Bevacizumab plus Irinotecan,Fluorouracil,and Leucovorin for Metastatic Colorectal Cancer

2013 AHA/ACC/TOS Guideline for the Management of Overweight

Food intake is regulated by the hypothalamus, including the melanocortin and neuropeptide Y (NPY) systems in the arcuate nucleus. The NPY Y2 receptor (Y2R), a putative inhibitory presynaptic receptor, is highly expressed on NPY neurons in the arcuate nucleus, which is accessible to peripheral hormones. Peptide YY3-36 (PYY3-36), a Y2R agonist, is released from the gastrointestinal tract postprandially in proportion to the calorie content of a meal. Here we show that peripheral injection of PYY3-36 in rats inhibits food intake and reduces weight gain. PYY3-36 also inhibits food intake in mice but not in Y2r-null mice, which suggests that the anorectic effect requires the Y2R. Peripheral administration of PYY3-36 increases c-Fos immunoreactivity in the arcuate nucleus and decreases hypothalamic Npy messenger RNA. Intra-arcuate injection of PYY3-36 inhibits food intake. PYY3-36 also inhibits electrical activity of NPY nerve terminals, thus activating adjacent pro-opiomelanocortin (POMC) neurons. In humans, infusion of normal postprandial concentrations of PYY3-36 significantly decreases appetite and reduces food intake by 33% over 24 h. Thus, postprandial elevation of PYY3-36 may act through the arcuate nucleus Y2R to inhibit feeding in a gut–hypothalamic pathway.

BRIEF COMMUNICATION ARISING: Gut hormone PYY3-36 physiologically inhibits food intake

/pdf/practice-guideline-for-the-treatment-of-patients-with-major-ofberaz3o1.pdf

PRACTICE GUIDELINE FOR THE Treatment of Patients With Major Depressive Disorder

Context Obesity is a risk factor for cardiovascular events. Weight loss might protect against cardiovascular events, but solid evidence is lacking. Objective To study the association between bariatric surgery, weight loss, and cardiovascular events. Design, Setting, and Participants The Swedish Obese Subjects (SOS) study is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care. Patients were recruited between September 1, 1987, and January 31, 2001. Date of analysis was December 31, 2009, with median follow-up of 14.7 years (range, 0-20 years). Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Exclusion criteria were identical in surgery and control patients. Surgery patients underwent gastric bypass (13.2%), banding (18.7%), or vertical banded gastroplasty (68.1%), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals. Main Outcome Measures The primary end point of the SOS study (total mortality) was published in 2007. Myocardial infarction and stroke were predefined secondary end points, considered separately and combined. Results Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P  Conclusion Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.

Bariatric Surgery and Long-term Cardiovascular Events

Die bariatrische/metabolische Chirurgie stellt derzeit die effektivste Therapie zur dauerhaften Gewichtsreduktion und Verbesserung der mit Adipositas assoziierten metabolischen Begleiterkrankungen wie Diabetes mellitus Typ 2, arterielle Hypertonie, Lipidstoffwechselstorungen und kardiovaskulare Erkrankungen dar. Trotz kontinuierlich steigender Operationszahlen in Deutschland und weltweit sowie belegter Effektivitat sind die genauen Wirkmechanismen der Operationsverfahren jedoch nicht vollstandig geklart. Einer der am haufigsten durchgefuhrten und am besten untersuchten Eingriffe ist der Roux-en-Y-Magenbypass (RYGB), dessen Wirksamkeit traditionell durch mechanische Nahrungsrestriktion und kalorische Malabsorption begrundet wurde. Inzwischen hat sich allerdings gezeigt, dass die zugrunde liegenden Mechanismen weitaus komplexer sind und dass physiologische Prozesse wie beispielsweise veranderte Spiegel verschiedener gastrointestinaler Hormone, ein gesteigerter Energieumsatz und eine modifizierte Zusammensetzung des intestinalen Mikrobioms eine wichtigere Rolle spielen. Nachdem die Verbesserung der metabolischen Begleiterkrankungen lange Zeit als Folgeeffekt der Gewichtsreduktion nach RYGB interpretiert wurde, hat sich inzwischen gezeigt, dass dies zumindest teilweise gewichtsunabhangig zu sein scheint und direkt durch physiologische Veranderungen vermittelt wird. Dieser Artikel soll eine Ubersicht zu den potenziellen und aktuell wichtigsten Wirkmechanismen der RYGB-Operation liefern, die sowohl an der Therapie des Ubergewichts als auch der adipositasassoziierten metabolischen Begleiterkrankungen beteiligt sind.

