to use for some joints. The main goal of our study was to determine reliability and intertester reproducibility of the MP-BV, an inertial sensor (the MotionPod(®) [MP]) combined with specific software (BioVal [BV]), for elbow passive range-of-motion measurements in geriatrics. METHODS: This open, monocentric, randomized study compared inertial sensor to inclinometer in patients hospitalized in an acute, post-acute, and long-term-care gerontology unit. RESULTS: Seventy-seven patients (mean age 83.5±6.4 years, sex ratio 1.08 [male/female]) were analyzed. The MP-BV was reliable for each of the three measurements (flexion, pronation, and supination) for 24.3% (CI 95% 13.9-32.8) of the patients. Separately, the percentages of reliable measures were 59.7% (49.2-70.5) for flexion, 68.8% (58.4-79.5) for pronation, and 62.3% (51.2-73.1) for supination. The intraclass correlation coefficients were 0.15 (0.07-0.73), 0.46 (0.27-0.98), and 0.50 (0.31-40 0.98) for flexion, pronation, and supination, respectively. CONCLUSION: This study shows the convenience of the MP-BV in terms of ease of use and of export of measured data. However, this instrument seems less reliable and valuable compared to the reference instruments used to measure elbow range of motion in gerontology.

Effect of a sugar-free chewing gum containing magnolia bark extract on different variables related to caries and gingivitis: a randomized controlled intervention trial.

The effect of magnolia bark extract (MBE) on different variables related to caries and gingivitis administered daily through a sugar-free chewing gum was evaluated. The study was performed with healthy adult volunteers at high risk for caries as a randomized double-blind interventional study. 120 subjects with a salivary mutans streptococci (MS) concentration ≥10(5) CFU/ml and presence of bleeding on probing >25% were enrolled and divided into three groups: magnolia, xylitol and control. The study design included examinations at baseline, after 7 days, after 30 days of gum use and 7 days after the end of gum use. Plaque pH was assessed using the strip method following a sucrose challenge. Area under the curve (AUC(5.7) and AUC(6.2)) was recorded. Whole saliva was collected and the number of salivary MS (CFU/ml) was counted. Bleeding on probing was recorded as a proxy of dental plaque. Data were analyzed using ANOVA repeated measures. Magnolia gum significantly reduced plaque acidogenicity, MS salivary concentration and gingival bleeding compared to xylitol and control gums. Subjects from the magnolia and xylitol groups showed both MS concentration (p = 0.01 and 0.06, respectively) and AUC(5.7) (p = 0.01 and 0.04, respectively) to be significantly lower compared to baseline. Thirty-day use of a chewing gum containing MBE showed beneficial effects on oral health, including reduction of salivary MS, plaque acidogenicity and bleeding on probing.

Six months of daily high-dose xylitol in high-risk schoolchildren: a randomized clinical trial on plaque pH and salivary mutans streptococci.

A randomized clinical trial was designed to evaluate the effect of daily high-dose xylitol chewing gum on plaque pH and salivary mutans streptococci (MS) in a sample of schoolchildren at high risk of caries. The study was performed on 204 subjects (acceptance rate 88.3%). Inclusion criteria were: >1 and <4 carious lesions, and a salivary MS concentration >10(5) CFU/ml. Subjects were randomly assigned to the xylitol or control group. Study design included one examination at baseline (t(0)), one after 3 months of chewing (t(1)), one after 6 months of chewing (t(2)) and the last 3 months after the end of chewing period (t(3)). Plaque pH was assessed using the MicroTouch technique, following a sucrose challenge. The area under the curve (AUC(5.7) and AUC(6.2)) was recorded. Whole saliva was collected in sterile vials and MS CFU/ml were counted. Data were analysed using repeated-measures ANOVA. The main result was that plaque acidogenicity was reduced in both groups. The differences between treatments were statistically significant both for plaque pH and MS concentration; the interaction term for treatment and time was statistically significant (p < 0.01). At t(2), the xylitol group children with a salivary MS concentration >10(5) and those with < or =10(5) showed significantly lower AUC(5.7) and AUC(6.2) values than the control group. These results suggest that the long-term use of high-dose non-sucrose chewing gums had beneficial effects on plaque pH, and that this effect was statistically greater when using xylitol chewing gums, both on plaque pH and MS salivary concentration.

