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1. Biliopancreatic Diversion (BPD), Long Common Limb Revisional Biliopancreatic Diversion (BPD + LCL–R), Roux-en-Y Gastric Bypass [RYGB] and Sleeve Gastrectomy (SG) mediate differential quantitative changes in body weight and qualitative modifications in body composition: a 5-year study

Author

Franco Folli, Roberto Manfrini, Ahmed S. Zakaria, Valerio Ceriani, Antonio E. Pontiroli, Ferdinando Pinna, and Antonio Galantino

Subjects
Sleeve gastrectomy, medicine.medical_specialty, Gastric bypass, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Body water, Revised biliary pancreatic diversion, Gastroenterology, Body composition, Endocrinology, Weight loss, Gastrectomy, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Humans, Obesity, Biliary pancreatic diversion, Biliopancreatic Diversion, Retrospective Studies, Bariatric surgery, Fat mass, business.industry, nutritional and metabolic diseases, General Medicine, medicine.disease, Roux-en-Y anastomosis, Obesity, Morbid, Fat-free mass, Treatment Outcome, Total body water, Original Article, medicine.symptom, business, Body mass index, Follow-Up Studies
Abstract

Aims Bariatric surgeries induce profound weight loss (decrease in body mass index, BMI), through a decrease in fat mass (FM) and to a much lesser degree of fat-free mass (FFM). Some reports indicate that the weight which is lost after gastric bypass (RYGB) and sleeve gastrectomy (SG) is at least partially regained 2 years after surgery. Here we compare changes in BMI and body composition induced by four bariatric procedures in a 5 years follow-up study. Methods We analyzed retrospectively modifications in BMI, FM and FFM obtained through Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), biliopancreatic diversion (BPD) and a long common limb revisional biliopancreatic diversion (reduction of the gastric pouch and long common limb; BPD + LCL−R). Patients were evaluated at baseline and yearly for 5 years. Of the whole cohort of 565 patients, a subset of 180 patients had all yearly evaluations, while the remaining had incomplete evaluations. Setting University Hospital. Results In a total of 180 patients evaluated yearly for 5 years, decrease in BMI and FM up to 2 years was more rapid with RYGB and SG than BPD and BPD + LCL−R; with RYGB and SG both BMI and FM slightly increased in the years 3–5. At 5 years, the differences were not significant. When analysing the differences between 2 and 5 years, BPD + LCL−R showed a somewhat greater effect on BMI and FM than RYGB, BPD and SG. Superimposable results were obtained when the whole cohort of 565 patients with incomplete evaluation was considered. Conclusions All surgeries were highly effective in reducing BMI and fat mass at around 2 years; with RYGB and SG both BMI and FM slightly increased in the years 3–5, while BPD and BPD + LCL−R showed a slight further decreases in the same time interval.

Published
2021

2. Compared with Controls, Bariatric Surgery Prevents Long-Term Mortality in Persons with Obesity Only Above Median Age of Cohorts: a Systematic Review and Meta-Analysis

Author

Antonio E. Pontiroli, Valerio Ceriani, and Elena Tagliabue

Subjects
medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, MEDLINE, Bariatric Surgery, 030209 endocrinology & metabolism, Cochrane Library, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Diabetes mellitus, Diabetes Mellitus, Risk of mortality, Humans, Medicine, Obesity, Nutrition and Dietetics, business.industry, Cancer, Publication bias, medicine.disease, Obesity, Morbid, Surgery, Meta-analysis, 030211 gastroenterology & hepatology, business
Abstract

Compared to medical treatment, bariatric surgery reduces long-term mortality in persons with obesity. Some studies indicate that the effect only applies to patients above median age of cohorts, not to younger patients. Our objective was to assess the role of age in the reduction of mortality (global mortality and mortality for specific causes) through bariatric surgery. Data sources: PubMed, Cochrane Library, MEDLINE, and Embase. Study selection: studies reporting mortality in relation to median age of patients. Data extraction and synthesis: pooled random effects of estimates of the risk of mortality in participants undergoing surgery compared with controls, as function of median age. Mortality was lower in patients undergoing surgery than in controls (OR = 0.29, 95% CI 0.17–0.49). Below median age, the difference between surgery patients and controls was nonsignificant (OR = 0.78, 95% CI 0.57–1.06). Above median age, the difference was significant (OR = 0.23, 95% CI 0.12–0.44). In a subset of 5 studies, deaths due to various causes were less, and external causes-related deaths were more frequent in surgery than in controls. Below median age, deaths due to CVD were less frequent in surgery than in controls. Above median age, total deaths and deaths due to various causes (cardiovascular, diabetes, cancer, and other causes) were less in surgery than in controls. Publication bias was absent. Compared with controls, bariatric surgery reduces long-term global mortality only above median age, not below median age. Also mortality due to specific causes is mainly reduced in persons above median age.

Published
2020

3. Intranasal versus injectable glucagon for hypoglycemia in type 1 diabetes: systematic review and meta-analysis

Author

Antonio E. Pontiroli and Elena Tagliabue

Subjects
Type 1 diabetes, medicine.medical_specialty, business.industry, Endocrinology, Diabetes and Metabolism, Insulin, medicine.medical_treatment, 030209 endocrinology & metabolism, General Medicine, Odds ratio, 030204 cardiovascular system & hematology, Hypoglycemia, medicine.disease, Glucagon, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Basal (medicine), Meta-analysis, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, business
Abstract

Glucagon is used to resolve severe hypoglycemia in unconscious patients with diabetes, requiring third-party assistance. A few studies have shown that intranasal (IN) glucagon causes resolution of hypoglycemia in insulin-treated patients with type 1 (T1DM) diabetes. This systematic review and meta-analysis updates the comparison of the effectiveness of IN glucagon with injected intramuscular/subcutaneous (IM/SC) glucagon in treatment of hypoglycemia in T1DM. Controlled randomized studies were considered; eight studies, published in English, were included in a meta-analysis (random-effects model). Intervention effect (resolution of hypoglycemia) was expressed as odds ratio (OR), with 95% confidence intervals. Meta-regression was employed to correlate the effect with size of studies, age of patients, basal blood glucose levels. In a total of 467 treatments in 269 patients with IN and IM/SC glucagon, the OR IN versus IM/SC was 0.61 (CI 0.13–2.82); since four of eight studies showed 100% effectiveness, a simulation was made with 1 failure for each treatment; in this simulation analysis, the OR was 0.80 (95% CI 0.28–2.32). Heterogeneity was low and not statistically significant. Publication bias was absent, and quality of papers was high. At meta-regression, no correlation was found between the effect and number of patients in each study, age of patients, basal blood glucose levels. No study formally compared IN versus IM/SC in unconscious patients. This meta-analysis indicates that in conscious T1DM patients IN glucagon and IM/SC glucagon are equally effective in resolution of hypoglycemia.

Published
2020

4. New Fast Acting Glucagon for Recovery from Hypoglycemia, a Life-Threatening Situation: Nasal Powder and Injected Stable Solutions

Author

Lucia La Sala and Antonio E. Pontiroli

Subjects
endocrine system diseases, medicine.medical_treatment, Type 2 diabetes, Review, Subcutaneous injection, Insulin, Regular, Human, diabetic complications, Medicine, Insulin, T2D, Biology (General), Child, Spectroscopy, diabetes, dasiglucagon, General Medicine, Computer Science Applications, Chemistry, Treatment Outcome, Anesthesia, Powders, hormones, hormone substitutes, and hormone antagonists, Adult, endocrine system, Critical Care, QH301-705.5, Injections, Subcutaneous, Hypoglycemia, Glucagon, Catalysis, Inorganic Chemistry, Diabetes mellitus, Humans, Hypoglycemic Agents, stable non-aqueous injected glucagon, Physical and Theoretical Chemistry, QD1-999, Molecular Biology, Administration, Intranasal, Glycemic, business.industry, Organic Chemistry, nutritional and metabolic diseases, medicine.disease, Diabetes Mellitus, Type 1, Sulfonylurea Compounds, nasal glucagon, Diabetes Mellitus, Type 2, Metabolic control analysis, glycemic control, T1D, business
Abstract

The goal of diabetes care is to achieve and maintain good glycemic control over time, so as to prevent or delay the development of micro- and macrovascular complications in type 1 (T1D) and type 2 diabetes (T2D). However, numerous barriers hinder the achievement of this goal, first of all the frequent episodes of hypoglycemia typical in patients treated with insulin as T1D patients, or sulphonylureas as T2D patients. The prevention strategy and treatment of hypoglycemia are important for the well-being of patients with diabetes. Hypoglycemia is strongly associated with an increased risk of cardiovascular disease in diabetic patients, due probably to the release of inflammatory markers and prothrombotic effects triggered by hypoglycemia. Treatment of hypoglycemia is traditionally based on administration of carbohydrates or of glucagon via intramuscular (IM) or subcutaneous injection (SC). The injection of traditional glucagon is cumbersome, such that glucagon is an under-utilized drug. In 1983, it was shown for the first time that intranasal (IN) glucagon increases blood glucose levels in healthy volunteers, and in 1989–1992 that IN glucagon is similar to IM glucagon in resolving hypoglycemia in normal volunteers and in patients with diabetes, both adults and children. IN glucagon was developed in 2010 and continued in 2015; in 2019 IN glucagon obtained approval in the US, Canada, and Europe for severe hypoglycemia in children and adults. In the 2010s, two ready-to-use injectable formulations, a stable non-aqueous glucagon solution and the glucagon analog dasiglucagon, were developed, showing an efficacy similar to traditional glucagon, and approved in the US in 2020 and in 2021, respectively, for severe hypoglycemia in adults and in children. Fast-acting glucagon (nasal administration and injected solutions) appears to represent a major breakthrough in the treatment of severe hypoglycemia in insulin-treated patients with diabetes, both adults and children. It is anticipated that the availability of fast-acting glucagon will expand the use of glucagon, improve overall metabolic control, and prevent hypoglycemia-related complications, in particular cardiovascular complications and cognitive impairment.

Published
2021

6. Role of obesity and hypertension in the incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes

Author

Antonio E. Pontiroli and Lucia La Sala

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Databases, Factual, Endocrinology, Diabetes and Metabolism, Myocardial Ischemia, Heart failure, Risk Assessment, Cohort Studies, Diabetes mellitus, Sex Factors, Risk Factors, Internal medicine, Atrial Fibrillation, Medicine, Diseases of the circulatory (Cardiovascular) system, Humans, Prospective Studies, Obesity, Longitudinal Studies, Risk factor, Prospective cohort study, Original Investigation, Aged, Netherlands, Aged, 80 and over, Ischaemic heart disease, business.industry, Incidence, Diabetes, Age Factors, Atrial fibrillation, Middle Aged, medicine.disease, Cardiovascular disease, Prognosis, Heart Disease Risk Factors, RC666-701, Hypertension, Commentary, Female, Cardiology and Cardiovascular Medicine, business, Body mass index, Cohort study
Abstract

Background Diabetes has strongly been linked to atrial fibrillation, ischaemic heart disease and heart failure. The epidemiology of these cardiovascular diseases is changing, however, due to changes in prevalence of obesity-related conditions and preventive measures. Recent population studies on incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes are needed. Methods A dynamic longitudinal cohort study was performed using primary care databases of the Julius General Practitioners’ Network. Diabetes status was determined at baseline (1 January 2014 or upon entering the cohort) and participants were followed-up for atrial fibrillation, ischaemic heart disease and heart failure until 1 February 2019. Age and sex-specific incidence and incidence rate ratios were calculated. Results Mean follow-up was 4.2 years, 12,168 patients were included in the diabetes group, and 130,143 individuals in the background group. Incidence rate ratios, adjusted for age and sex, were 1.17 (95% confidence interval 1.06–1.30) for atrial fibrillation, 1.66 (1.55–1.83) for ischaemic heart disease, and 2.36 (2.10–2.64) for heart failure. Overall, incidence rate ratios were highest in the younger age categories, converging thereafter. Conclusion There is a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably with heart failure with a more than twice increased risk. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01313-7.

Published
2021

7. Prevalence of orthorexic traits in type 2 diabetes mellitus: at the crossroads between nutritional counseling and eating disorders

Author

Giulio Marchesini, Antonio E. Pontiroli, Marina Trento, F.D. Merlo, Riccardo C. Bonadonna, Marina Croci, Graziella Bruno, Alessandra Dei Cas, Maria Letizia Petroni, Anna Veronelli, Cecilia Invitti, Saula Vigili de Kreutzenberg, Francesca Alessandra Barbanti, Chiara D'Eusebio, Barbanti F.A., Trento M., Bruno G., Bonadonna R., Croci M., D'Eusebio C., Dei Cas A., Invitti C., Merlo F., Pontiroli A.E., Veronelli A., Vigili de Kreutzenberg S., Marchesini G., and Petroni M.L.

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Endocrinology, Diabetes and Metabolism, MEDLINE, Type 2 Diabetes Mellitus, Type 2 diabetes, General Medicine, medicine.disease, Nutritional counseling, Eating disorders, Endocrinology, Diabetes mellitus, Internal Medicine, medicine, orthorexia, type 2 diabetes mellitus, disorder eating, Type 2 diabetes, disorder eating, business
Abstract

not provided

Published
2020

8. Bariatric surgery, compared to medical treatment, reduces morbidity at all ages but does not reduce mortality in patients aged < 43 years, especially if diabetes mellitus is present: a post hoc analysis of two retrospective cohort studies

Author

Elena Tagliabue, Ahmed S. Zakaria, Franco Folli, Antonio E. Pontiroli, Annamaria Veronelli, Valerio Ceriani, Ivan Zanoni, Pontiroli, A, Ceriani, V, Tagliabue, E, Zakaria, A, Veronelli, A, Folli, F, and Zanoni, I

Subjects
Adult, Male, medicine.medical_specialty, Diabetes mellitu, Adolescent, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Disease, 030204 cardiovascular system & hematology, Logistic regression, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Diabetes mellitus, Post-hoc analysis, Diabetes Mellitus, Internal Medicine, medicine, Humans, Obesity, Retrospective Studies, Cancer, Bariatric surgery, Biliointestinal bypa, business.industry, Retrospective cohort study, General Medicine, Middle Aged, Kidney disease, medicine.disease, Cardiovascular disease, Obesity, Morbid, Surgery, ICD10, Laparoscopic gastric banding, Cohort, Female, Logistic regression analysi, Morbidity, business, Liver disease, Biliopancreatic diversion
Abstract

Background and aims: Bariatric surgery (BS) reduces long-term mortality in comparison with medical treatment of obesity. Some studies indicate that this effect is significant for patients above mean age in different cohorts, but not for younger patients. These findings raise the question whether morbid obese patients should undergo BS as soon as possible, or whether patients might undergo surgery later in their life. Methods: We performed a post hoc analysis of two studies; we evaluated surgery-related long-term mortality in: (1) the whole cohort [857 surgery patients (163 diabetes) vs. 2086 controls (512 diabetes)]; (2) patients above mean age [> 43 years, 427 surgery patients (133 diabetes) vs. 1054 controls (392 diabetes)]; (3) patients below mean age [≤ 43 years, 432 surgery patients (30 diabetes) vs. 1032 controls (120 diabetes]. Then, we analyzed age-related long-term mortality in the whole cohort, as well as in surgery patients and in controls. Finally, we analyzed incident diseases (diabetes, cardiovascular disease, and cancer) as a function of surgery versus no-surgery and of mean age. Results: Surgery patients, compared with controls receiving standard medical/dietary treatment, had reduced mortality in the whole cohort (HR = 0.45, 95% CI 0.33–0.62, p = 0.001) and in the study group aged > 43 years (HR = 0.39, 95% CI 0.28–0.56, p = 0.001), but not in the study group aged ≤ 43 years (HR = 0.87, 95% CI 0.42–1.80, p = 0.711). Reduced mortality was observed in non-diabetic and diabetic patients aged > 43 years (HR = 0.37, 95% CI 0.23–0.62, p = 0.001 and HR = 0.45, 95% CI 0.27–0.74, p = 0.002, respectively) who underwent bariatric surgery. In contrast, in patients aged ≤ 43 years, no significant protective effect of bariatric surgery appeared in non-diabetic patients (HR = 0.64, 95% CI 0.24–1.71, p = 0.371), and mortality increased, almost significantly, in diabetic patients aged < 43 years (HR = 2.87, 95% CI 0.96–8.56, p = 0.058), and even more in diabetic patients aged 33–43years; HR = 4.99, 95% CI 1.18–21.09, p = 0.029). As expected, age-related mortality was increased in the whole cohort (HR = 7.23, 95% CI 5.14–10.17, p = 0.001), in non-diabetic and diabetic controls (HR = 8.55, 95% CI 5.77–12.68, p = 0.001, and HR = 3.76, 95% CI 1.97–7.18, p = 0.001, respectively). The effect of aging was slightly reduced in surgery patients (HR = 3.76, 95% CI 1.87–7.58, p = 0.001), while it was not significant in diabetic surgery patients (HR = 0.70, 95% CI 0.26–1.90, p = 0.88), further emphasizing that diabetes per se has a strong negative effect on survival, also with concomitant bariatric surgery. In a supplementary analysis, HRs did not change when surgery and control parents were matched for the presence of diabetes. Incident diseases (cardiovascular, diabetes, and cancer) were less frequent in surgery than in control patients, irrespective of age. Conclusion: Bariatric surgery reduces long-term mortality in comparison with medical treatment when performed in patients aged > 43 years, but not in younger patients, where it is neutral or could even increase mortality; reduction in morbidity occurs at any age.

Published
2020

9. High plasma renin activity associates with obesity-related diabetes and arterial hypertension, and predicts persistent hypertension after bariatric surgery

Author

Lucia La Sala, Elena Tagliabue, Franco Folli, Elaine Vieira, and Antonio E. Pontiroli

Subjects
Blood Glucose, Male, Weight loss, Time Factors, Endocrinology, Diabetes and Metabolism, 030204 cardiovascular system & hematology, Severity of Illness Index, Plasma renin activity, Renin-Angiotensin System, chemistry.chemical_compound, 0302 clinical medicine, Renin, Glucose homeostasis, Aldosterone, Original Investigation, Diabetes, Middle Aged, Treatment Outcome, Laparoscopic gastric banding (LAGB), Hypertension, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Adult, medicine.medical_specialty, Gastroplasty, 030209 endocrinology & metabolism, HOMA index, 03 medical and health sciences, Diabetes mellitus, Renin–angiotensin system, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, Arterial Pressure, Obesity, Bariatric surgery, Ferritin, business.industry, medicine.disease, Surgery, Blood pressure, chemistry, RC666-701, Laparoscopy, business, Biomarkers
Abstract

Background Information about the renin–angiotensin–aldosterone system (RAAS) in obese individuals before and after bariatric surgery is scarce. Aim of this study was to analyze the RAAS in severely obese subjects, in relation to anthropometric and metabolic variables, with special reference to glucose tolerance. Methods 239 subjects were evaluated at baseline, and 181 one year after bariatric surgery [laparoscopic gastric banding (LAGB)]. Results At baseline, renin (plasma renin activity, PRA) was increased from normal to glucose tolerance and more in diabetes, also correlating with ferritin. After LAGB, the decrease of PRA and aldosterone was significant in hypertensive, but not in normotensive subjects, and correlatied with decrease of ferritin. PRA and glucose levels were predictive of persistent hypertension 1 year after LAGB. Conclusions These data support the role of RAAS in the pathophysiology of glucose homeostasis, and in the regulation of blood pressure in obesity. Ferritin, as a proxy of subclinical inflammation, could be another factor contributing to the cross-talk between RAAS and glucose metabolism.