/pdf/chirurgie-als-pluripotentes-instrument-gegen-eine-37ksar39ht.pdf

Chirurgie als pluripotentes Instrument gegen eine metabolische Erkrankung

Bariatric surgery (BS) has been shown to ameliorate health-related quality of life and eating disorder symptoms. However, the correlation of these changes with weight loss is not uniform, suggesting that additional factors have an impact on postoperative outcomes. To assess the impact of BS on eating disorder symptoms at 1 year postoperatively and to generate predictive models for the achievement of optimal eating behavior. Retrospective cohort study on a prospectively collected database of all consecutive patients who underwent primary BS in our academic center between January 2015 and March 2017. Eating Disorder Examination-Questionnaire (EDE-Q) was used to measure eating psychopathology. Logistic regression was used to estimate the odds ratio of achieving “healthy” EDE-Q at 1 year. Missing data was handled by multiple imputations for the regression model. Two-hundred thirty-four patients were included. A complete-case analysis in 135 cases showed a “healthy” EDE-Q in 27.4% at baseline and in 83.7% at 1 year (difference = 56.3%, P = 0.018). Only the baseline EDE-Q “healthy” status influenced significantly the odds of achieving “healthy” EDE-Q at 1 year (OR 6.7, 95% CI 1.18–38.14, P = 0.04). BS seems to promote successful treatment of self-reported eating disorder symptoms during the first postoperative year. The achievement of optimal results is independent of age, sex, weight loss, obesity-related comorbidity status, surgical technique, or 30-day surgical complications. Future studies, using validated questionnaires specifically designed to investigate eating behavior after BS and/or direct measurements of the eating behavior are needed to clarify the underlying neuropsychologic mechanisms that drive the observed postoperative changes.

/pdf/predictors-of-a-healthy-eating-disorder-examination-25cp804yj0.pdf

Predictors of a Healthy Eating Disorder Examination-Questionnaire (EDE-Q) Score 1 Year After Bariatric Surgery

BackgroundObesity is associated with hypertension, but the exact mechanism is not fully understood. Bariatric surgery significantly decreases weight and blood pressure (BP). Low plasma nitric oxide...

https://journals.sagepub.com/doi/pdf/10.1258/acb.2012.012069

Improved blood pressure, nitric oxide and asymmetric dimethylarginine are independent after bariatric surgery.

Mental and emotional representations of “weight loss”: free-word association networks in members of bariatric surgery-related social media communities

Bariatric surgery is the most effective treatment of obesity and its associated diseases like type 2 diabetes mellitus. Given the obesity epidemic and the efficacy of surgical treatment, the number of surgical weight loss procedures has grown in recent years. Nevertheless, there is little consensus regarding the extent of preoperative investigations required prior to patients undergoing surgery. This article aims to discuss the available evidence on which preoperative tests are useful for the detection and treatment of conditions such as venous thromboembolism, obstructive sleep apnea syndrome and Helicobacter pylori-positive gastritis prior to an operation. The present literature suggests that only a few preoperative investigations are essential, but that preoperative multidisciplinary care is beneficial.

/pdf/where-to-begin-and-where-to-end-preoperative-assessment-for-19x924cyb7.pdf

Marco Bueter

Papers

Chirurgie als pluripotentes Instrument gegen eine metabolische Erkrankung

Predictors of a Healthy Eating Disorder Examination-Questionnaire (EDE-Q) Score 1 Year After Bariatric Surgery

Improved blood pressure, nitric oxide and asymmetric dimethylarginine are independent after bariatric surgery.

Mental and emotional representations of “weight loss”: free-word association networks in members of bariatric surgery-related social media communities

Where to begin and where to end? Preoperative assessment for patients undergoing metabolic surgery.