LDL apheresis in the treatment of non-arteritic ischaemic optic neuropathy: a 6-month follow-up study.

PURPOSE: Verify the recovery of visual capacity after the administration of a combination of LDL apheresis (LA) and conventional therapy (CT). Design, prospective and interventional case series. METHODS: 20 patients affected by NAION were randomly subdivided into two groups of 10 patients (Group 1 and Group 2). Group 1 underwent three sessions of LA associated with CT, whereas group 2 received only CT. At discharge and at the 6 months follow-up visit, assessment in both groups was made of the best corrected visual acuity (BCVA) and the computerised visual field (CVF), comparing the findings with those at admission in each patient. RESULTS: Only the mean deviation (MD) at CVF was statistically improved in group 1 as compared with group 2 at discharge, judged against the values at admission (-11.08+/-6.51 vs -16.53+/-10.03, P=0.039; -17+/-5.24 vs -14.14+/-9.42, respectively). However, this increase was not confirmed at 6 months (-16.83+/- -10.72, group 1; -13.56+/-3.60 group 2). CONCLUSION: In NAION, LA induced a short term improvement in the MD, but by 6 months this had disappeared.

Periodontal disease and preterm birth relationship: a review of the literature.

Despite medical care improves consistently, the rate of preterm birth has risen in recent years. In Italy the rate of preterm birth between the XXXIII and the XXXVI week is 13.5%, while it amounts to 1.3% for preterm birth between XXIV and the XXXII week. Consequently, the identification of risk factors for preterm birth that might be modified would have far-reaching and long-lasting effects. A significant number of preterm birth may be attributed to infections of the urogenital tract, such as bacterial vaginosis. In the last decade, great interest has been generated to support the hypothesis that sub-clinical infection at sites that are also distant from the genito-urinary tract may be an important cause of preterm labour, probably through the activation of abnormal inflammatory responses within the uterus and intrauterine tissues. There is emerging evidence of a possible relationship between maternal periodontal diseases as a potential risk factor of adverse pregnancy outcomes, like preterm low birth weight even though not all of the actual data support such hypothesis. Further studies are clearly required to clarify the causes and/or relationships linking pathologic oral conditions and adverse pregnancy outcomes. So far, from a clinical standpoint, it would appear that the assessment of the periodontal status of pregnant women during an early pregnancy might be useful in providing an important indicator of risk for future obstetric complications.

Caries prevalence and need for dental care in 13-18-year-olds in the Municipality of Milan, Italy.

OBJECTIVE: To assess the relationship between caries prevalence and toothbrushing and dietary habits in adolescents in the city of Milan (Italy). RESEARCH DESIGN: The study consisted of a cross-sectional survey using clustering samples. DMFT was recorded following the WHO guidelines by three calibrated examiners. A dental health questionnaire was completed by the subjects to assess their toothbrushing and oral hygiene habits. Univariate and multivariate analysis were performed. PARTICIPANTS: A sample of 1,333 students (age-range 13-18 years, 648 males and 685 females) was studied. The students came from three secondary schools located in different socio-economic and cultural areas of the city. RESULTS: Caries experience (DMFT>0) was 59.11%. A significant linear trend (p<0.01) was observed for DT>0 among the three different schools selected. The mean DMFT was 1.94 +/- 2.46 and difference observed in DT, FT and DMFT among the three schools was statistically significant (p<0.05). Eating snacks more than once a day provided a significantly higher odds ratio for DMFT>0 and for DT>0 (OR=5.24, p<0.001 and OR= 1.46, p=0.01 respectively). CONCLUSIONS: A significant trend between caries experience and socioeconomic status was observed: adolescents, attending school in a low-socio-economic areas, showed higher caries prevalence and higher levels of untreated caries than their counterparts attending schools located in medium-high socio-economic areas.