Published
2021

10. Coffee, LDL-cholesterol and cardiovascular risk

Author

Lucia La Sala and Antonio E. Pontiroli

Subjects
Ldl cholesterol, medicine.medical_specialty, Nutrition and Dietetics, business.industry, Cholesterol, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), Cholesterol, LDL, Coffee, chemistry.chemical_compound, Endocrinology, chemistry, Cardiovascular Diseases, Heart Disease Risk Factors, Risk Factors, Internal medicine, Medicine, Humans, Cardiology and Cardiovascular Medicine, business
Published
2021

11. Liver alterations in anorexia nervosa are not caused by insulin resistance

Author

A. Benetti, Antonio E. Pontiroli, Alice Fanin, Emanuela Bertolini, Lucia Miele, and Alessia Giorgini

Subjects
medicine.medical_specialty, Anorexia Nervosa, 030204 cardiovascular system & hematology, Gastroenterology, Pathogenesis, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Insulin resistance, Internal medicine, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Ultrasonography, Anthropometry, medicine.diagnostic_test, business.industry, Fatty liver, Alanine Transaminase, Magnetic resonance imaging, medicine.disease, Fatty Liver, Liver, Anorexia nervosa (differential diagnoses), Emergency Medicine, Homeostatic model assessment, Insulin Resistance, Transient elastography, business
Abstract

Liver dysfunction has been widely reported in connection with anorexia nervosa (AN) but the pathogenesis of these alterations has never been fully understood despite reported theories about the presence of insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD). The aim of this study is to investigate if hypertransaminasemia in AN is linked to IR and NAFLD. Anthropometric data and laboratory exams of 34 patients and 34 controls were analyzed, including alanine-aminotransferase, aspartate-aminotransferase and homeostatic model assessment of insulin resistance (HOMA-IR) index. All subjects also underwent magnetic resonance imaging (MRI), ultrasonography (US), and transient elastography (TE). Evidence of increased alanine aminotransferase in AN patients was confirmed in our sample together with a lower HOMA-IR index compared to controls. Positive results in US appeared in 16 patients vs none in controls (p = 0.0007); patients with liver parenchyma abnormalities in US were not different than normal-US patients in any of the studied variables. Only one patient showed non-alcoholic fatty liver disease in MRI while abnormal TE was found in four patients and never in controls. Liver damage suggested by increased serum liver enzymes cannot be due to liver steatosis but potentially to a different liver disease (not identified by MRI) or to an early liver fibrosis not associated with an insulin-resistant status.

Published
2019

12. Key Points for Cholelithiasis and Gallstone Ileus Prevention Following Biliointestinal Bypass

Author

Elisa Reitano, Domenico Tringali, Antonio E. Pontiroli, Giancarlo Micheletto, Valerio Panizzo, and Guglielmo Niccolò Piozzi

Subjects
Male, medicine.medical_specialty, Malabsorption, medicine.medical_treatment, Jejunostomy, Jejunoileal bypass, Bariatric Surgery, Gallstones, 030204 cardiovascular system & hematology, Jejunum, 03 medical and health sciences, Ileus, Postoperative Complications, 0302 clinical medicine, Gallstone ileus, medicine, Humans, Risk factor, business.industry, Articles, General Medicine, Middle Aged, Surgical procedures, medicine.disease, Obesity, Morbid, Surgery, medicine.anatomical_structure, Obesity, Abdominal, 030220 oncology & carcinogenesis, business, Body mass index
Abstract

Patient: Male, 48 Final Diagnosis: Gallstone ileus in biliointestinal bypass Symptoms: Abdominal pain • jaundice • vomiting Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: Biliointestinal bypass is a malabsorptive procedure for surgical treatment of morbid obesity. It is the evolution of jejunoileal bypass, and it is characterized by a cholecysto-jejunostomy on the proximal end of the excluded jejunum, therefore, allowing bile flow through the excluded bowel loop reducing the risk of postoperative diarrhea and malabsorption syndrome. Obesity is a well-known risk factor for cholelithiasis; moreover, bariatric surgery has been showed to increases the risk of gallstones formation. Case Report: A 48-years-old male (body mass index 42 kg/m2) received a laparoscopic biliointestinal bypass. Nine years later, the patient received a cholecystotomy for removal of biliary stones. No surgical procedures were performed on the cholecysto-jejunostomy. Fourteen years after the bariatric treatment, the patient underwent enterolithotomy after a diagnosis of gallstone ileus. The impacted biliary stone was documented in the excluded loop proximal to the anti-reflux valvular system. The postoperative course and 1-year follow-up were uneventful. Conclusions: Few cases of gallstone ileus following biliointestinal bypass have been described in the literature. We report a new case and also propose few tips and tricks for cholelithiasis and gallstone ileus prevention after biliointestinal bypass.

Published
2019

13. Duodenal adipose tissue is associated with obesity in baboons (Papio sp): a novel site of ectopic fat deposition in non-human primates

Author

Natalia Schlabritz-Loutsevitch, Jaydee Foster, Márcia Cristina Ribeiro Andrade, Franco Folli, Vicki Mattern, A.E. Pontiroli, Shyamesh Kumar, Rodolfo Guardado-Mendoza, Anthony G. Comuzzie, Paolo Fiorina, Paul B. Higgins, Edward J. Dick, Gene Hubbard, Rita Paroni, Gaetano Bulfamante, Michael A. Owston, and V. Saroja Voruganti

Subjects
Leptin, medicine.medical_specialty, Duodenum, Endocrinology, Diabetes and Metabolism, Adipose tissue, 030209 endocrinology & metabolism, Intra-Abdominal Fat, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, Insulin resistance, Internal medicine, Submucosa, Internal Medicine, medicine, Animals, Obesity, Triglycerides, Adiposity, Triglyceride, Adiponectin, business.industry, General Medicine, medicine.disease, Major duodenal papilla, medicine.anatomical_structure, chemistry, Female, business, Papio
Abstract

AIMS: Ectopic fat is a recognized contributor to insulin resistance and metabolic dysfunction, while the role of fat deposition inside intestinal wall tissue remains understudied. We undertook this study to directly quantify and localize intramural fat deposition in duodenal tissue and determine its association with adiposity. METHODS: Duodenal tissues were collected from aged (21.2 ±1.3yrs, 19.5 ±3.1kg, n=39) female baboons (Papio sp.). Fasted blood was collected for metabolic profiling and abdominal circumference (AC) measurements were taken. Primary tissue samples were collected at the major duodenal papilla at necropsy: one full cross-section was processed for hematoxylin and eosin staining and evaluated; a second full cross-section was processed for direct chemical lipid analysis on which percentage duodenal fat content was calculated. RESULTS: Duodenal fat content obtained by direct tissue quantification showed considerable variability (11.95 ±6.93%) and was correlated with AC (r=0.60, p

Published
2019

14. Incidence of Diabetes Mellitus, Cardiovascular Diseases, and Cancer in Patients Undergoing Malabsorptive Surgery (Biliopancreatic Diversion and Biliointestinal Bypass) vs Medical Treatment

Author

Giuliano Sarro, Antonio E. Pontiroli, Marco Fanchini, Franco Folli, Valerio Ceriani, Italo Nosari, Giancarlo Micheletto, Chiara Osio, Anna Veronelli, Ahmed S. Zakaria, and Alessandro Giovanelli

Subjects
Adult, Male, medicine.medical_specialty, Sleeve gastrectomy, Adolescent, Eye Diseases, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Hyperlipidemias, 030209 endocrinology & metabolism, Comorbidity, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Diabetes mellitus, Weight Loss, Hyperlipidemia, Diabetes Mellitus, medicine, Humans, Aged, Retrospective Studies, Nutrition and Dietetics, business.industry, Incidence, Incidence (epidemiology), Anastomosis, Surgical, Cancer, Middle Aged, Biliopancreatic Diversion, medicine.disease, Obesity, Obesity, Morbid, Surgery, Intestines, Biliary Tract Surgical Procedures, Blood pressure, Italy, Cardiovascular Diseases, Female, 030211 gastroenterology & hepatology, Bile Ducts, business, Body mass index
Abstract

Bariatric surgeries such as gastric banding (LAGB), gastric bypass (RYGB), vertical banded gastroplasty (VBG), and sleeve gastrectomy (LSG) decrease body weight in morbid obesity, leading to the resolution of coexisting diabetes mellitus and arterial hypertension in the majority of cases as well as improvements of renal function and liver steatosis. BS (LAGB, RYGB, VBG, and LSG) also reduce incident cases of diabetes, of cardiovascular diseases, and of cancer; these therapeutic and preventive effects on comorbidities of obesity have not been analyzed for malabsorptive surgeries such as biliopancreatic diversion (BPD) or biliointestinal bypass (BIBP). The aim of this study was to analyze the incidence of comorbidities, i.e., diabetes, cardiovascular diseases, and cancer, in obese subjects undergoing BPD and BIBP, in comparison with standard medical treatment of obesity. Medical records of 1983 obese patients (body mass index (BMI) > 35 kg/m2, aged 18–65 years, undergoing surgery (n = 472, of which 111 with diabetes) or medical treatment (n = 1511, of which 422 with diabetes), during the period 1999–2008 (visit 1)) were collected; incident cases of comorbidities were ascertained through December 31, 2016. Observation period was 12.0 ± 3.48 years (mean ± SD). Compared to non-surgical patients matched for age, body mass index, and blood pressure, malabsorptive surgeries were associated with reduced new incident cases of diabetes (p = 0.001), cardiovascular diseases (p = 0.001), hyperlipidemia (p = 0.001), oculopathy (p = 0.021), and cancer (p = 0.001). The preventive effect of BS was similar in both nondiabetic and diabetic patients for cardiovascular diseases and hyperlipidemia (both p = 0.001). The preventive effect was significant in nondiabetic subjects for coronary heart disease and for cancer, not significant in diabetic subjects. Patients undergoing malabsorptive bariatric surgery show less incident cases of diabetes, cardiovascular diseases, hyperlipidemia, oculopathy, and cancer than controls receiving medical treatment.

Published
2018

15. A 9 years comparison of weight loss, disappearance of obesity, and resolution of diabetes mellitus with biliointestinal bypass and with adjustable gastric banding: experience of a collaborative network

Author

Ahmed S. Zakaria, Franco Folli, Antonio E. Pontiroli, Giancarlo Micheletto, Alessandro Saibene, and Chiara Osio

Subjects
Adult, Male, Comparative Effectiveness Research, Sleeve gastrectomy, medicine.medical_specialty, Gastric banding, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Bariatric Surgery, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Time, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Weight loss, Internal medicine, Diabetes mellitus, Outcome Assessment, Health Care, Weight Loss, Diabetes Mellitus, Internal Medicine, medicine, Humans, Postoperative Period, Biliopancreatic Diversion, Retrospective Studies, business.industry, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Obesity, Obesity, Morbid, Blood pressure, Cardiology, Female, medicine.symptom, business
Abstract

Long-term comparisons between bariatric surgical techniques have been performed for gastric bypass (RYGB), sleeve gastrectomy (LSG), and biliopancreatic diversion (BPD) vs gastric banding (LAGB), but short-term studies (6 months–4 years) have only compared biliointestinal bypass (BIBP) and LAGB. The participating institutions regularly perform both BIBP and LAGB with a common protocol, and the aim of this retrospective study was to compare long-term effects of the two procedures on body weight, on clinical and metabolic variables, and on resolution of obesity and of diabetes. All procedures performed between 01/01/1998 and 31/12/2005 were considered; 73 out of 91 patients undergoing BIBP, and 154 out of 249 patients undergoing LAGB were evaluable up to 9 years. BIBP was significantly more effective than LAGB in terms of weight loss and of resolution of obesity (BMI

Published
2018

17. Baseline Conditions and Nutritional State Upon Hospitalization are Major Risks for Mortality for Several Diseases

Author

Ahmed S. Zakaria, Antonio E. Pontiroli, Annamaria Veronelli, L. Loreggian, Filippo Giorgini, Elena Tagliabue, and Marco Fanchini

Subjects
medicine.medical_specialty, Univariate analysis, Heart disease, business.industry, Declaration, Charlson index, Disease, medicine.disease, Pneumonia, Emergency medicine, medicine, Risk factor, General hospital, business
Abstract

Background: Survival after hospital admission has been evaluated as a possible risk factor for long-term mortality in selected classes of diseases. The aim of this study was to evaluate survival after hospital admission in all patients admitted as in-patients in a general hospital of Milano, Italy. Methods: 2,580 consecutive patients admitted at Ospedale San Paolo, July1-December 31, 2012, for several classes of diseases (internal medicine, cancer, infectious diseases, trauma and surgery, pneumonia, and heart diseases) were studied; age, total diseases, type of admission, length of admission, age-adjusted Charlson index, prognostic nutritional index (PNI), and full blood count were evaluated. Results: At univariate analysis, all investigated variables, except sex and lymphocytes, were associated with death of patients. At stepwise regression analysis, Charlson index or age plus total diseases, type of admission, number of admissions, and PNI were significant risk factors in the whole sample and in the majority of classes of diseases. Conclusion: Pre-existing conditions and nutritional state represent the major risk factor for mortality in most classes of disease, and possibly influence other predictors, such as type of admission, length of stay. This suggests that the current model of hospital admission might be improved, for instance through comprehensive care at home, instead of hospital admission, or before admission. Funding Information: This study received only institutional funds from Universita degli Studi di Milano and from IRCCS Multimedica; a grant by the Italian Ministry of Health (Ministero della Salute), was issued to IRCCS Multimedica (Ricerca Corrente). Declaration of Interests: LL, FG, ASZ, MF, AV, AEP, and ET declare no conflict of interest with the content of this paper. Ethics Approval Statement: The protocol of the study was approved by the local Ethics in 2013 (original study) and in 2020 (follow-up study).

