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Abstract Background The influential role of incretin hormones on glucose metabolism in patients with a history of Roux-en-Y gastric bypass (RYGB) has been investigated thoroughly, but there has been little examination of the effect of incretins and ectopic lipids on altered glucose profiles, especially severe hypoglycemia in pregnant women with RYGB. Methods In this prospective clinical study, an oral glucose tolerance test (OGTT), an intravenous glucose tolerance test (IVGTT), and continuous glucose monitoring (CGM) were conducted in 25 women with RYGB during pregnancy, 19 of normal weight (NW) and 19 with obesity (OB) between the 24th and the 28th weeks of pregnancy, and 3 to 6 months post-partum. Post-partum, the ectopic lipid content in the liver, heart, and skeletal muscle was analyzed using 1H-magnetic resonance spectroscopy (1H-MRS). Results RYGB patients presented with major fluctuations in glucose profiles, including a high occurrence of postprandial hyperglycemic spikes and hypoglycemic events during the day, as well as a high risk of hypoglycemic periods during the night (2.9 ± 1.1% vs. 0.1 ± 0.2% in the OB and vs. 0.8 ± 0.6% in the NW groups, p < 0.001). During the extended OGTT, RYGB patients presented with exaggerated expression of GLP-1, which was the main driver of the exaggerated risk of postprandial hypoglycemia in a time-lagged correlation analysis. Basal and dynamic GLP-1 levels were not related to insulin sensitivity, insulin secretion, or beta cell function and did not differ between pregnant women with and without GDM. A lower amount of liver fat (2.34 ± 5.22% vs.5.68 ± 4.42%, p = 0.015), which was positively related to insulin resistance (homeostasis model assessment of insulin resistance, HOMA-IR: rho = 0.61, p = 0.002) and beta-cell function (insulinogenic index: rho = 0.65, p = 0.001), was observed in the RYGB group after delivery in comparison to the OB group. Conclusion GLP-1 is mainly involved in the regulation of postprandial glucose metabolism and therefore especially in the development of postprandial hypoglycemia in pregnant RYGB patients, who are characterized by major alterations in glucose profiles, and thus in long-term regulation, multiple organ-related mechanisms, such as the lipid content in the liver, must be involved. Highlights • Pregnant women with a history of RYGB operation are at high risk of postprandial hypoglycemic events. • GLP-1 is mainly involved in the regulation of postprandial glucose metabolism and in pregnant women with RYGB. • In the long-term regulation of glucose metabolism, multiple organ-related mechanisms, such as the lipid content in the liver, have to be involved. • To avoid hypoglycemic periods during the night and postprandial hypoglycemic events, the dietary recommendations of pregnant RYGB patients have to be adapted. [ABSTRACT FROM AUTHOR]

Combining mouse experiments with big data analysis of the Austrian population, we investigated the association between high-dose statin treatment and bone quality. The bone microarchitecture of the femur and vertebral body L4 was measured in male and ovariectomized female mice on a high-fat diet containing simvastatin (1.2 g/kg). A sex-specific matched big data analysis of Austrian health insurance claims using multiple logistic regression models was conducted (simvastatin 60–80 mg/day vs. controls; males: n = 138,666; females: n = 155,055). High-dose simvastatin impaired bone quality in male and ovariectomized mice. In the trabecular femur, simvastatin reduced bone volume (µm3: ♂, 213 ± 15 vs. 131 ± 7, p < 0.0001; ♀, 66 ± 7 vs. 44 ± 5, p = 0.02) and trabecular number (1/mm: ♂, 1.88 ± 0.09 vs. 1.27 ± 0.06, p < 0.0001; ♀, 0.60 ± 0.05 vs. 0.43 ± 0.04, p = 0.01). In the cortical femur, bone volume (mm3: ♂, 1.44 ± 0.03 vs. 1.34 ± 0.03, p = 0.009; ♀, 1.33 ± 0.03 vs. 1.12 ± 0.03, p = 0.0002) and cortical thickness were impaired (µm: ♂, 211 ± 4 vs. 189 ± 4, p = 0.0004; ♀, 193 ± 3 vs. 169 ± 3, p < 0.0001). Similar impairments were found in vertebral body L4. Simvastatin-induced changes in weight or glucose metabolism were excluded as mediators of deteriorations in bone quality. Results from mice were supported by a matched cohort analysis showing an association between high-dose simvastatin and increased risk of osteoporosis in patients (♂, OR: 5.91, CI: 3.17–10.99, p < 0.001; ♀, OR: 4.16, CI: 2.92–5.92, p < 0.001). High-dose simvastatin dramatically reduces bone quality in obese male and ovariectomized female mice, suggesting that direct drug action accounts for the association between high dosage and increased risk of osteoporosis as observed in comparable human cohorts. The underlying pathophysiological mechanisms behind this relationship are presently unknown and require further investigation. [Display omitted] • High-dose simvastatin (SV) therapy impairs bone quality in mice. • High-dose SV therapy reduced trabecular and cortical bone quality as well as that of the vertebral body L4. • High-dosages of statins are related to an increased risk of osteoporosis in humans. [ABSTRACT FROM AUTHOR]