Two cases of foodborne botulism with home-preserved asparagus.

Botulism is a rare but potentially fatal disease caused by toxins produced by Clostridium botulinum. We report botulism in two adult females, one of them just tasting from "bad" asparagus and the other eating the full portion. Both patients survived after intermittent mechanical ventilation and trivalent antitoxin administration. The diagnosis was confirmed by detection of botulinum toxin. Acute onset of bilateral cranial neuropathies associated with symmetric descending weakness as well as some key features of the botulism syndrome including absence of fever, symmetric neurologic deficits, the patients remaining responsive and no sensory deficits, with the exception of blurred vision, led to the clinical diagnosis in the first presenting case which was then easily made in the second. Despite the fact that amount of toxin ingested, time-to-symptom development, and time-to-recovery markedly differed in the two patients, their maximal disease severity was similar.

Hysteroscopic permanent tubal sterilization using a nitinol-dacron intratubal device without anaesthesia in the outpatient setting: procedure feasibility and effectiveness.

BACKGROUND: Hysteroscopic permanent tubal sterilization has recently been introduced, resulting in a non-invasive, safe and effective technique. The aim of this study was to assess the feasibility of outpatient hysteroscopic tubal sterilization using a nitinol-dacron intratubal device without anaesthesia and to assess patient procedure compliance. MATERIALS AND METHODS: We untertook a prospective study of 36 consecutive cases of outpatient hysteroscopic tubal sterilization using a nitinol-dacron intratubal device without anaesthesia. Tubal sterilization was performed by placing the device with the aid of a 5.2-mm continuous-flow operative hysteroscope. At the end of the procedure women were asked to rate the pain experienced on a visual analogue scale (VAS) (0, no discomfort to 100, severe discomfort). Successful device placement was assessed after 3 months by hysterosalpingography and diagnostic hysteroscopy. RESULTS: Successful bilateral placement was obtained in 32 patients (88.9%); in one (2.8%) the placement was monolateral; and in three (8.3%) the procedure failed. Mean operating time was 8.6 +/- 5.3 min. A mean VAS of 36.1 +/- 23.9 was recorded. CONCLUSIONS: The nitinol-dacron intratubal device is safe, appears to be effective long-term, is non-invasive and can be used in the outpatient setting without anaesthesia. Low-level discomfort was experienced by the patients. Limitations of its use include that it is not effective immediately, it is irreversible, it requires special equipment and training, and it is difficult to use in cases of uterine anomalies. We conclude that this method may be offered to all woman asking for permanent tubal sterilization, particularly those who refuse or have contraindications for anaesthesia.

Adenosarcoma of the ovary. A case report.

Adenosarcoma of the ovary is a rare condition. We report a case of a 32-year-old patient that has been treated in our Department. The diagnosis of ovarian adenosarcoma was carried out after laparoscopy with removal of an ovarian endometriotic cyst. Laparoscopic homolateral ovariectomy was then performed and conservative treatment was decided on considering the young age, low stage and low grade of the disease. Second-look laparoscopy, clinical evaluation and ultrasound were performed for four years of follow-up. No recurrence has been detected. Conservative treatment should be proposed in fertile age with low-grade ovarian adenosarcoma, but a strict follow-up is always necessary.

Laparoscopic management of early stage endometrial cancer.

PURPOSE OF INVESTIGATION: The purpose of this study was to evaluate the feasibility of laparoscopic hysterectomy versus the transabdominal approach with systemic pelvic lymphadenectomy in early stage endometrial cancer. METHODS: From January 1996 to April 2002, 59 women were treated for endometrial cancer at the Department of Gynecology in Padova, Italy (29 by the laparoscopic technique and 30 by laparotomy). Every patient underwent hysterosalpingo-oophorectomy with systemic pelvic lymphadenectomy. RESULTS: Comparing the two techniques, operating time was longer and hospital stay was significantly shorter for laparoscopy; no differences were observed about the number of removed lymph nodes (range 5-33) or intra-postoperatory complications. CONCLUSION: The laparoscopic approach to endometrial cancer is certainly to be considered appropriate and efficacious, even if it requires skilled surgeons and adequate oncologic training. It is important to perform pelvic lymphadenectomy in all cases of early stage cancer.