Published
2021

18. Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Author

Adrian F Hernandez, Jennifer B Green, Salim Janmohamed, Ralph B D'Agostino, Christopher B Granger, Nigel P Jones, Lawrence A Leiter, Anne E Rosenberg, Kristina N Sigmon, Matthew C Somerville, Karl M Thorpe, John J V McMurray, Stefano Del Prato, John J.V. McMurray, Ralph B. D'Agostino, Christopher B. Granger, Adrian F. Hernandez, Lawrence A. Leiter, Robert M Califf, Rury Holman, David DeMets, Matthew Riddle, Shaun Goodman, Darren McGuire, Karen Alexander, Adam Devore, Chiara Melloni, Chetan Patel, David Kong, Gerald Bloomfield, Matthew Roe, Pierluigi Tricoci, Rob Harrison, Renato Lopes, Robin Mathews, Rajendra Mehta, William Schuyler Jones, Sreekanth Vemulapalli, Thomas Povsic, Zubin Eapen, Keith Dombrowski, Brad Kolls, Dedrick Jordan, Andrew Ambrosy, Stephen Greene, Aditya Mandawat, Jay Shavadia, Lauren Cooper, Abhinav Sharma, Patricia Guimaraes, Daniel Friedman, Matt Wilson, Patricia Endsley, Tracy Gentry, Jeannie Collier, Kathleen Perez, Kourtnei James, Jennifer Roush, Connie Pope, Christina Howell, Megan Johnson, Matt Bailey, Joanna Cole, Teresa Akers, Beth Vandyne, Betsy Thomas, Jenny Rich, Susan Bartone, Gail Beaulieu, Kim Brown, Tuan Chau, Tamra Christian, Rebecca Coker, Deb Greene, Trevorlyn Haddock, Wendy Jenkins, Ghazala Haque, Marsha Marquess, Jean Pesarchick, Renee Rethaford, Allegra Stone, Firas Al Kawas, Michelle Anderson, Robert Enns, Isaac Sinay, Chantal Mathieu, Victor Yordanov, Irene Hramiak, Martin Haluzik, Søren Galatius, Bruno Guerci, Michael Nauck, Ilias Migdalis, Choon Beng Kathryn Tan, Gyozo Kocsis, Andrea Giaccari, Moon Kyu Lee, Ernesto German Cardona Muñoz, Jan Cornel, Kare Birkeland, Miguel Pinto, Louie Tirador, Martyna Olesinska-Mader, Marina Shestakova, Larry Distiller, Jose Lopez-Sendon, Bjorn Eliasson, Chern-En Chiang, Suphot Srimahachota, Boris Mankovsky, M Angelyn Bethel, Kathleen Dungan, Mikhail Kosiborod, Andres Alvarisqueta, Jorge Baldovino, Diego Besada, Pedro Calella, Maria Cecilia Cantero, Patricia Castaño, Alejandro Chertkoff, Jesus Cuadrado, Luis De Loredo, Andrea Dominguez, Maria Vanesa Español, Hernan Finkelstein, Gustavo Frechtel, Jose Fretes, Natalia Garrido Santos, Joaquin Gonzalez, Marcos Litvak, Juan Loureyro, Laura Maffei, Natacha Maldonado, Diego Mohr Gasparini, Silvia Orio, Federico Perez Manghi, Nelson Rodriguez Papini, Jorgelina Sala, Pablo Schygiel, Georgina Sposetti, Maria Ulla, Fernando Verra, Silvina Zabalua, Cesar Zaidman, Laurent Crenier, Corinne Debroye, Francis Duyck, André Scheen, Luc Van Gaal, Chris Vercammen, Velichka Damyanova, Stefan Dimitrov, Snezhina Kovacheva, Lachezar Lozanov, Viktor Margaritov, Rositsa Mihaylova-Shumkova, Antoaneta Nikolaeva, Zhasmina Stoyanova, Ronald Akhras, Yves Beaudry, Jacques Bedard, Joseph Berlingieri, Raja Chehayeb, Stephen Cheung, James Conway, Jean Cusson, Anthony Della Siega, Richard Dumas, Peter Dzongowski, Murdo Ferguson, Daniel Gaudet, Francois Grondin, Anil Gupta, Milan Gupta, Frank Halperin, Pierre-Alain Houle, Michael Jones, Simon Kouz, Christopher Kovacs, Daniel Landry, Eva Lonn, William O'Mahony, Sean Peterson, Dennis Reich, Alan Rosenbloom, Francois St-Maurice, Barna Tugwell, Saul Vizel, Vincent Woo, Tomas Brychta, Vladimir Cech, Eva Dvorakova, Tomas Edelsberger, Katarina Halciakova, Jarmila Krizova, Jiri Lastuvka, Martin Piperek, Vera Prymkova, Lea Raclavska, Elena Silhova, Robin Urbanek, Jan Vrkoc, Ulla Andersen, Jens Brønnum-Schou, Jens Hove, Jan Skov Jensen, Lars Kober, Ole Peter Kristiansen, Per Lund, Thomas Melchior, Ole Nyvad, Morten Schou, Alain Boye, Didier Cadinot, Didier Gouet, Patrick Henry, Laurence Kessler, Jean-Daniel Lalau, Catherine Petit, Jean-Francois Thuan, Christel Voinot, Julien Vouillarmet, Christoph Axthelm, Dirk Berger, Tasso Bieler, Andreas Birkenfeld, Jochen Bott, Klaus Busch, Karel Caca, Julia Chevts, Torsten Donaubauer, Rudolf Erlinger, Klaus Funke, Josef Grosskopf, Andreas Hagenow, Monika Hamann, Manfred Hartard, Peter Heymer, Wolfgang Huppertz, Gabriele Illies, Stephan Jacob, Thomas Jung, Gerd Kahrmann, Petra Kast, Monika Kellerer, Hans-Peter Kempe, Andrei Khariouzov, Gerhard Klausmann, Christiane Klein, Uwe Kleinecke-Pohl, Klaus Kleinertz, Thorsten Koch, Christine Kosch, Babette Lorra, Joerg Luedemann, Matthias Luttermann, Stephan Maxeiner, Karsten Milek, Andrea Moelle, Gerhard Neumann, Ruth Nischik, Edith Oehrig-Pohl, Georg Plassmann, Lars Pohlmeier, Felix Proepper, Stefan Regner, Werner Rieker, Ludger Rose, Holger Samer, Joachim Sauter, Frank Schaper, Clemens Schiffer, Juergen Schmidt, Bernd-M. Scholz, Joerg Schulze, Alexander Segner, Jochen Seufert, Helena Sigal, Joerg Steindorf, Juergen Stockhausen, Petra Stuebler, Heidrun Taeschner, Dietrich Tews, Diethelm Tschoepe, Karl Wilhelm, Helga Zeller-Stefan, Iakovos Avramidis, Stavros Bousboulas, Magdalini Bristianou, Georgios Dimitriadis, Moses Elisaf, Kalliopi Kotsa, Andreas Melidonis, Asimina Mitrakou, Emmanouil Pagkalos, Nikolaos Papanas, Angelos Pappas, Christos Sampanis, Nikolaos Tentolouris, Apostolos Tsapas, Glykeria Tzatzagou, Risa Ozaki, Csaba Hajdú, Eleonóra Harcsa, Laszlo Konyves, János Mucsi, Zsolt Pauker, Gizella Petró, Zsolt Plés, Katalin Revesz, Vangel Sándor, Viktor Vass, Angelo Avogaro, Massimo Boemi, Riccardo Bonadonna, Agostino Consoli, Salvatore De Cosmo, Paolo Di Bartolo, Francesco Dotta, Simona Frontoni, Marianna Galetta, Alessandra Gambineri, Carmine Gazzaruso, Francesco Giorgino, Davide Lauro, Emanuela Orsi, Giuseppe Paolisso, Gabriele Perriello, Piermarco Piatti, Antonio Pontiroli, Paola Ponzani, Angela Albarosa Rivellese, Giorgio Sesti, Giancarlo Tonolo, Roberto Trevisan, Chul Woo Ahn, Sei-Hyun Baik, Bong-Soo Cha, Choon-Hee Chung, Hak Chul Jang, Chong-Jin Kim, Hye Soon Kim, In Joo Kim, Eun Young Lee, Hyoung Woo Lee, Kwan-Woo Lee, Keon-Woong Moon, June Namgung, Kyong Soo Park, Soon Jib Yoo, Jaemyung Yu, Edmundo-Alfredo Bayram Llamas, Jose-Luis Cervantes-Escárcega, Luis Fernando Flota-Cervera, José Gerardo González-González, Sara Pascoe-Gonzalez, Emilia Susana Pelayo-Orozco, Santiago-Paulino Ramirez-Diaz, Arturo Saldana-Mendoza, Carlos Sánchez Jerjes-Díaz, Jose Juan Torres-Colores, Maricela Vidrio-Velázquez, Juan Villagordoa-Mesa, Hugo Peter Beijerbacht, Reginald G.E.J. Groutars, Boudewijn A Hoek, Pieter A.M. Hoogslag, Adriaan Kooy, Johannes A. Kragten, Aloysius G. Lieverse, Hendrik P. Swart, Eric P. Viergever, Jørn Ahlqvist, John Cooper, Hanne Gulseth, Gaute Guttormsen, Cecilie Wium, Hugo Arbañil, Jorge Calderon, Luis Camacho, Augusto Dextre Espinoza, Elizabeth Garrido, Alejandro Luna, Helard Manrique, Frederick Massucco Revoredo, Rolando Vargas Gonzales, Luis Zapata Rincon, Carlos Zubiate, Geraldine Ebo, Ellen Morales-Palomares, Malgorzata Arciszewska, Marek Banach, Renata Bijata-Bronisz, Tadeusz Derezinski, Waldemar Gadzinski, Jacek Gajek, Katarzyna Klodawska, Ewa Krzyzagorska, Andrzej Madej, Pawel Miekus, Jaroslaw Opiela, Piotr Romanczuk, Anna Siegel, Ewa Skokowska, Andrzej Stankiewicz, Teresa Stasinska, Iwona Trznadel-Morawska, Robert Witek, Sergey Aksentyev, Irina Bondar, Irina Demidova, Alexander Dreval, Olga Ershova, Gagik Galstyan, Alla Garganeeva, Nadezhda Izmozherova, Victoria Karetnikova, Marina Kharakhulakh, Aleksandr Khokhlov, Zhanna Kobalava, Olga Koshelskaya, Elena Kosmacheva, Vladimir Kostin, Natalia Koziolova, Anatoly Kuzin, Victor Lesnov, Tatyana Lysenko, Valentin Markov, Alexander Mayorov, Sergey Moiseev, Svetlana Myasoedova, Nina Petunina, Andrey Rebrov, Ludmila Ruyatkina, Julia Samoylova, Olga Sazonova, Natalia Shilkina, Nadezhda Sokolova, Olga Vasilevskaya, Nelli Verbovaya, Elena Vishneva, Sergey Vorobyev, Natalya Vorokhobina, Olga Zanozina, Elena Zhdanova, Tatyana Zykova, Lesley Burgess, Kathleen Coetzee, Saleem Dawood, Landman Lombard, Ellen Makotoko, Rajendran Moodley, Wessels Oosthuysen, Mohamed Sarvan, Carlos Calvo Gómez, Isidoro Cano Rodríguez, Almudena Castro Conde, Angel Cequier Fillat, Guillem Cuatrecasas Cambra, Fernando de Álvaro Moreno, Luis De Teresa Parreño, Javier Delgado Lista, José Ramón Domínguez Escribano, Santiago Durán García, Javier Elvira González, José María Fernández Rodríguez, Alberto Goday Arno, Ricardo Gomez Huelgas, José Ramón González Juanatey, Antonio Hernandez Mijares, Víctor Alfonso Jiménez Díaz, Esteban Jodar Gimeno, Tomás Lucas Morante, Monica Marazuela, Nieves Martell Claros, Didac Mauricio Puente, Elena Mena Ribas, Juan Francisco Merino Torres, Pedro Mezquita Raya, Andreu Nubiola Calonge, Xavier Ordoñez Sánchez, Jose Maria Pascual Izuel, Verónica Perea Castilla, Antonio Pérez Pérez, Isabel Perez Soto, Miguel Quesada Charneco, Angustias Quesada Simón, Josep Redón Mas, Antonia Rego Iraeta, Maria Rodriguez Alvarez, Irene Rodríguez Rodríguez, José Sabán Ruiz, Alfonso Soto González, Francisco Tinahones Madueno, Carlos Trescoli Serrano, Angels Ulied Armiñana, Erasmus Bachus, Katarina Berndtsson Blom, Ken Eliasson, Pekka Koskinen, Hans Larnefeldt, Cornelia Lif-Tiberg, Carina Linderfalk, Gustav Lund, Pia Lundman, Linda Moris, Åke Olsson, Staffan Salmonsson, Johan Sanmartin Berglund, Folke Sjöberg, Stefan Söderberg, Ingemar Torstensson, Jung-Fu Chen, Kai Jen Tien, Shih-Ting Tseng, Shih-Te Tu, Chih-Yuan Wang, Ji-Hung Wang, Arintaya Phrommintikul, Sukit Yamwong, Woravut Jintapakorn, Pisit Hutayanon, Nakarin Sansanayudh, Larysa Bazhan, Ivan Fushtey, Mariya Grachova, Vitaliy Katerenchuk, Vadym Korpachev, Nonna Kravchun, Oleksandr Larin, Galyna Mykhalchyshyn, Halyna Myshanych, Olga Oleksyk, Valeriia Orlenko, Nataliia Pashkovska, Nataliia Pertseva, Olena Petrosyan, Ivan Smirnov, Maryna Vlasenko, Tetiana Zlova, Myint Aye, Arun Baksi, Mathangi Balasubramani, Ronnie Beboso, Mark Blagden, Charles Bundy, Tobias Cookson, Allan Copland, Alistair Emslie-Smith, Fiona Green, Anthony Gunstone, Basil Issa, Ewart Jackson-Voyzey, Andrew Johnson, Malcolm Maclean, John McKnight, Solomon Muzulu, Ian O'Connell, Babatunde Oyesile, Catherine Patterson, Ewan Pearson, Sam Philip, Paul Smith, Usha Sukumaran, Jalal Abbas, Gaurav Aggarwala, Faiq Akhter, James Andersen, Moise Anglade, Georges Argoud, Mehrdad Ariani, Reswan Ashdji, Ladan Bakhtari, Subhash Banerjee, Andrew Bartlett, Howard Baum, Harold Bays, Richard Beasley, Renata Belfort de Aguiar, Sabrina Benjamin, Ravi Bhagwat, Anuj Bhargava, Bruce Bode, Christina Bratcher, Toby Briskin, Andrew Brockmyre, Raymond Broughton, Judith Brown, Madhusudan Budhraja, Kevin Cannon, Jewell Carr, Harold Cathcart, Arvind Cavale, Louis Chaykin, Deanna Cheung, Richard Childress, Allan Cohen, Jonathan Condit, Erin Cooksey, George Mitchell Cornett, Ira Dauber, William Davila, Luis De Armas, Julius Dean, Robert Detweiler, Ernesto Diaz, Michael Di Giovanna, Isaac Dor, Waymon Drummond, Donald Eagerton, John Earl, Charles Eaton, Howard Ellison, Neil Farris, Thomas Fiel, Anthony Firek, Brian First, Les Forgosh, William French, Winston Gandy, Ronald Garcia, Santosh Gill, Murray Gordon, Michael Guice, Siva Gummadi, Jonathan Hackenyos, Kristen Hairston, Lenita Hanson, Lindsay Harrison, Israel Hartman, John Heitner, Srini Hejeebu, Paul Hermany, Carlos Hernandez-Cassis, Horacio Hidalgo, Alexander Higgins, Hassan Ibrahim, Shahram Jacobs, David Johnson, Parag Joshi, Steven Kaster, Daniel Kellum, Christopher Kim, Ellen Kim, William Kirby, Albert Knouse, Steven Kulback, Mariananda Kumar, Tulsidas Kuruvanka, Ajay Labroo, William Lasswell, John Lentz, Thomas Lenzmeier, David Lewis, Zhaoping Li, Michael Lillestol, Raymond Little, Richard Lorraine, Cecilia McKeown-Biagas, Robert McNeill, Anand Mehta, Alan Miller, Joseph Moran, Emily Morawski, Venkatesh Nadar, Thomas O'Connor, Alberto Odio, Reginald Parker, Rajesh Patel, Lawrence Phillips, George Raad, Aref Rahman, Marina Raikhel, Ajit Raisinghani, Raj Rajan, Neda Rasouli, Frank Rauzi, Kathryn Rohr, Hal Roseman, Sergio Rovner, Fadi Saba, Richard Sachson, Alex Schabauer, Ricky Schneider, Timothy Schuchard, John Sensenbrenner, Yshay Shlesinger, Narendra Singh, Kanagaratnam Sivalingam, Larry Stonesifer, Daniel Storey, David Suh, Mohammed Tahir, Anjanette Tan, Marilyn Tan, Alain Taylon, Maitreya Thakkar, Devjit Tripathy, Gabriel Uwaifo, Amarnath Vedere, Chandra Venugopal, Anthony Vo, Michelle Welch, James Welker, Alexander White, John Willis, Alan Wynne, Shahram Yazdani, Anne Rosenberg, Lauren Price, Kristina Sigmon, Yuliya Lokhngina, Weibing Xing, Robert Overton, Murray Stewart, Janet Stead, Alistair Lindsay, Vickas Patel, Jorge Ross, Joseph Soffer, Shruti Daga, Margaret Sowell, Prashant Patel, Louisa Garvey, Jessica Ackert, Sybil Abraham, Mary Beth Sabol, Desma Altobelli, JuYoung Ha, Mangesh Kulkarni, Matthew Somerville, Drusilla Noronha, Ed Casson, Eddie Zang, Chamandeep Sandhu, Rakesh Kumar, David Chen, Lin Taft, Rajivkumar Patel, June Ye, Jennifer Shannon, Tim Wilson, Charleen Babi, Diane Miller, Karl Thorpe, Rachael Russell, Georgina Bull, Belinda Hereghty, Eva Fernandez-Salazar, Troy Longley, Jill Donaldson, Marie Jarosz, Karen Murphy, Patricia Adams, Peter Smith, Rachel James, Jackie Richards, Sangeeta Sedani, Denise Althouse, David Watson, Jamie Lorimer, Steven Lauder, Ron Schultheis, Terese Womer, Ella Wraight, Wenyan Li, Emma Price-Olsen, Anthony Watson, Aoife Kelly, Patricia McLaughlin, John Fleming, Jessica Schubert, Debra Schleiden, Tara Harris, Rahul Prakash, Jody Breneman, Sameer Deshpande, Aarti Saswadkar, Aditi Kumari, Aditi Shitut, Amruta Raorane, Anisha Karmalkar, Ankita Mhambrey, Archana Bhosale, Ashok Vaphare, Ashwini P Patil, Chaitali Khandelwal, Fayaz Shaik, Madhumitha Nadar, Mounika Karka, Neha Kadgaonkar, Nikita Gupta, Nutan Aher, Omkar Potnis, Pallavi Naicker, Rakesh Shinde, Richa Sharma, Rupali Godse, Sheetal Solanki, Shruti Sahu, Snehal Dumbre, Somesh Kumar, Suradnya Patil, Trisha Mandal, Hernandez, Adrian F, Green, Jennifer B, Janmohamed, Salim, D'Agostino, Ralph B, Granger, Christopher B, Jones, Nigel P, Leiter, Lawrence A, Rosenberg, Anne E, Sigmon, Kristina N, Somerville, Matthew C, Thorpe, Karl M, Mcmurray, John J V, Del Prato, Stefano, Mcmurray, John J. V., D'Agostino, Ralph B., Granger, Christopher B., Hernandez, Adrian F., Leiter, Lawrence A., Califf, Robert M, Holman, Rury, Demets, David, Riddle, Matthew, Goodman, Shaun, Mcguire, Darren, Alexander, Karen, Devore, Adam, Melloni, Chiara, Patel, Chetan, Kong, David, Bloomfield, Gerald, Roe, Matthew, Tricoci, Pierluigi, Harrison, Rob, Lopes, Renato, Mathews, Robin, Mehta, Rajendra, Schuyler Jones, William, Vemulapalli, Sreekanth, Povsic, Thoma, Eapen, Zubin, Dombrowski, Keith, Kolls, Brad, Jordan, Dedrick, Ambrosy, Andrew, Greene, Stephen, Mandawat, Aditya, Shavadia, Jay, Cooper, Lauren, Sharma, Abhinav, Guimaraes, Patricia, Friedman, Daniel, Wilson, Matt, Endsley, Patricia, Gentry, Tracy, Collier, Jeannie, Perez, Kathleen, James, Kourtnei, Roush, Jennifer, Pope, Connie, Howell, Christina, Johnson, Megan, Bailey, Matt, Cole, Joanna, Akers, Teresa, Vandyne, Beth, Thomas, Betsy, Rich, Jenny, Bartone, Susan, Beaulieu, Gail, Brown, Kim, Chau, Tuan, Christian, Tamra, Coker, Rebecca, Greene, Deb, Haddock, Trevorlyn, Jenkins, Wendy, Haque, Ghazala, Marquess, Marsha, Pesarchick, Jean, Rethaford, Renee, Stone, Allegra, Al Kawas, Fira, Anderson, Michelle, Enns, Robert, Sinay, Isaac, Mathieu, Chantal, Yordanov, Victor, Hramiak, Irene, Haluzik, Martin, Galatius, Søren, Guerci, Bruno, Nauck, Michael, Migdalis, Ilia, Tan, Choon Beng Kathryn, Kocsis, Gyozo, Giaccari, Andrea, Lee, Moon Kyu, Muñoz, Ernesto German Cardona, Cornel, Jan, Birkeland, Kare, Pinto, Miguel, Tirador, Louie, Olesinska-Mader, Martyna, Shestakova, Marina, Distiller, Larry, Lopez-Sendon, Jose, Eliasson, Bjorn, Chiang, Chern-En, Srimahachota, Suphot, Mankovsky, Bori, Bethel, M Angelyn, Dungan, Kathleen, Kosiborod, Mikhail, Alvarisqueta, Andre, Baldovino, Jorge, Besada, Diego, Calella, Pedro, Cantero, Maria Cecilia, Castaño, Patricia, Chertkoff, Alejandro, Cuadrado, Jesu, De Loredo, Lui, Dominguez, Andrea, Español, Maria Vanesa, Finkelstein, Hernan, Frechtel, Gustavo, Fretes, Jose, Garrido Santos, Natalia, Gonzalez, Joaquin, Litvak, Marco, Loureyro, Juan, Maffei, Laura, Maldonado, Natacha, Mohr