Purpose: Shared Electronic Health Record (EHR) systems, which provide a health information exchange (HIE) within a community of care, were found to be a key enabler of informational continuity of diabetes mellitus (DM) care. Quantitative analyses of the actual contribution of Shared EHR systems to informational continuity of care are rare. The goal of this study was to quantitatively analyze (i) the degree of fragmentation of DM care in Austria as an indicator for the need for HIE, and (ii) the quantity of information (i.e. number of documents) from Austrian DM patients that would be made available by a nationwide Shared EHR system for HIE.Methods: Our analyses are based on social security claims data of 7.9 million Austrians from 2006 and 2007. DM patients were identified through medication data and inpatient diagnoses. The degree of fragmentation was determined by the number of different healthcare providers per patient. The amount of information that would be made available by a nationwide Shared EHR system was estimated by the number of documents that would have been available to a healthcare provider if he had access to information on the patient's visits to any of the other healthcare providers. As a reference value we determined the number of locally available documents that would have originated from the patient's visits to the healthcare provider himself. We performed our analysis for two types of systems: (i) a "comprehensive" Shared EHR system (SEHRS), where each visit of a patient results in a single document (progress note), and (ii) the Austrian ELGA system, which allows four specific document types to be shared.Results: 391,630 DM patients were identified, corresponding to 4.7% of the Austrian population. More than 90% of the patients received health services from more than one healthcare provider in one year. Both, the SEHRS as well as ELGA would have multiplied the available information during a patient visit in comparison to an isolated local EHR system; the median ratio of external to local medical documents was between 1:1 for a typical visit at a primary care provider (SEHRS as well as ELGA) and 39:1 (SEHRS) respectively 28:1 (ELGA) for a typical visit at a hospital.Conclusions: Due to the high degree of care fragmentation, there is an obvious need for HIE for Austrian DM patients. Both, the SEHRS as well as ELGA could provide a substantial contribution to informational continuity of care in Austrian DM treatment. Hospitals and specialists would have gained the most amount of external information, primary care providers and pharmacies would have at least doubled their available information. Despite being the most important potential feeders of a national Shared EHR system according to our analysis, primary care providers will not tap their full corresponding potential under the current implementation scenario of ELGA. [ABSTRACT FROM AUTHOR]

Abstract: The effect of personal pronouns such as “ein” (German for “a”), “mein” (German for “my”) and “sein” (German for “his”) on the processing of associated nouns was investigated using MEG. Three different encoding strategies were provided in order to vary the level of consciousness involved in verbal information processing. A shallow (alphabetic), a deep (semantic) and a very deep (contextual) encoding instruction related to visual word presentation were given to all study participants. After the encoding of pronoun–noun pairs, recognition performances of nouns only were tested. The number of correctly recognized nouns previously associated with “sein” was significantly lower than the number of correctly recognized nouns previously associated with “ein” in the shallow encoding condition. The same trend was found for “mein” associated nouns which were also less accurately recognized compared to “ein” associated nouns. Magnetic field distributions recorded during the encoding phases revealed two significant effects, one between about 200 and 400ms after stimulus onset and the other between about 500 and 800ms. The earlier effect was found over occipito-parietal sensors, whereas the later effect occurred over left frontal sensors. Within both time ranges, brain activation varied significantly as a function of associated pronoun independent of depth of word processing. In the respective areas of both time ranges, conditions including personal pronouns (“mein” and “sein”) showed higher magnetic field components compared to the control condition of no personal pronouns (“ein”). Evidence is shown that early stage processing is able to distinguish between no personal and personal information, whereas later stage processing is able to distinguish between information related to oneself and to another person (self and non-self). Along with other previous reports our MEG findings support the notion that particular human brain functions involved in processing neurophysiological correlates of self and non-self can be identified. [Copyright &y& Elsevier]

• We establish a network model for the analysis and management of pest outbreaks. • We account for small-scale host-pest interactions as well as landscape topology. • Our model explains outbreak cycles both for geometrid moths and bark beetles. • We provide predictions of future outbreak risk based on a mechanistic system model. • Our forest management strategy optimally reduces the spreading potential of a pest. Recent research suggests that the spread of pest outbreaks is driven by ecological processes acting at different spatial scales. In this work, we establish a network model for the analysis and management of pest outbreaks that takes into account small-scale host-pest interactions as well as landscape topology and connectivity. The model explains outbreak cycles both for geometrid moths and bark beetles, and provides insight into the relative importance and interactions between the multi-scale drivers of outbreak dynamics. Our results demonstrate that outbreak behavior is most sensitive to changes in pest pressure at the local scale, and that accounting for the spatial connectivity of habitat patches is crucial to capturing the spreading behavior through landscapes. In contrast to early warning signals based on retrospective data, our model provides predictions of future outbreak risk based on a mechanistic understanding of the system, which we apply for landscape-scale forest management. [ABSTRACT FROM AUTHOR]