Protein S deficiency. Description of a case associated with chronic inflammatory bowel disease.

Thrombotic disease is one of the most relevant clinical problems for morbility and mortality. We can differentiate congenital and acquired forms. In this short communication we describe 1 case observed by us that seems interesting for the association of a congenital and acquired form [Protein S deficiency and inflammatory bowel disease (IBD)] and for the dramatic events suffered before receiving a complete diagnosis and therapy, indicating the importance of recollection of information from the patients, starting from anamnestic data.

Endogenous cytokine production protects T cells from spontaneous apoptosis during highly active antiretroviral therapy.

BACKGROUND: The availability of therapeutic regimens that effectively interfere with HIV-1 replication provides novel opportunities to investigate mechanisms of T-cell depletion as well as repopulation in infected individuals. METHODS: Nineteen HIV-1-infected individuals were investigated during one-year follow-up of highly active retroviral therapy (HAART). The frequencies of apoptotic T cells, as determined by propidium iodide, staining, TUNEL assay and analysis of annexin V, were assessed either in the absence or in the presence of anti-interleukin (IL)2 and anti-IL-4 neutralizing Ab. Spontaneous and lectin-induced cytokine production were assessed by ELISA. RESULTS: Increments of both naive and memory CD4 and CD8 T cells during HAART are accompanied by a decrease of T-cell apoptosis that, after 12 months of HAART, reaches normal levels. This is associated with increments of both spontaneous and activation-induced production of IL-2 and IL-4 by peripheral blood mononuclear cells (PBMCs), though only the latter was found defective at enrolment. During HAART, blocking of either IL-2 or IL-4 production by PBMCs using neutralizing Ab restores levels of T-cell apoptosis consistent with those determined at enrolment. These data suggest that both IL-2 and IL-4 produced by PBMCs during HAART provide anti-apoptotic signals that can contribute to an increased survival of T cells and may thus play a part in long-term immune reconstitution. CONCLUSIONS: An effective viral suppression and, possibly, effects of PI on molecular targets other than viral components, can support a progressive normalization of T-cell survival that, at least in part, depends upon the restoration of proper soluble signals. These results provide evidence of a supporting role of endogenous cytokine production in peripheral T-cell repopulation during an effective and prolonged viral suppression. This may be relevant for the definition of immune-intervention targets aimed at immune reconstitution in HIV-1-infected patients.

Cardioprotective effects of zofenopril, a new angiotensin-converting enzyme inhibitor, on doxorubicin-induced cardiotoxicity in the rat.

We have studied the effect of zofenopril, a new angiotensin-converting enzyme inhibitor in preventing cardiac injury induced by chronic doxorubicin treatment in rats. Cardiac function was assessed by measuring changes in electrocardiogram (ECG) tracings, haemodynamics and cardiac responses in vivo to isoprenaline, 4 weeks after suspension of doxorubicin treatment, in vehicle-treated rats and in animals receiving zofenopril (15 mg/kg/os/day) alone, doxorubicin (1.5 mg/kg i.v. once a week for 5 weeks) or zofenopril+doxorubicin treatment. Doxorubicin induced a significant lengthening of the QalphaT interval, which was completely prevented by zofenopril treatment. The cardiac positive inotropic effect induced by i.v. isoprenaline was selectively depressed by doxorubicin (no changes in chronotropic responses) and this adverse effect of doxorubicin was also prevented in zofenopril+doxorubicin pretreated rats. Doxorubicin induced a significant increase in relative heart weight, which was likewise prevented in zofenopril+doxorubicin treated rats. In separate experiments, zofenopril did not interfere with the antitumor activity of doxorubicin (inhibition of tumor growth in nude mice xenografted with A2780 human tumor line). In conclusion, the oral administration of zofenopril is able to significantly ameliorate, up to 4 weeks after the end of doxorubicin administration, doxorubicin-induced cardiotoxicity without affecting the antitumor activity of this anthracycline.