Gasparini, Diego, Orio, Silvia, Perez Manghi, Federico, Rodriguez Papini, Nelson, Sala, Jorgelina, Schygiel, Pablo, Sposetti, Georgina, Ulla, Maria, Verra, Fernando, Zabalua, Silvina, Zaidman, Cesar, Crenier, Laurent, Debroye, Corinne, Duyck, Franci, Scheen, André, Van Gaal, Luc, Vercammen, Chri, Damyanova, Velichka, Dimitrov, Stefan, Kovacheva, Snezhina, Lozanov, Lachezar, Margaritov, Viktor, Mihaylova-Shumkova, Rositsa, Nikolaeva, Antoaneta, Stoyanova, Zhasmina, Akhras, Ronald, Beaudry, Yve, Bedard, Jacque, Berlingieri, Joseph, Chehayeb, Raja, Cheung, Stephen, Conway, Jame, Cusson, Jean, Della Siega, Anthony, Dumas, Richard, Dzongowski, Peter, Ferguson, Murdo, Gaudet, Daniel, Grondin, Francoi, Gupta, Anil, Gupta, Milan, Halperin, Frank, Houle, Pierre-Alain, Jones, Michael, Kouz, Simon, Kovacs, Christopher, Landry, Daniel, Lonn, Eva, O'Mahony, William, Peterson, Sean, Reich, Denni, Rosenbloom, Alan, St-Maurice, Francoi, Tugwell, Barna, Vizel, Saul, Woo, Vincent, Brychta, Toma, Cech, Vladimir, Dvorakova, Eva, Edelsberger, Toma, Halciakova, Katarina, Krizova, Jarmila, Lastuvka, Jiri, Piperek, Martin, Prymkova, Vera, Raclavska, Lea, Silhova, Elena, Urbanek, Robin, Vrkoc, Jan, Andersen, Ulla, Brønnum-Schou, Jen, Hove, Jen, Jensen, Jan Skov, Kober, Lar, Kristiansen, Ole Peter, Lund, Per, Melchior, Thoma, Nyvad, Ole, Schou, Morten, Boye, Alain, Cadinot, Didier, Gouet, Didier, Henry, Patrick, Kessler, Laurence, Lalau, Jean-Daniel, Petit, Catherine, Thuan, Jean-Francoi, Voinot, Christel, Vouillarmet, Julien, Axthelm, Christoph, Berger, Dirk, Bieler, Tasso, Birkenfeld, Andrea, Bott, Jochen, Busch, Klau, Caca, Karel, Chevts, Julia, Donaubauer, Torsten, Erlinger, Rudolf, Funke, Klau, Grosskopf, Josef, Hagenow, Andrea, Hamann, Monika, Hartard, Manfred, Heymer, Peter, Huppertz, Wolfgang, Illies, Gabriele, Jacob, Stephan, Jung, Thoma, Kahrmann, Gerd, Kast, Petra, Kellerer, Monika, Kempe, Hans-Peter, Khariouzov, Andrei, Klausmann, Gerhard, Klein, Christiane, Kleinecke-Pohl, Uwe, Kleinertz, Klau, Koch, Thorsten, Kosch, Christine, Lorra, Babette, Luedemann, Joerg, Luttermann, Matthia, Maxeiner, Stephan, Milek, Karsten, Moelle, Andrea, Neumann, Gerhard, Nischik, Ruth, Oehrig-Pohl, Edith, Plassmann, Georg, Pohlmeier, Lar, Proepper, Felix, Regner, Stefan, Rieker, Werner, Rose, Ludger, Samer, Holger, Sauter, Joachim, Schaper, Frank, Schiffer, Clemen, Schmidt, Juergen, Scholz, Bernd-M., Schulze, Joerg, Segner, Alexander, Seufert, Jochen, Sigal, Helena, Steindorf, Joerg, Stockhausen, Juergen, Stuebler, Petra, Taeschner, Heidrun, Tews, Dietrich, Tschoepe, Diethelm, Wilhelm, Karl, Zeller-Stefan, Helga, Avramidis, Iakovo, Bousboulas, Stavro, Bristianou, Magdalini, Dimitriadis, Georgio, Elisaf, Mose, Kotsa, Kalliopi, Melidonis, Andrea, Mitrakou, Asimina, Pagkalos, Emmanouil, Papanas, Nikolao, Pappas, Angelo, Sampanis, Christo, Tentolouris, Nikolao, Tsapas, Apostolo, Tzatzagou, Glykeria, Ozaki, Risa, Hajdú, Csaba, Harcsa, Eleonóra, Konyves, Laszlo, Mucsi, Jáno, Pauker, Zsolt, Petró, Gizella, Plés, Zsolt, Revesz, Katalin, Sándor, Vangel, Vass, Viktor, Avogaro, Angelo, Boemi, Massimo, Bonadonna, Riccardo, Consoli, Agostino, De Cosmo, Salvatore, Di Bartolo, Paolo, Dotta, Francesco, Frontoni, Simona, Galetta, Marianna, Gambineri, Alessandra, Gazzaruso, Carmine, Giorgino, Francesco, Lauro, Davide, Orsi, Emanuela, Paolisso, Giuseppe, Perriello, Gabriele, Piatti, Piermarco, Pontiroli, Antonio, Ponzani, Paola, Rivellese, Angela Albarosa, Sesti, Giorgio, Tonolo, Giancarlo, Trevisan, Roberto, Ahn, Chul Woo, Baik, Sei-Hyun, Cha, Bong-Soo, Chung, Choon-Hee, Jang, Hak Chul, Kim, Chong-Jin, Kim, Hye Soon, Kim, In Joo, Lee, Eun Young, Lee, Hyoung Woo, Lee, Kwan-Woo, Moon, Keon-Woong, Namgung, June, Park, Kyong Soo, Yoo, Soon Jib, Yu, Jaemyung, Llamas, Edmundo-Alfredo Bayram, Cervantes-Escárcega, Jose-Lui, Flota-Cervera, Luis Fernando, González-González, José Gerardo, Pascoe-Gonzalez, Sara, Pelayo-Orozco, Emilia Susana, Ramirez-Diaz, Santiago-Paulino, Saldana-Mendoza, Arturo, Jerjes-Díaz, Carlos Sánchez, Torres-Colores, Jose Juan, Vidrio-Velázquez, Maricela, Villagordoa-Mesa, Juan, Beijerbacht, Hugo Peter, Groutars, Reginald G. E. J., Hoek, Boudewijn A, Hoogslag, Pieter A. M., Kooy, Adriaan, Kragten, Johannes A., Lieverse, Aloysius G., Swart, Hendrik P., Viergever, Eric P., Ahlqvist, Jørn, Cooper, John, Gulseth, Hanne, Guttormsen, Gaute, Wium, Cecilie, Arbañil, Hugo, Calderon, Jorge, Camacho, Lui, Espinoza, Augusto Dextre, Garrido, Elizabeth, Luna, Alejandro, Manrique, Helard, Revoredo, Frederick Massucco, Gonzales, Rolando Varga, Rincon, Luis Zapata, Zubiate, Carlo, Ebo, Geraldine, Morales-Palomares, Ellen, Arciszewska, Malgorzata, Banach, Marek, Bijata-Bronisz, Renata, Derezinski, Tadeusz, Gadzinski, Waldemar, Gajek, Jacek, Klodawska, Katarzyna, Krzyzagorska, Ewa, Madej, Andrzej, Miekus, Pawel, Opiela, Jaroslaw, Romanczuk, Piotr, Siegel, Anna, Skokowska, Ewa, Stankiewicz, Andrzej, Stasinska, Teresa, Trznadel-Morawska, Iwona, Witek, Robert, Aksentyev, Sergey, Bondar, Irina, Demidova, Irina, Dreval, Alexander, Ershova, Olga, Galstyan, Gagik, Garganeeva, Alla, Izmozherova, Nadezhda, Karetnikova, Victoria, Kharakhulakh, Marina, Khokhlov, Aleksandr, 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B., Altobelli, D., Ha, J., Kulkarni, M., Noronha, D., Casson, E., Zang, E., Sandhu, C., Kumar, R., Chen, D., Taft, L., Ye, J., Shannon, J., Wilson, T., Babi, C., Miller, D., Russell, R., Bull, G., Hereghty, B., Fernandez-Salazar, E., Longley, T., Donaldson, J., Jarosz, M., Murphy, K., Adams, P., James, R., Richards, J., Sedani, S., Althouse, D., Watson, D., Lorimer, J., Lauder, S., Schultheis, R., Womer, T., Wraight, E., Li, W., Price-Olsen, E., Watson, A., Kelly, A., Mclaughlin, P., Fleming, J., Schubert, J., Schleiden, D., Harris, T., Prakash, R., Breneman, J., Deshpande, S., Saswadkar, A., Kumari, A., Shitut, A., Raorane, A., Karmalkar, A., Mhambrey, A., Bhosale, A., Vaphare, A., Patil, A. P., Khandelwal, C., Shaik, F., Nadar, M., Karka, M., Kadgaonkar, N., Gupta, N., Aher, N., Potnis, O., Naicker, P., Shinde, R., Sharma, R., Godse, R., Solanki, S., Sahu, S., Dumbre, S., Kumar, S., Patil, S., Mandal, T., Skin function and permeability, Dermatology, Hernandez, A, Green, J, Janmohamed, S, D'Agostino, R, Granger, C, Jones, N, Leiter, L, Rosenberg, A, Sigmon, K, Somerville, M, Thorpe, K, Mcmurray, J, Del Prato, S, Califf, R, Holman, R, Demets, D, Riddle, M, Goodman, S, Mcguire, D, Alexander, K, Devore, A, Melloni, C, Patel, C, Kong, D, Bloomfield, G, Roe, M, Tricoci, P, Harrison, R, Lopes, R, Mathews, R, Mehta, R, Schuyler Jones, W, Vemulapalli, S, Povsic, T, Eapen, Z, Dombrowski, K, Kolls, B, Jordan, D, Ambrosy, A, Greene, S, Mandawat, A, Shavadia, J, Cooper, L, Sharma, A, Guimaraes, P, Friedman, D, Wilson, M, Endsley, P, Gentry, T, Collier, J, Perez, K, James, K, Roush, J, Pope, C, Howell, C, Johnson, M, Bailey, M, Cole, J, Akers, T, Vandyne, B, Thomas, B, Rich, J, Bartone, S, Beaulieu, G, Brown, K, Chau, T, Christian, T, Coker, R, Greene, D, Haddock, T, Jenkins, W, Haque, G, Marquess, M, Pesarchick, J, Rethaford, R, Stone, A, Al Kawas, F, Anderson, M, Enns, R, Sinay, I, Mathieu, C, Yordanov, V, Hramiak, I, Haluzik, M, Galatius, S, Guerci, B, Nauck, M, Migdalis, I, Tan, C, Kocsis, G, Giaccari, A, Lee, M, Munoz, E, Cornel, J, Birkeland, K, Pinto, M, Tirador, L, Olesinska-Mader, M, Shestakova, M, Distiller, L, Lopez-Sendon, J, Eliasson, B, Chiang, C, Srimahachota, S, Mankovsky, B, Bethel, M, Dungan, K, Kosiborod, M, Alvarisqueta, A, Baldovino, J, Besada, D, Calella, P, Cantero, M, Castano, P, Chertkoff, A, Cuadrado, J, De Loredo, L, Dominguez, A, Espanol, M, Finkelstein, H, Frechtel, G, Fretes, J, Garrido Santos, N, Gonzalez, J, Litvak, M, Loureyro, J, Maffei, L, Maldonado, N, Mohr Gasparini, D, Orio, S, Perez Manghi, F, Rodriguez Papini, N, Sala, J, Schygiel, P, Sposetti, G, Ulla, M, Verra, F, Zabalua, S, Zaidman, C, Crenier, L, Debroye, C, Duyck, F, Scheen, A, Van Gaal, L, Vercammen, C, Damyanova, V, Dimitrov, S, Kovacheva, S, Lozanov, L, Margaritov, V, Mihaylova-Shumkova, R, Nikolaeva, A, Stoyanova, Z, Akhras, R, Beaudry, Y, Bedard, J, Berlingieri, J, Chehayeb, R, Cheung, S, Conway, J, Cusson, J, Della Siega, A, Dumas, R, Dzongowski, P, Ferguson, M, Gaudet, D, Grondin, F, Gupta, A, Gupta, M, Halperin, F, Houle, P, Jones, M, Kouz, S, Kovacs, C, Landry, D, Lonn, E, O'Mahony, W, Peterson, S, Reich, D, Rosenbloom, A, St-Maurice, F, Tugwell, B, Vizel, S, Woo, V, Brychta, T, Cech, V, Dvorakova, E, Edelsberger, T, Halciakova, K, Krizova, J, Lastuvka, J, Piperek, M, Prymkova, V, Raclavska, L, Silhova, E, Urbanek, R, Vrkoc, J, Andersen, U, Bronnum-Schou, J, Hove, J, Jensen, J, Kober, L, Kristiansen, O, Lund, P, Melchior, T, Nyvad, O, Schou, M, Boye, A, Cadinot, D, Gouet, D, Henry, P, Kessler, L, Lalau, J, Petit, C, Thuan, J, Voinot, C, Vouillarmet, J, Axthelm, C, Berger, D, Bieler, T, Birkenfeld, A, Bott, J, Busch, K, Caca, K, Chevts, J, Donaubauer, T, Erlinger, R, Funke, K, Grosskopf, J, Hagenow, A, Hamann, M, Hartard, M, Heymer, P, Huppertz, W, Illies, G, Jacob, S, Jung, T, Kahrmann, G, Kast, P, Kellerer, M, Kempe, H, Khariouzov, A, Klausmann, G, Klein, C, Kleinecke-Pohl, U, Kleinertz, K, Koch, T, Kosch, C, Lorra, B, Luedemann, J, Luttermann, M, Maxeiner, S, Milek, K, Moelle, A, Neumann, G, Nischik, R, Oehrig-Pohl, E, Plassmann, G, Pohlmeier, L, Proepper, F, Regner, S, Rieker, W, Rose, L, Samer, H, Sauter, J, Schaper, F, Schiffer, C, Schmidt, J, Scholz, B, Schulze, J, Segner, A, Seufert, J, Sigal, H, Steindorf, J, Stockhausen, J, Stuebler, P, Taeschner, H, Tews, D, Tschoepe, D, Wilhelm, K, Zeller-Stefan, H, Avramidis, I, Bousboulas, S, Bristianou, M, Dimitriadis, G, Elisaf, M, Kotsa, K, Melidonis, A, Mitrakou, A, Pagkalos, E, Papanas, N, Pappas, A, Sampanis, C, Tentolouris, N, Tsapas, A, Tzatzagou, G, Ozaki, R, Hajdu, C, Harcsa, E, Konyves, L, Mucsi, J, Pauker, Z, Petro, G, Ples, Z, Revesz, K, Sandor, V, Vass, V, Avogaro, A, Boemi, M, Bonadonna, R, Consoli, A, De Cosmo, S, Di Bartolo, P, Dotta, F, Frontoni, S, Galetta, M, Gambineri, A, Gazzaruso, C, Giorgino, F, Lauro, D, Orsi, E, Paolisso, G, Perriello, G, Piatti, P, Pontiroli, A, Ponzani, P, Rivellese, A, Sesti, G, Tonolo, G, Trevisan, R, Ahn, C, Baik, S, Cha, B, Chung, C, Jang, H, Kim, C, Kim, H, Kim, I, Lee, E, Lee, H, Lee, K, Moon, K, Namgung, J, Park, K, Yoo, S, Yu, J, Llamas, E, Cervantes-Escarcega, J, Flota-Cervera, L, Gonzalez-Gonzalez, J, Pascoe-Gonzalez, S, Pelayo-Orozco, E, Ramirez-Diaz, S, Saldana-Mendoza, A, Jerjes-Diaz, C, Torres-Colores, J, Vidrio-Velazquez, M, Villagordoa-Mesa, J, Beijerbacht, H, Groutars, R, Hoek, B, Hoogslag, P, Kooy, A, Kragten, J, Lieverse, A, Swart, H, Viergever, E, Ahlqvist, J, Cooper, J, Gulseth, H, Guttormsen, G, Wium, C, Arbanil, H, Calderon, J, Camacho, L, Espinoza, A, Garrido, E, Luna, A, Manrique, H, Revoredo, F, Gonzales, R, Rincon, L, Zubiate, C, Ebo, G, Morales-Palomares, E, Arciszewska, M, Banach, M, Bijata-Bronisz, R, Derezinski, T, Gadzinski, W, Gajek, J, Klodawska, K, Krzyzagorska, E, Madej, A, Miekus, P, Opiela, J, Romanczuk, P, Siegel, A, Skokowska, E, Stankiewicz, A, Stasinska, T, Trznadel-Morawska, I, Witek, R, Aksentyev, S, Bondar, I, Demidova, I, Dreval, A, Ershova, O, Galstyan, G, Garganeeva, A, Izmozherova, N, Karetnikova, V, Kharakhulakh, M, Khokhlov, A, Kobalava, Z, Koshelskaya, O, Kosmacheva, E, Kostin, V, Koziolova, N, Kuzin, A, Lesnov, V, Lysenko, T, Markov, V, Mayorov, A, Moiseev, S, Myasoedova, S, Petunina, N, Rebrov, A, Ruyatkina, L, Samoylova, J, Sazonova, O, Shilkina, N, Sokolova, N, Vasilevskaya, O, Verbovaya, N, Vishneva, E, Vorobyev, S, Vorokhobina, N, Zanozina, O, Zhdanova, E, Zykova, T, Burgess, L, Coetzee, K, Dawood, S, Lombard, L, Makotoko, E, Moodley, R, Oosthuysen, W, Sarvan, M, Calvo Gomez, C, Cano Rodriguez, I, Castro Conde, A, Cequier Fillat, A, Cuatrecasas Cambra, G, de Alvaro Moreno, F, De Teresa Parreno, L, Delgado Lista, J, Dominguez Escribano, J, Duran Garcia, S, Elvira Gonzalez, J, Fernandez Rodriguez, J, Goday Arno, A, Gomez Huelgas, R, Gonzalez Juanatey, J, Hernandez Mijares, A, Jimenez Diaz, V, Jodar Gimeno, E, Lucas Morante, T, Marazuela, M, Martell Claros, N, Mauricio Puente, D, Mena Ribas, E, Merino Torres, J, Mezquita Raya, P, Nubiola Calonge, A, Ordonez Sanchez, X, Pascual Izuel, J, Perea Castilla, V, Perez Perez, A, Perez Soto, I, Quesada Charneco, M, Quesada Simon, A, Redon Mas, J, Rego Iraeta, A, Rodriguez Alvarez, M, Rodriguez Rodriguez, I, Saban Ruiz, J, Soto Gonzalez, A, Tinahones Madueno, F, Trescoli Serrano, C, Ulied Arminana, A, Bachus, E, Berndtsson Blom, K, Eliasson, K, Koskinen, P, Larnefeldt, H, Lif-Tiberg, C, Linderfalk, C, Lund, G, Lundman, P, Moris, L, Olsson, A, Salmonsson, S, Sanmartin Berglund, J, Sjoberg, F, Soderberg, S, Torstensson, I, Chen, J, Tien, K, Tseng, S, Tu, S, Wang, C, Wang, J, Phrommintikul, A, Yamwong, S, Jintapakorn, W, Hutayanon, P, Sansanayudh, N, Bazhan, L, Fushtey, I, Grachova, M, Katerenchuk, V, Korpachev, V, Kravchun, N, Larin, O, Mykhalchyshyn, G, Myshanych, H, Oleksyk, O, Orlenko, V, Pashkovska, N, Pertseva, N, Petrosyan, O, Smirnov, I, Vlasenko, M, Zlova, T, Aye, M, Baksi, A, Balasubramani, M, Beboso, R, Blagden, M, Bundy, C, Cookson, T, Copland, A, Emslie-Smith, A, Green, F, Gunstone, A, Issa, B, Jackson-Voyzey, E, Johnson, A, Maclean, M, Mcknight, J, Muzulu, S, O'Connell, I, Oyesile, B, Patterson, C, Pearson, E, Philip, S, Smith, P, Sukumaran, U, Abbas, J, Aggarwala, G, Akhter, F, Andersen, J, Anglade, M, Argoud, G, Ariani, M, Ashdji, R, Bakhtari, L, Banerjee, S, Bartlett, A, Baum, H, Bays, H, Beasley, R, Belfort de Aguiar, R, Benjamin, S, Bhagwat, R, Bhargava, A, Bode, B, Bratcher, C, Briskin, T, Brockmyre, A, Broughton, R, Brown, J, Budhraja, M, Cannon, K, Carr, J, Cathcart, H, Cavale, A, Chaykin, L, Cheung, D, Childress, R, Cohen, A, Condit, J, Cooksey, E, Cornett, G, Dauber, I, Davila, W, De Armas, L, Dean, J, Detweiler, R, Diaz, E, Di Giovanna, M, Dor, I, Drummond, W, Eagerton, D, Earl, J, Eaton, C, Ellison, H, Farris, N, Fiel, T, Firek, A, First, B, Forgosh, L, French, W, Gandy, W, Garcia, R, Gill, S, Gordon, M, Guice, M, Gummadi, S, Hackenyos, J, Hairston, K, Hanson, L, Harrison, L, Hartman, I, Heitner, J, Hejeebu, S, Hermany, P, Hernandez-Cassis, C, Hidalgo, H, Higgins, A, Ibrahim, H, Jacobs, S, Johnson, D, Joshi, P, Kaster, S, Kellum, D, Kim, E, Kirby, W, Knouse, A, Kulback, S, Kumar, M, Kuruvanka, T, Labroo, A, Lasswell, W, Lentz, J, Lenzmeier, T, Lewis, D, Li, Z, Lillestol, M, Little, R, Lorraine, R, McKeown-Biagas, C, Mcneill, R, Mehta, A, Miller, A, Moran, J, Morawski, E, Nadar, V, O'Connor, T, Odio, A, Parker, R, Patel, R, Phillips, L, Raad, G, Rahman, A, Raikhel, M, Raisinghani, A, Rajan, R, Rasouli, N, Rauzi, F, Rohr, K, Roseman, H, Rovner, S, Saba, F, Sachson, R, Schabauer, A, Schneider, R, Schuchard, T, Sensenbrenner, J, Shlesinger, Y, Singh, N, Sivalingam, K, Stonesifer, L, Storey, D, Suh, D, Tahir, M, Tan, A, Tan, M, Taylon, A, Thakkar, M, Tripathy, D, Uwaifo, G, Vedere, A, Venugopal, C, Vo, A, Welch, M, Welker, J, White, A, Willis, J, Wynne, A, Yazdani, S, Price, L, Lokhngina, Y, Xing, W, Overton, R, Stewart, M, Stead, J, Lindsay, A, Patel, V, Ross, J, Soffer, J, Daga, S, Sowell, M, Patel, P, Garvey, L, Ackert, J, Abraham, S, Sabol, M, Altobelli, D, Ha, J, Kulkarni, M, Noronha, D, Casson, E, Zang, E, Sandhu, C, Kumar, R, Chen, D, Taft, L, Ye, J, Shannon, J, Wilson, T, Babi, C, Miller, D, Russell, R, Bull, G, Hereghty, B, Fernandez-Salazar, E, Longley, T, Donaldson, J, Jarosz, M, Murphy, K, Adams, P, James, R, Richards, J, Sedani, S, Althouse, D, Watson, D, Lorimer, J, Lauder, S, Schultheis, R, Womer, T, Wraight, E, Li, W, Price-Olsen, E, Watson, A, Kelly, A, Mclaughlin, P, Fleming, J, Schubert, J, Schleiden, D, Harris, T, Prakash, R, Breneman, J, Deshpande, S, Saswadkar, A, Kumari, A, Shitut, A, Raorane, A, Karmalkar, A, Mhambrey, A, Bhosale, A, Vaphare, A, Patil, A, Khandelwal, C, Shaik, F, Nadar, M, Karka, M, Kadgaonkar, N, Gupta, N, Aher, N, Potnis, O, Naicker, P, Shinde, R, Sharma, R, Godse, R, Solanki, S, Sahu, S, Dumbre, S, Kumar, S, Patil, S, and Mandal, T

Subjects
Male, Placebo-controlled study, Myocardial Infarction, alanine aminotransferase, albiglutide, bilirubin, placebo, antidiabetic agent, glucagon like peptide 1, rGLP-1 protein, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Glucagon-Like Peptide 1, Cardiovascular Disease, Medicine(all), education.field_of_study, Subcutaneous, Medicine (all), albigutide, Hazard ratio, General Medicine, Middle Aged, Albiglutide, Stroke, Treatment Outcome, Tolerability, Cardiovascular Diseases, Female, type 2 diabetes, Type 2, Human, Adult, medicine.medical_specialty, Injections, Subcutaneous, Population, 030209 endocrinology & metabolism, Placebo, Injections, Subcutaneou, Drug Administration Schedule, Injections, 03 medical and health sciences, Double-Blind Method, Internal medicine, Diabetes Mellitus, medicine, Humans, Hypoglycemic Agents, education, Aged, Diabetes Mellitus, Type 2, Hypoglycemic Agent, business.industry, Semaglutide, Settore MED/13 - ENDOCRINOLOGIA, Harmony, business
Abstract

Background: \ud Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke.\ud \ud Methods: \ud We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515.\ud \ud Findings: \ud Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p

Published
2018

19. Pre-existing diabetes is worse for SARS-CoV-2 infection; an endothelial perspective

Author

Antonio E. Pontiroli, Lucia La Sala, and Livio Luzi

Subjects
Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Endocrinology, Diabetes and Metabolism, Pneumonia, Viral, Medicine (miscellaneous), Article, Betacoronavirus, Risk Factors, Diabetes mellitus, Pandemic, Diabetes Mellitus, Humans, Medicine, Hospital Mortality, Pandemics, Pre existing diabetes, Nutrition and Dietetics, biology, SARS-CoV-2, business.industry, Perspective (graphical), COVID-19, biology.organism_classification, medicine.disease, Virology, Coronavirus Infections, business, Cardiology and Cardiovascular Medicine
Published
2020
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20. Body Mass Index and ARDS severity in patients with and without SARS-CoV-2 infection

Author

Antonio E. Pontiroli, Tommaso Pozzi, Davide Chiumello, Alessio Caccioppola, Enrico Storti, and Silvia Coppola

Subjects
Male, medicine.medical_specialty, obesity, Critical Care, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, body mass index, Overweight, Article, Internal medicine, Pandemic, C-ARDS, Medicine, Humans, In patient, Simplified Acute Physiology Score, Pandemics, Aged, Retrospective Studies, Respiratory Distress Syndrome, business.industry, SARS-CoV-2, COVID-19, Retrospective cohort study, Middle Aged, medicine.disease, Obesity, Respiratory Function Tests, Anesthesiology and Pain Medicine, Female, ARDS, medicine.symptom, business, Coronavirus Infections, Body mass index
Published
2020

22. Does microRNA Perturbation Control the Mechanisms Linking Obesity and Diabetes? Implications for Cardiovascular Risk

Author

Paola de Candia, Antonio E. Pontiroli, Silvia Garavelli, Lucia La Sala, Maurizio Crestani, Sala, L. L., Crestani, M., Garavelli, S., de Candia, P., and Pontiroli, A. E.

Subjects
0301 basic medicine, obesity, Adipose tissue, Review, Type 2 diabetes, Diabete, Bioinformatics, Antioxidants, lcsh:Chemistry, 0302 clinical medicine, Cardiovascular Disease, Insulin, T2D, lcsh:QH301-705.5, Spectroscopy, Adipogenesis, microRNA, diabetes, General Medicine, Heart Disease Risk Factor, CVD, Computer Science Applications, Adipose Tissue, Cardiovascular Diseases, Atherosclerosi, RNA Interference, Disease Susceptibility, Antioxidant, medicine.symptom, Human, cardiovascular complications, Paracrine Communication, 030209 endocrinology & metabolism, Inflammation, metabolic syndrome, Catalysis, Inorganic Chemistry, Islets of Langerhans, 03 medical and health sciences, Diabetes mellitus, medicine, Animals, Humans, Physical and Theoretical Chemistry, Molecular Biology, Adipogenesi, Animal, business.industry, Gene Expression Profiling, Cardiovascular complication, Organic Chemistry, Islets of Langerhan, medicine.disease, Obesity, MicroRNAs, 030104 developmental biology, Diabetes Mellitus, Type 2, Gene Expression Regulation, lcsh:Biology (General), lcsh:QD1-999, Heart Disease Risk Factors, inflammation, atherosclerosis, Metabolic syndrome, business
Abstract

Metabolic disorders such as obesity and type 2 diabetes (T2D) are considered the major risk factors for the development of cardiovascular diseases (CVD). Although the pathological mechanisms underlying the mutual development of obesity and T2D are difficult to define, a better understanding of the molecular aspects is of utmost importance to identify novel therapeutic targets. Recently, a class of non-coding RNAs, called microRNAs (miRNAs), are emerging as key modulators of metabolic abnormalities. There is increasing evidence supporting the role of intra- and extracellular miRNAs as determinants of the crosstalk between adipose tissues, liver, skeletal muscle and other organs, triggering the paracrine communication among different tissues. miRNAs may be considered as risk factors for CVD due to their correlation with cardiovascular events, and in particular, may be related to the most prominent risk factors. In this review, we describe the associations observed between miRNAs expression levels and the most common cardiovascular risk factors. Furthermore, we sought to depict the molecular aspect of the interplay between obesity and diabetes, investigating the role of microRNAs in the interorgan crosstalk. Finally, we discussed the fascinating hypothesis of the loss of protective factors, such as antioxidant defense systems regulated by such miRNAs.

Published
2020

23. Subcutaneous fat loss is greater than visceral fat loss with diet and exercise, weight-loss promoting drugs and bariatric surgery: a critical review and meta-analysis

Author

Alberto Morabito, Antonio E. Pontiroli, C. Merlotti, and Valerio Ceriani

Subjects
medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Bariatric Surgery, Medicine (miscellaneous), 030209 endocrinology & metabolism, Intra-Abdominal Fat, 030204 cardiovascular system & hematology, Body Mass Index, 03 medical and health sciences, Basal (phylogenetics), 0302 clinical medicine, Classification of obesity, Weight loss, Internal medicine, Weight Loss, Humans, Medicine, Obesity, Exercise physiology, Exercise, Nutrition and Dietetics, business.industry, Stomach, medicine.disease, Subcutaneous Fat, Abdominal, Diet, Surgery, Treatment Outcome, Endocrinology, medicine.anatomical_structure, Meta-analysis, Anti-Obesity Agents, medicine.symptom, Tomography, X-Ray Computed, business, Body mass index
Abstract

Aim of this review is to compare visceral and subcutaneous fat loss with all available strategies (diet and exercise, weight-loss promoting agents and bariatric surgery). Eighty-nine studies, all full papers, were analyzed to evaluate visceral and subcutaneous fat changes, measured through ultrasound, computerized tomography, magnetic resonance imaging and expressed as thickness, weight, area and volume. Studies were included in a meta-analysis (random-effects model). Intervention effect (absolute and percent changes of visceral and subcutaneous fat) was expressed as standardized mean differences, with 95% confidence intervals. Publication bias was formally assessed. The result was that subcutaneous fat was greater than visceral fat when measured as area, volume and weight, not as thickness; decrease of subcutaneous fat was greater than visceral fat when measured as area, volume and weight, not as thickness; percent decrease of visceral fat was always greater than percent decrease of subcutaneous fat, with no differences between different strategies. No intervention preferentially targets visceral fat. Basal visceral fat depots are smaller than basal subcutaneous fat depots. Visceral fat loss is linked to subcutaneous fat loss. With all strategies, percent decrease of visceral fat prevails on subcutaneous fat loss.

Published
2017

24. Bariatric surgery and diabetic retinopathy: a systematic review and meta-analysis of controlled clinical studies

Author

C. Merlotti, Valerio Ceriani, Antonio E. Pontiroli, and Alberto Morabito

Subjects
medicine.medical_specialty, business.industry, Endocrinology, Diabetes and Metabolism, Public Health, Environmental and Occupational Health, 030209 endocrinology & metabolism, Type 2 diabetes, Publication bias, Odds ratio, Diabetic retinopathy, medicine.disease, Surgery, 03 medical and health sciences, 0302 clinical medicine, Systematic review, Diabetes mellitus, Meta-analysis, medicine, 030212 general & internal medicine, business, Retinopathy
Abstract

SummaryBackground Uncontrolled studies have indicated appearance or progression of diabetic retinopathy in obese diabetic patients after bariatric surgery. The aim of this systematic review and meta-analysis was to compare the rate of appearance, as well as progression or regression of diabetic retinopathy in studies comparing medical and surgical treatment of obese type 2 diabetes. Methods and findings Intervention effect (new cases of retinopathy, and cases with any change of diabetic retinopathy score) was expressed as odds ratio (OR), with 95% confidence intervals (CIs); change of diabetic retinopathy score was expressed as standardized mean difference (SMD), with 95% CIs. Meta-analyses were performed by a random-effects model according to DerSimonian and Laird. Heterogeneity was assessed through Q and I2 statistics for each comparison, and potential sources of heterogeneity were discussed where appropriate. Appropriate methodology [preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement] was used. Seven studies were analyzed, and incident cases of retinopathy were fewer with bariatric surgery than with medical treatment; change of retinopathy score (three studies) was not different, while only two studies were available on numbers of patients showing progression or regression of retinopathy. Heterogeneity was not significant, and publication bias was not present. Conclusions Bariatric surgery seems to prevent new cases of diabetic retinopathy, but available studies are not sufficient to support progression or regression of retinopathy. Further studies are needed to draw firm conclusions on the effect of bariatric surgery on diabetic retinopathy.

Published
2017

25. Therapeutic Use of Intranasal Glucagon: Resolution of Hypoglycemia

Author

Antonio E. Pontiroli and Elena Tagliabue

Subjects
Blood Glucose, Risk, Pediatrics, medicine.medical_specialty, endocrine system, insulin, medicine.medical_treatment, 030209 endocrinology & metabolism, Review, Hypoglycemia, Glucagon, Catalysis, Inorganic Chemistry, lcsh:Chemistry, 03 medical and health sciences, Subcutaneous injection, 0302 clinical medicine, Diabetes mellitus, Animals, Humans, Medicine, 030212 general & internal medicine, Physical and Theoretical Chemistry, Molecular Biology, lcsh:QH301-705.5, Administration, Intranasal, Spectroscopy, Glycemic, Type 1 diabetes, business.industry, Insulin, intranasal, Organic Chemistry, General Medicine, medicine.disease, Computer Science Applications, Diabetes Mellitus, Type 1, Treatment Outcome, hypoglycemia, Diabetes Mellitus, Type 2, glucagon, lcsh:Biology (General), lcsh:QD1-999, diabetes mellitus, Nasal administration, business
Abstract

Episodes of hypoglycemia are frequent in patients with diabetes treated with insulin or sulphonylureas. Hypoglycemia can lead to severe acute complications, and, as such, both prevention and treatment of hypoglycemia are important for the well-being of patients with diabetes. The experience of hypoglycemia also leads to fear of hypoglycemia, that in turn can limit optimal glycemic control in patients, especially with type 1 diabetes. Treatment of hypoglycemia is still based on administration of carbohydrates (oral or parenteral according to the level of consciousness) or of glucagon (intramuscular or subcutaneous injection). In 1983, it was shown for the first time that intranasal (IN) glucagon drops (with sodium glycocholate as a promoter) increase blood glucose levels in healthy volunteers. During the following decade, several authors showed the efficacy of IN glucagon (drops, powders, and sprays) to resolve hypoglycemia in normal volunteers and in patients with diabetes, both adults and children. Only in 2010, based on evaluation of patients’ beliefs and patients’ expectations, a canadian pharmaceutical company (Locemia Solutions, Montreal, Canada) reinitiated efforts to develop glucagon for IN administration. The project has been continued by Eli Lilly, that is seeking to obtain registration in order to make IN glucagon available to insulin users (children and adolescents) worldwide. IN glucagon is as effective as injectable glucagon, and devoid of most of the technical difficulties associated with administration of injectable glucagon. IN glucagon appears to represent a major breakthrough in the treatment of severe hypoglycemia in insulin-treated patients with diabetes, both children and adults.

Published
2019

27. Discrete Element Analysis to Predict Penetration and Perforation of Concrete Targets Struck by Rigid Projectiles

Author

Laurent Daudeville, Serguei Potapov, Philippe Marin, Christophe Pontiroli, Ahmad Omar, Andria Antoniou, Laboratoire sols, solides, structures - risques [Grenoble] (3SR ), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Risques, Vulnérabilité des structures et comportement mécanique des matériaux (RV ), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Laboratoire de Mécanique des Structures Industrielles Durables (LAMSID - UMR 8193), EDF R&D (EDF R&D), EDF (EDF)-EDF (EDF)-Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), GRAMAT (DAM/GRAMAT), Direction des Applications Militaires (DAM), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), David Edward Lambert, Crystal L. Pasiliao, Benjamin Erzar, Benoit Revil-Baudard, Oana Cazacu, Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS)-EDF R&D (EDF R&D), EDF (EDF)-EDF (EDF), and Daudeville, Laurent

Subjects
Element analysis, Materials science, Projectile, business.industry, [SPI.GCIV.STRUCT] Engineering Sciences [physics]/Civil Engineering/Structures, 020101 civil engineering, 02 engineering and technology, Penetration (firestop), Structural engineering, [SPI.MECA.MEMA] Engineering Sciences [physics]/Mechanics [physics.med-ph]/Mechanics of materials [physics.class-ph], Discrete element method, Finite element method, 0201 civil engineering, 020303 mechanical engineering & transports, 0203 mechanical engineering, [SPI.MECA.STRU]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Structural mechanics [physics.class-ph], [SPI.MECA.MEMA]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Mechanics of materials [physics.class-ph], [SPI.MECA.STRU] Engineering Sciences [physics]/Mechanics [physics.med-ph]/Structural mechanics [physics.class-ph], [SPI.GCIV.STRUCT]Engineering Sciences [physics]/Civil Engineering/Structures, business, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2019

28. The Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) Study Rationale, Design, and Baseline Characteristics

Author

Abdallah J, Abdul Ghani R, Abdul Kadir K, Abdullah R, Abejuela Z, Abraham O, Abramowitz M, Abusnana S, Accini Mendoza JL, Acosta I, Agafyina A, Aggarwal N, Ahmed F, Ahuad Guerrero RA, Aiello J, Ainsworth P, Aizenberg D, Akiyama H, Akright L, Akyea-Djamson A, Alamartine E, Alappan R, Ali N, Ali Z, Alicic R, Al-Karadsheh A, Alpizar Salazar M, Alvarez Garcia P, Alvarisqueta A, Amodeo C, Andreeva V, Andreotti Turatti LA, Angelescu LM, Angelova A, Anghel V, Antic S, Aoki H, Aquitania G, Arauz-Pacheco C, Arce-Nunez E, Arcos Palma EG, Arfeen S, Arif A, Aronson R, Arutchelvam V, Asano A, Atray N, Avram RI, Awad A, Baas Cruz J, Babikova J, Badat A, Bajaj H, Baker J, Bakris G, Barbarash O, Barna O, Barnard M, Barranco E, Barrera C, Bartaskova D, Bartolacci I, Barysheva O, Behara V, Bellary S, Belo D, Bentley-Lewis R, Benusova O, Berenguer R, Berli MA, Bernardo M, Biscoveanu M, Bordonava AP, Borot S, Botsyurko V, Bowman-Stroud C, Brandon D, Bregman R, Brusco O, Buganova I, Burgos Soto M, Busch R, Busegeanu MM, Calella P, Camelo Sanches FC, Canaan Y, Canani LH, Cantero MC, Cariou B, Cartasegna LR, Castellino P, Cereto Castro F, Certow G, Chacra AR, Chae DW, Chang CT, Chang T, Che Yusof MD, Chen N, Chen Q, Cherney D, Cheung NW, Chevaile Ramos J, Chew Wong A, Chiovato L, Chizhov D, Cho YM, Christiano C, Christofides E, Chuang LM, Chuateco C, Cif A, Cigarran Guldris S, Cohen K, Cohen R, Coloma GC, Comia RS, Commendatore V, Conway J, Cook C, Cosma D, Cournoyer S, Coyne D, Crisan C, Csecsei G, Csiky B, Cuadrado J, Cuneo CA, Cunha Borges JL, Cunha Vêncio SA, Cusumano AM, da Silva Franco RJ, Daboul N, Danos P, DaRoza G, Davies E, Davies M, Davies S, Dawson A, De Cosmo S, De Nicola L, De Serres S, de Souza Portes E, Deak L, Deck K, Deepak D, Derosa G, Desouza C, Dev D, Dhillon M, DI CARLO, Alfonso, Di Cianni G, Diaz Escalante T, Dimitrov S, Distiller L, Djordjevic M, Dobronravov V, Dohnalova L, Dominguez Lopez M, Douthat WG, Dran RD, Drasnar T, Dreval A, Droste C, Dua S, Dube F, Dudar I, Dudas M, Dussol B, Dzupina A, Eder F, Egido de Los Rios J, El Kossi M, El-Shahawy M, English P, Enriquez Sosa FE, Ervin J, Esquenazi A, Evans J, Faghih M, Farias E, Faulmann G, Fauvel JP, Ferariu IE, Fernandez MF, Fernandez Fresnedo G, Fernandez Montenegro MA, Finkelstein H, Flores Lozano F, Flota Cervera L, Fraige Filho F, Fraser D, Frenk Baron P, Fretes JO, Frias J, Fuiano G, Fulop P, Fushtey I, Galan Serrano A, Galphin C, Gan S, Gan CL, Garcia NH, Garcia I, Garcia Ballesteros C, Garcia Ortiz LH, Garrido N, Gastaldi A, Gelersztein E, Geloneze Neto B, Genadieva V, Genova-Hristova G, Genovese S, Ghazi A, Giorda C, Glenny JA, Glinkina I, Godlevska O, Godoy Jorquera JG, Goldenberg R, Golovchenko O, Gomes Bastos M, Gomez O, Gomez Rangel JD, Gonzalez E, Gonzalez Dorado A, Gonzalez Martinez FJ, Gonzalez Orellana RA, Gopalakrishnan N, Gorriz JL, Gorson D, Govender V, Gracious N, Greco B, Gregar R, Greloni GC, Grineva E, Guinsburg A, Gulati R, Gunstone A, Gupta A, Gupta M, Gyrina O, Hadjadj S, Halciakova K, Hall T, Haller H, Halmagyi I, Hammoud J, Hancu N, Hanif W, Hansraj A, Hawley C, Henein S, Hermida S, Hernandez Triana E, Herrera Jimenez LE, Hershon K, Higuera Cobos JD, Hiser D, Hocking S, Hon G, Hristozov K, Hsieh CH, Hura C, Hwang SJ, Ilavska A, Irizar Santana SS, Ismail M, Jackson A, Jain D, Jamal A, Januszewicz A, Jeong IK, Jha V, Jimenez Flores F, Jodar Gimeno JE, Johnson A, Joseph F, Joshi M, Juncos LI, Jurgens J, Kajiyama S, Kaminska A, Kashine S, Kaupke C, Kawada T, Keiko Kohara S, Keitel E, Keltai K, Kendereski A, Keresztesi S, Kern E, Kerr Saraiva JF, Keshavamurthy CB, Khandwala H, Khanna R, Khitan Z, Khullar D, Kim SG, Kim YH, Kim S, Kiss K, Klein A, Klyver MI, Kodera T, Kolesnyk M, Kolmakova E, Komisarenko I, Kong Y, Kong WY, Kono H, Konyves L, Kopyt N, Korzh O, Kovar R, Kovesdy C, Koyama K, Kozloviene D, Kraft F, Krane V, Kravchun N, Krishna G, Krishnan S, Kropp JJ, Kumar A, Kumar J, Kumeda Y, Kumwenda M, Kurtz Lisboa HR, Kvitkova L, Kwon HS, Kwon MJ, Lalic K, Lalic N, Lanchiotti PV, Lastuvka J, Laviada Molina H, Lawrence M, Le Meur Y, Lee LY, Lee BW, Lee J, Lee MK, Legun O, Leiter L, Lentz J, Leon de la Fuente RA, Levin A, Lewis D, Li D, Li W, Li X, Lim SK, Lin H, Lin CC, Liss K, Liu J, Loh CL, Lombard L, Lopez Mendoza M, Lopez Tarabay C, Lorenzoni d'avila DO, Loss de Carvalho Contieri F, Lu W, Lu YC, Luna Ceballos R, M. Edwin F, MacDougall I, Macedo de Souza PA, Madej A, Madore F, Magalhaes Montenegro Junior R, Mah PM, Maheshwari H, Major L, Malberti F, Malek Marin T, Mandayam S, Mandreoli M, Manisha S, Mankovskyy B, Mannucci E, Manocha AB, Mao H, Marar I, Marasaev V, Marchetta N, Martin Del Campo Blanco B, Martinka E, Martynyuk L, Maxeiner S, Mazur S, McMahon A, Medina Farina M, Mehta B, Middleton J, Mileder M, Miyauchi S, Mizuyama K, Mkrtumyan A, Mlodawska-Choluj D, Molina de Salazar DI, Molnar M, Mookadam M, Morales Franco G, Morales Portillo C, Mordujovich J, Moreira de Brito C, Moreira Diaz JP, Moreno Loza OT, Mostovoy Y, Moustafa M, Muirhead N, Mujica Trenche S, Munar Vila MA, Munoz Torres M, Munteanu M, Mustieles Rocha C, Nagibovich G, Nam MS, Narvarte J, Nasser Hissa M, Navickas A, Nazario Sabbag ÂR, Nedogoda S, Negru D, Newman G, Ng KS, Ngcakani N, Nicholls K, Nicol P, Nieto Iglesias J, Niiya T, Nik Ahmad NNF, Nisnisan J, Nonchev B, Noronha IL, Nortje H, Nossuli AK, Nowicki M, Obialo C, Obrador Vera G, Ochodnicka Z, Oh KH, Oishi H, Olelewe S, Oliver M, Oosthuizen H, Orio SI, Orlowska-Kowalik G, Oroszlan T, Orozco Castellanos R, Orsi E, Ory I, O'Shaughnessy A, Ota S, Otreras F, Oviedo A, Packham D, Padron J, Panarotto D, Pankhaniya R, Pantoja Perez J, Paragh G, Park CY, Park SH, Pashkovska N, Patel D, Patel G, Pavon H, Pei D, Pella D, Penfornis A, Peralta Calcaneo J, Pereira MA, Pererva L, Perez Vera M, Peringat J, Pertseva T, Pesickova S, Peterfai E, Peterka K, Petrica L, Petro G, Pettis K, Pharr W, Philip S, Phillips A, Piatti P, Pichette V, Pontiroli A, Popa AR, Popenda G, Popovic-Radinovic V, Portoles Perez JM, Prasad N, Proietto J, Prozesky H, Pumprla J, Purighalla R, Quesada Simon MA, Quesada-Suarez L, Rabasa-Lhoret R, Ramirez Roca LA, Ramtoola S, Ranetti AE, Rangelov R, Ranjan R, Raskina T, Rastogi S, Ratnasingam V, Reddy J, Ren Y, Resk JH, Rewerska B, Reyes Rosano MA, Rich L, Rista L, Roberts A, Robinson M, Rodelo J, Rodriguez H, Rodriguez Papini N, Roger S, Rosas S, Rosas Guzman J, Rosivall L, Roussel R, Rucker Joerg IE, Rychlik I, Saavedra Gajardo V, Saavedra Sanchez SB, Sala J, Samoylov O, Samoylova Y, Sanchez Arenales JA, Sanchez Mijangos JH, Sanchez Polo JV, Sankaram R, Santoro D, Santos JC, Santos F, Sarin R, Saudek F, Saumell F, Saxena M, Sazonova O, Schiavi LB, Schiller A, Schuch T, Scott R, Scott D, Seeber M, Seiji Yamada S, Sekkarie M, Sensenbrenner J, Serafinceanu C, Serrano Sanson P, Sessa H, Shakeel M, Shamkhalova M, Shanik M, Shaw S, Sheu WH, Shinkov A, Shutemova E, Silva Pecoits Filho RF, Simo Canonge R, Simoes de Almeida R, Simon G, Singh B, Slompo Ramos C, Smatanova I, Smirnov I, Smith S, Smith Casabella T, Soares Felicio J, Soler Romeo MJ, Solomon R, Song W, Soto Gonzalez A, Sowinski D, Sprague A, Sree Bhushan R, Sreedhar R, Sreelatha M, Steele A, SPEDDING, Stephen John, Strzelecka A, Suchinda P, Sudhakar B, Sun J, Sun L, Surampudi P, Sussman S, Svyshchenko Y, Symonds R, Szlachcic Y, Takacs R, Takai M, Tamayo Y. Orozco J, Tan G, Tellez Chavez E, Temelkova M, Terns Riera M, Terront Lozano MA, Tesar V, Thompson M, Tibes Hachmann JC, Tinahones Madueno FJ, Tolentino M, Tomashkevych H, Tomonaga O, Topchii I, Torshizi A, Trespalacios F, Trevisan R, Trueba P, Tryshchuk N, Tseluyko V, Tsujimoto M, Tu P, Turcios Juarez E, Turner W, Twahirwa M, Ulla MR, Updegrove J, Urbanaviciene E, Valderrama Cometa L, Valdes Cepeda A, Valenzuela A, Valis M, Vallejos A, Vangel S, Vannorsdall M, Vargas Alonso RD, Varghese F, Vasas S, Vazelov E, Vejar M, Velasquez-Mieyer P, Velichkova E, Velo M, Venegas Carrillo L, Vengadasalam P, Ventrapragada S, Villagordoa Mesa J, Villarino AA, Villegas I, Visco VE, Vizir V, Vlasenko M, Vyasam RC, Wada T, Wadud K, Wahba M, Wakasugi M, Wakeling J, Wakida Y, WALKER, JOHN RICHARD, Wang G, Warren M, Wassermann A, Watanabe T, Watson E, Watts R, Weiner P, Weiner D, Welsh J, Wheeler D, Williams M, Winocour P, Woo V, Yamada M, Yanagida K, Yanase T, Yang J, Yao C, Yap YE, Ygpuara MDL, Yin A, 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d'avila, Do, Loss de Carvalho Contieri, F, Lu, W, Lu, Yc, Luna Ceballos, R, M., Edwin F, Macdougall, I, Macedo de Souza, Pa, Madej, A, Madore, F, Magalhaes Montenegro Junior, R, Mah, Pm, Maheshwari, H, Major, L, Malberti, F, Malek Marin, T, Mandayam, S, Mandreoli, M, Manisha, S, Mankovskyy, B, Mannucci, E, Manocha, Ab, Mao, H, Marar, I, Marasaev, V, Marchetta, N, Martin Del Campo Blanco, B, Martinka, E, Martynyuk, L, Maxeiner, S, Mazur, S, Mcmahon, A, Medina Farina, M, Mehta, B, Middleton, J, Mileder, M, Miyauchi, S, Mizuyama, K, Mkrtumyan, A, Mlodawska-Choluj, D, Molina de Salazar, Di, Molnar, M, Mookadam, M, Morales Franco, G, Morales Portillo, C, Mordujovich, J, Moreira de Brito, C, Moreira Diaz, Jp, Moreno Loza, Ot, Mostovoy, Y, Moustafa, M, Muirhead, N, Mujica Trenche, S, Munar Vila, Ma, Munoz Torres, M, Munteanu, M, Mustieles Rocha, C, Nagibovich, G, Nam, M, Narvarte, J, Nasser Hissa, M, Navickas, A, Nazario Sabbag, Âr, Nedogoda, S, Negru, D, Newman, G, Ng, K, Ngcakani, N, Nicholls, K, Nicol, P, Nieto Iglesias, J, Niiya, T, Nik Ahmad, Nnf, Nisnisan, J, Nonchev, B, Noronha, Il, Nortje, H, Nossuli, Ak, Nowicki, M, Obialo, C, Obrador Vera, G, Ochodnicka, Z, Oh, Kh, Oishi, H, Olelewe, S, Oliver, M, Oosthuizen, H, Orio, Si, Orlowska-Kowalik, G, Oroszlan, T, Orozco Castellanos, R, Orsi, E, Ory, I, O'Shaughnessy, A, Ota, S, Otreras, F, Oviedo, A, Packham, D, Padron, J, Panarotto, D, Pankhaniya, R, Pantoja Perez, J, Paragh, G, Park, Cy, Park, Sh, Pashkovska, N, Patel, D, Patel, G, Pavon, H, Pei, D, Pella, D, Penfornis, A, Peralta Calcaneo, J, Pereira, Ma, Pererva, L, Perez Vera, M, Peringat, J, Pertseva, T, Pesickova, S, Peterfai, E, Peterka, K, Petrica, L, Petro, G, Pettis, K, Pharr, W, Philip, S, Phillips, A, Piatti, P, Pichette, V, Pontiroli, A, Popa, Ar, Popenda, G, Popovic-Radinovic, V, Portoles Perez, Jm, Prasad, N, Proietto, J, Prozesky, H, Pumprla, J, Purighalla, R, Quesada Simon, Ma, Quesada-Suarez, L, Rabasa-Lhoret, R, Ramirez Roca, La, Ramtoola, S, Ranetti, Ae, Rangelov, R, Ranjan, R, Raskina, T, Rastogi, S, Ratnasingam, V, Reddy, J, Ren, Y, Resk, Jh, Rewerska, B, Reyes Rosano, Ma, Rich, L, Rista, L, Roberts, A, Robinson, M, Rodelo, J, Rodriguez, H, Rodriguez Papini, N, Roger, S, Rosas, S, Rosas Guzman, J, Rosivall, L, Roussel, R, Rucker Joerg, Ie, Rychlik, I, Saavedra Gajardo, V, Saavedra Sanchez, Sb, Sala, J, Samoylov, O, Samoylova, Y, Sanchez Arenales, Ja, Sanchez Mijangos, Jh, Sanchez Polo, Jv, Sankaram, R, Santoro, D, Santos, Jc, Santos, F, Sarin, R, Saudek, F, Saumell, F, Saxena, M, Sazonova, O, Schiavi, Lb, Schiller, A, Schuch, T, Scott, R, Scott, D, Seeber, M, Seiji Yamada, S, Sekkarie, M, Sensenbrenner, J, Serafinceanu, C, Serrano Sanson, P, Sessa, H, Shakeel, M, Shamkhalova, M, Shanik, M, Shaw, S, Sheu, Wh, Shinkov, A, Shutemova, E, Silva Pecoits Filho, Rf, Simo Canonge, R, Simoes de Almeida, R, Simon, G, Singh, B, Slompo Ramos, C, Smatanova, I, Smirnov, I, Smith, S, Smith Casabella, T, Soares Felicio, J, Soler Romeo, Mj, Solomon, R, Song, W, Soto Gonzalez, A, Sowinski, D, Sprague, A, Sree Bhushan, R, Sreedhar, R, Sreelatha, M, Steele, A, Spedding, Stephen John, Strzelecka, A, Suchinda, P, Sudhakar, B, Sun, J, Sun, L, Surampudi, P, Sussman, S, Svyshchenko, Y, Symonds, R, Szlachcic, Y, Takacs, R, Takai, M, Tamayo Y., Orozco J, Tan, G, Tellez Chavez, E, Temelkova, M, Terns Riera, M, Terront Lozano, Ma, Tesar, V, Thompson, M, Tibes Hachmann, Jc, Tinahones Madueno, Fj, Tolentino, M, Tomashkevych, H, Tomonaga, O, Topchii, I, Torshizi, A, Trespalacios, F, Trevisan, R, Trueba, P, Tryshchuk, N, Tseluyko, V, Tsujimoto, M, Tu, P, Turcios Juarez, E, Turner, W, Twahirwa, M, Ulla, Mr, Updegrove, J, Urbanaviciene, E, Valderrama Cometa, L, Valdes Cepeda, A, Valenzuela, A, Valis, M, Vallejos, A, Vangel, S, Vannorsdall, M, Vargas Alonso, Rd, Varghese, F, Vasas, S, Vazelov, E, Vejar, M, Velasquez-Mieyer, P, Velichkova, E, Velo, M, Venegas Carrillo, L, Vengadasalam, P, Ventrapragada, S, Villagordoa Mesa, J, Villarino, Aa, Villegas, I, Visco, Ve, Vizir, V, Vlasenko, M, Vyasam, Rc, Wada, T, Wadud, K, Wahba, M, Wakasugi, M, Wakeling, J, Wakida, Y, Walker, JOHN RICHARD, Wang, G, Warren, M, Wassermann, A, Watanabe, T, Watson, E, Watts, R, Weiner, P, Weiner, D, Welsh, J, Wheeler, D, Williams, M, Winocour, P, Woo, V, Yamada, M, Yanagida, K, Yanase, T, Yang, J, Yao, C, Yap, Ye, Ygpuara, Mdl, Yin, A, Yoiti Hayashida, C, Yoon, Kh, Young, S, Yu, X, Yumita, W, Yupanqui, H, Zaidman, Cj, Zamarripa Escobedo, R, Zanata Petry, Tb, Zanella, Mt, Zaoui, P, Zavaroni, I, Zemek, S, Zhang, H, Zhao, M, Zheng, H, Zlova, T, Zsom, M, and Zykova, T.

Subjects
medicine.medical_specialty, ALBUMINURIA, Urology, Renal function, 030209 endocrinology & metabolism, PROGRESSION, Type 2 diabetes, Diabetic nephropathy, 030204 cardiovascular system & hematology, GLOMERULAR-FILTRATION-RATE, CARDIOVASCULAR OUTCOMES, Nephropathy, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Chronic kidney disease, medicine, 03.02. Klinikai orvostan, Renal outcome, Canagliflozin, Science & Technology, ATRIAL-NATRIURETIC-PEPTIDE, IRBESARTAN, GFR DECLINE, business.industry, 1103 Clinical Sciences, KIDNEY-DISEASE, Urology & Nephrology, medicine.disease, Renal outcomes, Nephrology, COLLABORATIVE METAANALYSIS, Albuminuria, Original Report: Patient-Oriented, Translational Research, LOSARTAN, medicine.symptom, business, Life Sciences & Biomedicine, CREDENCE study investigators, medicine.drug, Kidney disease
Abstract

Background: People with diabetes and kidney disease have a high risk of cardiovascular events and progression of kidney disease. Sodium glucose co-transporter 2 inhibitors lower plasma glucose by reducing the uptake of filtered glucose in the kidney tubule, leading to increased urinary glucose excretion. They have been repeatedly shown to induce modest natriuresis and reduce HbA1c, blood pressure, weight, and albuminuria in patients with type 2 diabetes. However, the effects of these agents on kidney and cardiovascular events have not been extensively studied in patients with type 2 diabetes and established kidney disease. Methods: The Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial aims to compare the efficacy and safety of canagliflozin ­versus placebo at preventing clinically important kidney and cardiovascular outcomes in patients with diabetes and established kidney disease. CREDENCE is a randomized, double-blind, event-driven, placebo-controlled trial set in in 34 countries with a projected duration of ∼5.5 years and enrolling 4,401 adults with type 2 diabetes, estimated glomerular filtration rate ≥30 to 2, and albuminuria (urinary albumin:creatinine ratio >300 to ≤5,000 mg/g). The study has 90% power to detect a 20% reduction in the risk of the primary outcome (α = 0.05), the composite of end-stage kidney disease, doubling of serum creatinine, and renal or cardiovascular death. Conclusion: CREDENCE will provide definitive evidence about the effects of canagliflozin on renal (and cardiovascular) outcomes in patients with type 2 diabetes and established kidney disease. Trial Registration: EudraCT number: 2013-004494-28; ClinicalTrials.gov identifier: NCT02065791.

Published
2017

29. Ultra High Performance Fiber Reinforced Concrete Behavior under Static and High Velocity Impact

Author

Christophe Pontiroli, Eric Buzaud, and Benjamin Erzar

Subjects
010302 applied physics, Materials science, business.industry, Projectile, Mechanical Engineering, High velocity, 02 engineering and technology, Structural engineering, Fiber-reinforced concrete, Penetration (firestop), Plasticity, 01 natural sciences, law.invention, 020303 mechanical engineering & transports, 0203 mechanical engineering, Mechanics of Materials, law, 0103 physical sciences, Ultimate tensile strength, General Materials Science, Penetration process, Ultra high performance, business
Abstract

To evaluate the vulnerability of ultra-high performance fiber reinforced concrete (UHPFRC) infrastructure to rigid projectile penetration, CEA-Gramat has led since few years an experimental and numerical research program in collaboration with French universities. During the penetration process, concrete is subjected to extreme conditions of pressure and strain-rate. Plasticity mechanisms as well as dynamic tensile and/or shear damages are activated during the tunneling phase and the cratering of the concrete target. Each mechanism has been investigated independently at the laboratory scale and the role of steel fibers has been specially analyzed to understand their influence on the macroscopic behavior. In parallel, some improvements have been introduced into the concrete model developed by Pontiroli, Rouquand and Mazars (PRM model), especially to take into account the fibers contribution in the tensile fracture process. The capabilities of the PRM model have been illustrated by performing numerical simulations of material characterization experiments. Next step will be to assess the concrete model to simulate projectile penetration into UHPFRC concrete structures.

Published
2016

30. Shock characterization of an ultra-high strength concrete

Author

B. Erzar, E. Buzaud, and C. Pontiroli

Subjects
Materials science, business.industry, General Physics and Astronomy, 02 engineering and technology, Structural engineering, 021001 nanoscience & nanotechnology, Compression (physics), Characterization (materials science), law.invention, Shock (mechanics), 020303 mechanical engineering & transports, Compressive strength, 0203 mechanical engineering, law, Shock response spectrum, General Materials Science, Physical and Theoretical Chemistry, Hydrostatic equilibrium, 0210 nano-technology, business, High strength concrete
Abstract

Nowadays, the design of protective structures may imply ultra-high performance concretes. These materials present a compressive strength 5 times higher than standard concretes. However, few reliable data on the shock response of such materials are available in the literature. Thus, a characterization of an ultra-high strength concrete has been conducted by means of hydrostatic and triaxial tests in the quasi-static regime, and plate impact experiments for shock response. Data have been gathered up to 6 GPa and a simple modelling approach has been applied to get a reliable representation of the shock compression of this concrete.

Published
2016

31. Is blood glucose or obesity responsible for the bad prognosis of COVID-19 in obesity – diabetes?

Author

Franco Folli, Antonio E. Pontiroli, Lucia La Sala, and Davide Chiumello

Subjects
Blood Glucose, Adult, Male, 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Endocrinology, Diabetes and Metabolism, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, Comorbidity, Kaplan-Meier Estimate, Article, Diabetic Ketoacidosis, Diabetes Complications, Betacoronavirus, Young Adult, Endocrinology, Internal medicine, Diabetes mellitus, Diabetes Mellitus, Internal Medicine, Humans, Medicine, Obesity, Pandemics, Aged, Retrospective Studies, Aged, 80 and over, SARS-CoV-2, business.industry, Data Collection, COVID-19, General Medicine, Length of Stay, Middle Aged, Prognosis, medicine.disease, United Kingdom, Hospitalization, Cross-Sectional Studies, England, Female, Coronavirus Infections, business
Abstract

To describe the clinical characteristics and outcomes of hospitalized COVID-19 patients with diabetes.A retrospective cross-sectional study was conducted among patients admitted to the William Harvey Hospital in England between March 10th and May10th, 2020 with a laboratory-confirmed severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), known as COVID-19. Variation in characteristics, length of stay in hospital, diabetes status, duration of diabetes, control of diabetes, comorbidities and outcomes were examined.There were 232 COVID-19 presentations. Mean (standard deviation (SD), range) age was 70.5 (±15.7, 30-101) years, 62.5% were male, and 37.5% were having diabetes. There were 43.4% males and 27.6 females, p = 0.016, with diabetes admitted to our hospital due to COVID-19. Patients with diabetes were more likely to have longer length of stay (LOS) in hospital, 14.4 (SD ± 9.6) days, compared to the patients without diabetes, 9.8 (SD ± 17.1) days, p 0.0001. Patients with diabetic ketoacidosis (DKA) were more likely to survive (87.1%) compared to patients without DKA (50.6%), p = 0.046.Males were more likely to be admitted to hospital with COVID-19 illness than females. Hospitalized COVID-19 patients with diabetes had a longer LOS in hospital than patients without diabetes. Older age COVID-19 patients with diabetes and patients without DKA were less likely to survive compared to younger patients and patients with DKA, respectively. Further studies with large sample size are needed.

Published
2020

32. Advanced Age and Success of Bariatric Surgery

Author

Antonio E. Pontiroli, Chiara Osio, Franco Folli, and Valerio Ceriani

Subjects
medicine.medical_specialty, Nutrition and Dietetics, business.industry, Endocrinology, Diabetes and Metabolism, General surgery, MEDLINE, Bariatric Surgery, 030209 endocrinology & metabolism, medicine.disease, Obesity, Obesity, Morbid, 03 medical and health sciences, 0302 clinical medicine, Text mining, Weight loss, Weight Loss, medicine, Humans, Surgery, 030212 general & internal medicine, medicine.symptom, business, Aged
Published
2018

33. Long-term mortality in obese subjects undergoing malabsorptive surgery (biliopancreatic diversion and biliointestinal bypass) versus medical treatment

Author

Giuliano Sarro, Italo Nosari, Giancarlo Micheletto, Alberto Morabito, Marco Fanchini, Chiara Osio, Ahmed S. Zakaria, Alessandro Giovanelli, Valerio Ceriani, and Antonio E. Pontiroli

Subjects
Adult, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), Bariatric Surgery, 030209 endocrinology & metabolism, Conservative Treatment, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Diabetes mellitus, Cause of Death, Weight Loss, Medicine, Humans, 030212 general & internal medicine, Young adult, Survival rate, Biliopancreatic Diversion, Cause of death, Nutrition and Dietetics, business.industry, Middle Aged, medicine.disease, Obesity, Surgery, Obesity, Morbid, Survival Rate, Blood pressure, Health Care Surveys, Female, business, Body mass index
Abstract

Aim of this study was to analyze long-term mortality in obese patients receiving malabsorptive bariatric surgery (BS)[biliopancreatic diversion (BPD) and biliointestinal bypass (BIBP)] in comparison to medical treatment of obesity. Medical records of 1877 obese patients [body mass index (BMI) > 35 kg/m2, aged 18–65 years, undergoing BS (n = 472, 111 with diabetes) or non-surgical medical treatment (n = 1405, 385 with diabetes), during the period 1999–2008 (visit 1)] were collected; non-surgical patients were matched for age, sex, BMI, and blood pressure, and life status and causes of death were ascertained through December 2016. Survival was compared across surgery patients and non-surgical patients using Kaplan–Meier plots and Cox regression analyses. Observation period was 12.1 ± 3.41 years (mean ± SD). Compared to non-surgical patients, BS patients had reduced all-cause mortality (34/472 (7.2%) vs 181/1,405 (12.9%) patients, χ2 = 11.25, p = 0.001; HR = 0.64, 95% C.I. 0.43–0.93, p = 0.019). Cardiovascular and cancer causes of death were significantly less frequent in surgery vs no-surgery (HR = 0.26, 95% C.I. 0.09–0.72, p = 0.003; HR = 0.21, 95% C.I. 0.09–0.45, p

Published
2018

34. Numerical modeling of the elastoplastic damage behavior of dry and saturated concrete targets subjected to rigid projectile penetration

Author

Hanbing Bian, Christophe Pontiroli, Jian-Fu Shao, Yun Jia, Laboratoire de Mécanique de Lille - FRE 3723 (LML), Université de Lille, Sciences et Technologies-Centrale Lille-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Mécanique Multiphysique Multiéchelle (LaMcube), Centrale Lille-Université de Lille-Centre National de la Recherche Scientifique (CNRS), DAM Île-de-France (DAM/DIF), Direction des Applications Militaires (DAM), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Université de Lille-Centrale Lille-Centre National de la Recherche Scientifique (CNRS), Ecole Centrale de Lille-Université de Lille-Centre National de la Recherche Scientifique (CNRS), Laboratoire d'Etude des Microstructures et de Mécanique des Matériaux (LEM3), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Arts et Métiers Sciences et Technologies, HESAM Université (HESAM)-HESAM Université (HESAM), École polytechnique universitaire de Lille (Polytech Lille), GRAMAT (DAM/GRAMAT), and HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)

Subjects
Materials science, elastoplasticity, 0211 other engineering and technologies, Computational Mechanics, Numerical modeling, 02 engineering and technology, Penetration test, [SPI]Engineering Sciences [physics], 021105 building & construction, General Materials Science, Geotechnical engineering, ComputingMilieux_MISCELLANEOUS, 021101 geological & geomatics engineering, Projectile, business.industry, Numerical analysis, water saturation, Structural engineering, Penetration (firestop), Structural vulnerability, Geotechnical Engineering and Engineering Geology, [SPI.GCIV]Engineering Sciences [physics]/Civil Engineering, high confining pressure, Mechanics of Materials, mechanical behavior, concrete, pore collapse, business, Finite element code, damage, Triaxial compression
Abstract

International audience; The objective of the present paper is to present a numerical study on the penetration performance of concrete targets with 2 different water contents. Numerical analysis has been performed by using the finite element code Abaqus/Explicit, in which a coupled elastoplastic damage model has been developed for saturated/unsaturated concrete under a wide range of confining pressures. The performance of proposed model has been firstly verified by simulating the triaxial compression tests and penetration tests realized with saturated/dry concretes. Comparisons of available experimental results and numerical simulations show that the proposed model is able to reproduce satisfactorily the mechanical behavior of saturated and dry concretes. A higher failure stress and a more important pores closing are generally obtained in dry concrete samples with respect to saturated ones. Furthermore, the main observed patterns of penetration test realized with saturated concrete targets are also satisfactorily simulated by the numerical results. Therefore, the proposed model is used to numerically predict the penetration performance of dry concrete target, and the penetration performance of dry/saturated concrete target is discussed. We observe that in dry concrete target, the penetration of projectile is strongly declined, and a smaller damage zone is created. The numerical predictions and discussions can help engineers to enhance their understandings on the influence of hydraulic conditions on structural vulnerability of concrete structures subjected to near-field detonations or impacts.

Published
2018

35. More on Patients Expectations and Success with Bariatric Surgery

Author

Franco Folli, Valerio Ceriani, and Antonio E. Pontiroli

Subjects
medicine.medical_specialty, Nutrition and Dietetics, business.industry, Endocrinology, Diabetes and Metabolism, General surgery, Bariatric Surgery, 030209 endocrinology & metabolism, Obesity, Morbid, 03 medical and health sciences, 0302 clinical medicine, Text mining, Weight Loss, medicine, Humans, Surgery, 030212 general & internal medicine, business
Published
2018

36. Intranasal glucagon for hypoglycaemia in diabetic patients. An old dream is becoming reality?

Author

Antonio E. Pontiroli and Valerio Ceriani

Subjects
endocrine system, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Drug Compounding, Phosphorylcholine, 030209 endocrinology & metabolism, Type 2 diabetes, 030204 cardiovascular system & hematology, Glucagon, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Diabetes mellitus, Internal Medicine, Medicine, Humans, Hypoglycemic Agents, Insulin, Emergency Treatment, Administration, Intranasal, Emergency kits, Adjuvants, Pharmaceutic, Type 1 diabetes, business.industry, digestive, oral, and skin physiology, beta-Cyclodextrins, Common cold, medicine.disease, Hypoglycemia, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Anesthesia, Nasal administration, Powders, business, hormones, hormone substitutes, and hormone antagonists
Abstract

In 1983 it was shown that glucagon administered intranasally (IN) was absorbed through the nasal mucosa and increased blood glucose in healthy subjects. Shortly thereafter, it was shown that IN glucagon counteracts with hypoglycaemia in insulin-treated diabetic patients. In spite of this evidence, IN glucagon was not developed by any pharmaceutical company before 2010, when renewed interest led to intensive evaluation of a possible remedy for hypoglycaemia in insulin-treated diabetic adults and children. IN glucagon is now being developed as a needle-free device that delivers glucagon powder for treatment of severe hypoglycaemia; the ease of using this device stands in stark contrast to the difficulties encountered in use of the current intramuscular glucagon emergency kits. Studies have demonstrated the efficacy, safety and ease-of-use of this IN glucagon preparation, and suggest IN glucagon as a promising alternative to injectable glucagon for treating severe hypoglycaemia in children and adults who use insulin. This would meet the unmet medical need for an easily administered glucagon preparation.

Published
2018

37. High GADA titer increases the risk of insulin requirement in LADA patients: a 7-year follow-up (NIRAD study 7)

Author

Zampetti, S., Campagna, G., Tiberti, C., Songini, M., Arpi, Ml., De Simone, G., Cossu, E., Cocco, L., Osborn, J., Bosi, E., Giorgino, F., Spoletini, M., Buzzetti, R., NIRAD Study Group, Adda, G, Di Lembo, S, Aglialoro, A, Cattaneo, A, Scassi, V, Anichini, R, Arcangeli, A, Arpi, Ml, Bardini, Rg, Basciano, P, Bracaccia, M, Pistoni, S, Bracaglia, D, Borzı, V, Emanuele, V 2nd, Cannata, F, Capitano, G, Cignarelli, M, Piemontese, S, Capuano, G, Carro, S, Cazzalini, C, Cocco, L, Ciccarone, Am, Cicioni, G, Cossu, E, Sano, F, Cucinotta, D, Di Benedetto, A, De Mattia, G, Mollica, Mr, De Cosmo, S, Minenna, A, Dei Cas, A, De Simone, G, Di Berardino, P, Dotta, F, Contini, V, Franzetti, I, Frontoni, S, Gadaleta, G, Galeone, G, Magiar, Av, Garofano, Mr, Gentile, S, Guarino, G, Giansanti, R, Genovese, S, Giancaterini, A, Leotta, S, Gianni, E, Burrafato, S, Giordano, C, Gigante, A, Cicalo, A, Giorgino, F, Gnasso, A, Fiaschi, E, Grossi, G, Deverardinis, F, Ianni, L, Iovine, C, Lauro, R, Federici, M, Spallone, V, Lo Presti, A, Scarpetta, Am, Lunari, R, Manna, R, Margotta, A, Mantovani, E, Matteoli, Mc, Matteucci, E, Chiesi, F, Maran, A, Mascetti, P, Quintana, T, Mazzucca, P, Melga, P, Cordera, R, Meloncelli, I, Morano, S, Morviducci, L, Nannipieri, M, Parillo, M, Pacifico, A, Pascal, G, Papini, E, Graziano, F, Passaro, A, Pata, P, Pontiroli, Ae, Pozzilli, P, Cipolloni, L, Guglielmi, C, Puccio, L, Raffa, Lm, Richini, D, Romano, R, Rotella, C, Santantonio, G, Sbriglia, Ms, Songini, M, Cau, V, Scorsone, A, Taboga, C, Tatti, P, Turco, A, Trovati, M, Fiori, E, Vasta, M, Vitale, F, Zavaroni, D, Buzzetti, R, Bosi, E, Giaccari, A, Di Pietro, S, Suraci, C, Locatelli, M, Bazzigaluppi, E, Falorni, A, Tiberti, C, Capizzi, M, Marandola, L, and Petrone, A.

Subjects
Male, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Type 2 diabetes, Logistic regression, LADA, Settore MED/13 - Endocrinologia, Endocrinology, Insulin, Glutamate Decarboxylase, Medicine (all), Diabete di tipo 1, autoanticorpi, GADA, LADA, Titrimetry, General Medicine, Middle Aged, Diabetes and Metabolism, Titer, Female, Type 2, Type 1, Adult, Risk, medicine.medical_specialty, medicine.drug_class, autoanticorpi, Socio-culturale, GADA, Diabete di tipo 1, Internal medicine, Diabetes mellitus, Diabetes Mellitus, medicine, Humans, Hypoglycemic Agents, Aged, Autoantibodies, Case-Control Studies, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Follow-Up Studies, business.industry, Autoantibody, Case-control study, medicine.disease, Sulfonylurea, business
Abstract

ObjectiveThe aim of this study was to determine whether glutamic acid decarboxylase antibody (GADA) titer and other clinical parameters could define the risk of progression to insulin therapy in latent autoimmune diabetes in adults (LADA) patients during a 7-year follow-up.MethodsThis study involved 220 LADA and 430 type 2 diabetes subjects followed up for 7 years from the time of GADA screening to evaluate their progression toward insulin therapy. Kaplan–Meier curves and multivariate logistic regression analysis were performed to identify the markers capable of influencing this progression.ResultsDuring the follow-up, the drop out was 4% in both groups. A total of 119 (56.1%) out of 212 LADA patients required insulin during the 7 years of follow-up. The Kaplan–Meier plots showed that 74/104 (71.1%) of high GADA titer required insulin compared with 45/108 (41.6%) of low GADA titer and with 86/412 (20.9%) of type 2 diabetes (P2and IA-2ICand zinc transporter 8 (ZnT8) positivity were also shown as the markers of faster progression (PPPConclusionsHigh GADA titer, BMI ≤ 25, ZnT8 and IA-2ICpositivity and sulfonylurea treatment, in the first year from diagnosis, significantly increase the progression toward insulin requirement in LADA patients.

Published
2014

38. Glucagon for hypoglycemic episodes in insulin-treated diabetic patients: a systematic review and meta-analysis with a comparison of glucagon with dextrose and of different glucagon formulations

Author

Augusto Boido, Valerio Ceriani, and Antonio E. Pontiroli

Subjects
endocrine system, medicine.medical_specialty, Chemistry, Pharmaceutical, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Insulins, Hypoglycemia, Glucagon, Endocrinology, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Humans, Hypoglycemic Agents, Randomized Controlled Trials as Topic, business.industry, Insulin, digestive, oral, and skin physiology, General Medicine, Publication bias, Odds ratio, medicine.disease, Confidence interval, Glucose, Treatment Outcome, Meta-analysis, business, hormones, hormone substitutes, and hormone antagonists
Abstract

Glucagon is used as an emergency drug in hypoglycemia, mainly when the patient is unconscious. A few studies report on ineffectiveness of glucagon in relieving hypoglycemia. The present systematic review and meta-analysis evaluate the effectiveness of glucagon alone and in comparison with dextrose and the effectiveness of intranasal glucagon in comparison with injected glucagon. Studies were grouped into three groups: (1) reports on glucagon ineffectiveness; (2) comparison of glucagon and dextrose; (3) comparison of intranasal glucagon and injected glucagon. In groups 2 and 3, only controlled studies were included in the analysis, whether randomized or non-randomized studies. Appropriate methodology (PRISMA statement) was adhered to, and publication bias was formally assessed. Sixteen studies, published in any language as full papers, were analysed to identify predictors of ineffectiveness, and they were included in a meta-analysis (random effects model) to study the effect of different strategies. Intervention effect (number of failures) was expressed as odds ratio (OR), with 95 % confidence intervals. Failure rate ranged from 0.0 to 2.31 %, to 7.6 %, to 14.4 %, and to 59 %. Comparing glucagon and dextrose, the OR was 0.53 (0.20–1.42); comparing intranasal and intramuscular glucagon, the OR was 1.40 (0.18–10.93). Heterogeneity was low and not statistically significant. Publication bias was absent. These data indicate that ineffectiveness of glucagon is unfrequent, not different from dextrose; in addition, intranasal and injected glucagon are similarly effective. In the case of failure, a second dose can be administered.

Published
2014

39. Length of hospitalization is associated with selected biomarkers (albumin and lymphocytes) and with co-morbidities: study on 4000 patients

Author

Federico Raveglia, Alessandro Baisi, Antonio E. Pontiroli, M.P.L. Rovati, L. Loreggian, Matilde De Simone, Laura Folini, Ugo Cioffi, and Elena De Patto

Subjects
0301 basic medicine, Low albumin, medicine.medical_specialty, Multivariate analysis, Lymphocyte, Clinical Biochemistry, Length of hospitalization, Screening method, 03 medical and health sciences, Internal medicine, Medicine, Case Series, Lymphocytes, Co-morbidities, Male gender, 030109 nutrition & dietetics, business.industry, Albumin, Biochemistry (medical), Surgery, medicine.anatomical_structure, Cohort, Length of stay, Molecular Medicine, Co morbidity, business
Abstract

Background Low albumin levels and low lymphocyte counts are intra hospital conditions that exert a negative influence on prognosis, healing and length of hospitalization. The study aimed to analyze the correlation between low blood levels of albumin, low lymphocytes, and length of stay. The secondary aim was to identify other co-morbidities associated with prolonged hospital stay. Methods Retrospective pilot study was conducted by analyzing anamnestic and biochemical data, related to 4038 patients admitted to ten wards of Hospital San Paolo (Milan), collected from July 1st 2012 to December 31st 2012. A statistical analysis was carried out using the Correlation method, Multivariate Analysis and Regression. Lymphocyte count and co-morbidities were evaluated in the whole cohort, albumin levels in 1437 patients. Results In the whole sample, low albumin levels and low lymphocyte counts were directly correlated to longer hospitalizations. The stratification of the results by department and diagnosis suggests that there is a higher correlation in certain subpopulations, and albumin shows a greater correlation with length of stay than lymphocytes. Also advanced age, high platelets, type of diagnosis, male gender and emergency admission led to longer hospitalizations. Conclusions A routine check of albumin, lymphocytes and a spectrum of significant variables can provide precious information which can eventually lead to a shorter hospital stay. Knowledge of the general health status of a patient and the possibility to estimate his/her length of hospital stay are essential information for Clinical Governance, and for the improvement of internal services of hospitals on a large scale.

Published
2017

40. Revision of Biliopancreatic Diversion for Side Effects or Insufficient Weight Loss: Codification of a New Procedure

Author

Antonio E. Pontiroli, Tiziana Lodi, Ferdinando Pinna, and Valerio Ceriani

Subjects
Gastric pouch, Adult, Male, Reoperation, medicine.medical_specialty, Malabsorption, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Gastric Bypass, 030209 endocrinology & metabolism, 03 medical and health sciences, 0302 clinical medicine, Weight regain, Weight loss, Weight Loss, Medicine, Humans, Postoperative Period, Treatment Failure, Reduction (orthopedic surgery), Biliopancreatic Diversion, Aged, Retrospective Studies, Alimentary limb, Nutrition and Dietetics, business.industry, Middle Aged, medicine.disease, Surgery, Obesity, Morbid, Defecation, 030211 gastroenterology & hepatology, Female, medicine.symptom, business
Abstract

Addressing the problem of proctologic sequelae after Scopinaroʼs classical BPD, we elongated the common limb from 50 to 200 cm at the expense of the alimentary limb and simultaneously, with the aim of avoiding weight regain, reduced the gastric pouch from 500 to 40 ml. After increased experience with the new procedure, we observed a favourable tendency towards further weight loss. Thus, we subsequently extended the indication to the procedure to patients with unsatisfactory weight loss after Scopinaroʼs classical BPD (SBPD). We retrospectively reviewed our clinical experience with the new procedure. From March 2008 to December 2014, 38 patients were submitted to the revisional procedure. The indication to surgical revision was proctologic in 26 patients and unsatisfactory weight loss in 12. After the revisional procedure, a significant reduction in bowel movements per day was observed, together with a significant reduction in body weight (from preoperative 87.1 ± 21 to 69.2 ± 13.5 kg at post-operative year 1 and 68.1 ± 11.9 kg at year 5; p

Published
2017

41. Letter to the Editor: Intranasal Glucagon for Hypoglycemia

Author

Antonio E. Pontiroli

Subjects
Blood Glucose, medicine.medical_specialty, Letter to the editor, business.industry, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Hypoglycemia, Glucagon, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Humans, Insulin, Nasal administration, 030212 general & internal medicine, business, Administration, Intranasal
Published
2017

42. Chronic kidney disease in type 2 diabetes: Lessons from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study

Author

Pugliese, G, Solini, A, Bonora, E, Fondelli, C, Orsi, E, Nicolucci, A, Penno, G, RIACE Study Group, Trevisan, R, Laviola, L, De Cosmo, S, Gruden, G, Morano, S, Pugliese, F, Zerbini, G, Salvi, L, Bollanti, L, Bazuro, A, Cavallo Perin, P, Lorenzati, B, Trovati, M, Anfossi, G, Cavalot, F, Chirio, M, Martina, V, Maestroni, S, Montefusco, L, Zimbalatti, D, Pontiroli, A, Veronelli, A, Zecchini, B, Arosio, M, Dolci, A, Corsi, A, Zoppini, G, Avogaro, A, Vedovato, M, Pagnin, E, Pucci, L, Lucchesi, D, Russo, E, Garofolo, M, Dotta, Francesco, Nigi, L, Gatti, A, Buzzetti, R, Foffi, C, Cignarelli, M, Lamacchia, O, Pinnelli, S, Monaco, L, Giorgino, F, Perrini, S, Sesti, G, Andreozzi, F, Baroni, Mg, and Frau, G.

Subjects
Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), Renal function, Type 2 diabetes, urologic and male genital diseases, End stage renal disease, Coronary artery disease, Sex Factors, Albuminuria, cardiovascular disease, Chronic kidney disease, Diabetic retinopathy, eGFR, Risk Factors, Internal medicine, Prevalence, medicine, Humans, Hypoglycemic Agents, Multicenter Studies as Topic, Renal Insufficiency, Chronic, Intensive care medicine, Glycated Hemoglobin, Nutrition and Dietetics, business.industry, riace, medicine.disease, Metformin, Observational Studies as Topic, Sulfonylurea Compounds, Diabetes Mellitus, Type 2, Italy, Cardiovascular Diseases, Cohort, Female, type 2 diabetes, medicine.symptom, Cardiovascular disease, EGFR, Cardiology and Cardiovascular Medicine, business, Glomerular Filtration Rate, Kidney disease
Abstract

The Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study is an ongoing observational survey that examines the role of estimated glomerular filtration rate (eGFR) as an independent predictor of cardiovascular and renal outcomes in 15,773 Italian subjects with type 2 diabetes. The analysis of data collected at the enrollment visit provided a picture of chronic kidney disease (CKD) and its association with other complications, risk factors for cardiovascular disease (CVD) and treatments in a large contemporary cohort. Main results of this analysis were that (a) non-albuminuric renal impairment is the predominant clinical phenotype in patients, particularly women, with reduced eGFR; (b) concordance between CKD and diabetic retinopathy is low, with only a minority of patients with renal dysfunction presenting with any or advanced retinal lesions; (c) the non-albuminuric form is associated with a significant prevalence of CVD, especially at the level of the coronary vascular bed; (d) CKD is associated with hemoglobin (Hb) A1c variability more than with average HbA1c, whereas retinopathy and CVD are not; (e) in elderly individuals with moderate-to-severe eGFR reduction, use of agents which are not recommended, such as sulphonylureas and metformin, is still frequent; and (f) though complications are generally more prevalent in men (except non-albuminuric renal impairment) women show a less favorable CVD risk profile and achieve therapeutic targets to a lesser extent than men, despite the fact that treatment intensity is not lower. These data update existing information on the natural history of CKD in patients with type 2 diabetes.

Published
2014

43. Clinical and Metabolic Effects of Biliopancreatic Diversion Persist After Reduction of the Gastric Pouch and Elongation of the Common Alimentary Tract. Preliminary Report in a Series of Patients with a 10-Year Follow-Up

Author

Ferdinando Pinna, Antonio E. Pontiroli, Valerio Ceriani, Tiziana Lodi, and Francesco Cetta

Subjects
Adult, Male, Reoperation, medicine.medical_specialty, Malabsorption, Endocrinology, Diabetes and Metabolism, Renal function, Nutritional Status, 030209 endocrinology & metabolism, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Postoperative Complications, Diabetes mellitus, mental disorders, Weight Loss, medicine, Humans, Vitamin B12, Biliopancreatic Diversion, Creatinine, Nutrition and Dietetics, business.industry, Stomach, Middle Aged, medicine.disease, Surgery, Nutrition Disorders, Obesity, Morbid, Malnutrition, medicine.anatomical_structure, chemistry, Italy, 030211 gastroenterology & hepatology, Female, business, Follow-Up Studies
Abstract

Biliopancreatic diversion (BPD) is a bariatric technique burdened, in some instances, by clinical evidence of malabsorption and malnutrition, and by intractable diarrhea. The objective of this study was to assess metabolic and nutritional effects on patients undergoing BPD and BPD plus revisional surgery because of side effects. Thirty-five consecutive BPD patients underwent revisional surgery (elongation of the common limb from 50 to 200 cm and reduction of the gastric pouch from 500 to 40 ml) after a median 48-month period [48.3 ± 9.17 months (mean ± SD)] and were observed for a total period of 116.2 ± 6.21 months; 88 patients only undergoing BPD (controls) were observed for 120 months. Revisional surgery significantly improved side effects of BPD, with resolution of clinical symptoms in most instances. After revisional surgery, patients had a further decrease of body weight. The effect on disappearance of diabetes mellitus (DM) was remarkable, with no difference between revisional surgery and BPD. Triglycerides and transaminases decreased in a similar way, while cholesterol levels differed significantly. Estimated glomerular filtration rate improved. Nutritional parameters were similarly affected. This study suggests that it is possible to maintain the clinical and metabolic effects of BPD after a revisional procedure that leads to lesser malabsorption and to a greater restriction of the stomach. In particular, the positive effects on DM still persist after revisional surgery. This approach should be kept in mind in the presence of significant side effects due, inter alia, to excessive malabsorption.

Published
2016

44. Liver steatosis (LS) evaluated through chemical-shift magnetic resonance imaging liver enzymes in morbid obesity; effect of weight loss obtained with intragastric balloon gastric banding

Author

Annamaria Veronelli, Marco Cappelletti, Giancarlo Micheletto, Antonio E. Pontiroli, Carlo Pozzato, Laura Folini, A. Benetti, and Enzo Masci

Subjects
Adult, Male, medicine.medical_specialty, Waist, Adolescent, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Bariatric Surgery, digestive system, Young Adult, chemistry.chemical_compound, Endocrinology, Insulin resistance, Weight loss, Diabetes mellitus, Internal medicine, Weight Loss, Internal Medicine, Humans, Insulin, Medicine, Aspartate Aminotransferases, Aged, Gastric Balloon, business.industry, Alanine Transaminase, gamma-Glutamyltransferase, General Medicine, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Obesity, digestive system diseases, Obesity, Morbid, Fatty Liver, Radiography, Treatment Outcome, Liver, Basal (medicine), chemistry, Female, Glycated hemoglobin, medicine.symptom, business
Abstract

The aim of this study was to evaluate in morbid obesity clinical and metabolic effects related to weight loss on liver steatosis (LS), measured through chemical-shift magnetic resonance imaging (MRI) and liver enzymes. Forty obese subjects (8 M/32 W; BMI 42.8 ± 7.12 kg/m(2), mean ± SD) were evaluated for LS through ultrasound (US-LS), chemical-shift MRI (MRI-LS), liver enzymes [aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyltransferase (GGT), alkaline phosphatase (ALP)], anthropometric parameters [weight, BMI, waist circumference (WC)], lipids, insulin, insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), oral glucose tolerance test, and body composition [fat mass (FM) and fat-free mass (FFM) at bio-impedance analysis (BIA)]. Anthropometric measures, MRI-LS, BIA, and biochemical parameters were reevaluated 6 months later in 18 subjects undergoing restrictive bariatric approach, i.e., intragastric balloon (BIB, n = 13) or gastric banding (LAGB, n = 5), and in 13 subjects receiving hypocaloric diet. At baseline, US-LS correlates only with MRI-LS, and the latter correlates with ALT, AST, and GGT. After 6 months, subjects undergoing BIB or LAGB had significant changes of BMI, weight, WC, ALT, AST, GGT, ALP, HbA1c, insulin, HOMA-IR, FM, FFM, and MRI-LS. Diet-treated obese subjects had no significant change of any parameter under study; change of BMI, fat mass, and fat-free mass was significantly greater in LAGB/BIB subjects than in diet-treated subjects. Change of MRI-LS showed a significant correlation with changes in weight, BMI, WC, GGT, ALP, and basal MRI-LS. Significant weight loss after BIB or LAGB is associated with decrease in chemical-shift MRI-LS and with reduction in liver enzymes; chemical-shift MRI and liver enzymes allow monitoring of LS in follow-up studies.

Published
2013

45. Hypertriglyceridemia Is Independently Associated with Renal, but Not Retinal Complications in Subjects with Type 2 Diabetes: A Cross-Sectional Analysis of the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study

Author

Giuseppe Penno, Anna Solini, Giacomo Zoppini, Cecilia Fondelli, Roberto Trevisan, Monica Vedovato, Gabriella Gruden, Olga Lamacchia, Antonio E Pontiroli, Maura Arosio, Emanuela Orsi, Giuseppe Pugliese, Renal Insufficiency And Cardiovascular Events (RIACE) Study Group, Penno, G, Solini, A, Zoppini, G, Fondelli, C, Trevisan, R, Vedovato, M, Gruden, G, Lamacchia, O, Pontiroli, A, Arosio, M, Orsi, E, and Pugliese, G

Subjects
Male, Genetics and Molecular Biology (all), Complications, lcsh:Medicine, Type 2 diabetes, urologic and male genital diseases, Gastroenterology, Biochemistry, hydroxymethylglutaryl coenzyme A reductase inhibitor, Odds Ratio, Diabetic Nephropathies, Renal Insufficiency, lcsh:Science, Hypertriglyceridemia, Multidisciplinary, Medicine (all), creatinine, Italy, Female, medicine.symptom, triacylglycerol, Retinopathy, Glomerular Filtration Rate, Research Article, medicine.medical_specialty, Statin, medicine.drug_class, Renal function, Diabetes mellitus, Internal medicine, medicine, Albuminuria, Humans, Agricultural and Biological Sciences (all), Biochemistry, Genetics and Molecular Biology (all), Renal Insufficiency, Chronic, business.industry, lcsh:R, medicine.disease, Hypertriglyceridemia, Complications, Type 2 Diabetes, Endocrinology, Cross-Sectional Studies, Diabetes Mellitus, Type 2, albumin excretion rate, type 2 diabetes, chronic kidney disease, egfr, diabetic retinopathy, Type 2 Diabetes, creatinine, triacylglycerol, albuminuria, lcsh:Q, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business, Kidney disease
Abstract

Objective Atherogenic dyslipidemia seems to play a major role in microvascular complications and in residual microvascular risk after statin therapy, which reduces triglycerides up to 40%. We assessed whether raised TG levels are associated with an increased burden from microvascular complications in patients with type 2 diabetes. Methods Subjects from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study (n=15,773) were divided in 4 groups depending on whether they had plasma triglycerides below (NTG, 67.8%) or above (HTG, 32.2%) 1.7 mmol/L and were (42.4%) or not on (57.6%) statin therapy. Estimated GFR (eGFR) was calculated from serum creatinine, albuminuria was measured by immunonephelometry or immunoturbidimetry, and retinopathy was evaluated by fundus examination. Results HTG subjects, either with or without statin, had higher prevalence of albuminuria, reduced eGFR and chronic kidney disease (CKD), especially the albuminuric forms, but not of retinopathy, than NTG subjects. In contrast, cardiovascular disease and advanced DR were more prevalent in subjects on statin than in those not, independently of triglyceride levels. Logistic regression analysis confirmed that HTG, without or with statin, was independently associated with micro and macroalbuminuria, mildly to severely reduced eGFR, and all CKD phenotypes, but not with retinopathy. The adjusted odd ratios for CKD increased linearly for every 0.26 mmol/L increase (approximately one decile) in triglyceride levels. The increase was higher with increasing severity of albuminuria, eGFR loss and CKD phenotype as well as in subjects receiving than in those not receiving statin treatment. Conclusions Triglycerides are associated with CKD, but not retinopathy in subjects with type 2 diabetes, independently of statin treatment. These data point to a possible role of hypertriglyceridemia in the development of CKD, though it remains to be demonstrated that diabetic individuals might benefit from triglyceride reduction with statins and eventually with combination therapy with fibrates. Trial Registration www.ClinicalTrials.gov NCT00715481

Published
2015

46. No increase in prevalence of Barrett's oesophagus in a surgical sereies of obese patients referred for laparoscopic gastric banding

Author

Enzo, Masci, Paolo, Viaggi, Benedetto, Mangiavillano, Salvatore, Di Pietro, Giancarlo, Micheletto, Franco, Di Prisco, Michele, Paganelli, Antonio Ettore, Pontiroli, Ettore Antonio, Pontiroli, Marco, Laneri, Sabrina, Testoni, Pier Alberto, Testoni, Masci, E, Viaggi, P, Mangiavillano, B, Di Pietro, S, Micheletto, G, Di Prisco, F, Paganelli, M, Pontiroli, Ae, Laneri, M, Testoni, S, and Testoni, PIER ALBERTO

Subjects
Adult, Male, medicine.medical_specialty, Gastroplasty, Gastric banding, Gastroenterology, Body Mass Index, Hiatal hernia, Barrett Esophagus, Internal medicine, medicine, Esophagitis, Humans, Obesity, Prospective Studies, Risk factor, Prospective cohort study, Hepatology, business.industry, Reflux, Middle Aged, medicine.disease, digestive system diseases, Surgery, Hernia, Hiatal, Italy, GERD, Female, business, Body mass index
Abstract

Introduction Obesity is a risk factor for gastroesophageal reflux and oesophageal adenocarcinoma. However, only a few studies have examined obesity and lifestyle risk factors in relation to Barrett's oesophagus. In this prospective study we assessed the presence of oesophagitis and Barrett's oesophagus in obese patients selected for laparoscopic gastric banding. Methods 1049 obese patients were referred for laparoscopic gastric banding (233 males; mean age 41.0 ± 10.7 years). oesophagogastroduodenoscopy was performed before surgery to check for upper gastrointestinal tract disorders, especially hiatal hernia, signs of inflammation and/or erosions and/or ulcers of the oesophageal mucosa, and Barrett's epithelium. Results Mean body mass index was 45.15 ± 6.46 kg/m 2 . Overall 86/1049 (8.2%) patients had endoscopic signs of oesophagitis: 84 grade A, 1 grade B and 1 grade C, according to the Los Angeles classification. Hiatal hernia was detected in 127 patients (12.1%), with a mean size of 2.1 ± 0.7 cm (range 1–4 cm); of these, 38 (29.9%) had oesophagitis (37 grade A and 1 grade B). No patients had any visible length of columnar epithelium. Conclusions We could not confirm a high prevalence of Barrett's oesophagus in this series of obese patients.

Published
2011

47. Cholesterol Metabolism After Bariatric Surgery in Grade 3 Obesity

Author

Annamaria Veronelli, Giancarlo Micheletto, A. Benetti, Antonio E. Pontiroli, Andrea Crosignani, Enzo Masci, Valerio Panizzo, F. Frige, and Marina Del Puppo

Subjects
Advanced and Specialized Nursing, medicine.medical_specialty, Cholesterol, business.industry, Endocrinology, Diabetes and Metabolism, Insulin, medicine.medical_treatment, Campesterol, Lathosterol, medicine.disease, Sterol, Surgery, chemistry.chemical_compound, Endocrinology, Insulin resistance, chemistry, Weight loss, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, lipids (amino acids, peptides, and proteins), medicine.symptom, business
Abstract

OBJECTIVE Malabsorptive bariatric surgery (biliopancreatic diversion and biliointestinal bypass [BIBP]) reduces serum cholesterol levels more than restrictive surgery (adjustable gastric banding [AGB]), and this is thought to be due to greater weight loss. Our aim was to evaluate the changes of cholesterol metabolism induced by malabsorptive and restrictive surgery independent of weight loss. RESEARCH DESIGN AND METHODS In a nonrandomized, self-selected, unblinded, active-comparator, bicenter, 6-month study, glucose metabolism (blood glucose and serum insulin levels and homeostasis model assessment of insulin resistance [HOMA-IR] index) and cholesterol metabolism (absorption: serum campesterol and sitosterol levels; synthesis: serum lathosterol levels; catabolism: rate of appearance and serum concentrations of serum 7-α- and serum 27-OH-cholesterol after infusions of deuterated 7-α- and 27-OH-cholesterol in sequence) were assessed in grade 3 obesity subjects undergoing BIBP (n = 10) and AGB (n = 10). Evaluations were performed before and 6 months after surgery. RESULTS Subjects had similar values at baseline. Weight loss was similar in the two groups of subjects, and blood glucose, insulin levels, HOMA-IR, and triglycerides decreased in a similar way. In contrast, serum cholesterol, LDL cholesterol, non-HDL cholesterol, serum sitosterol, and campesterol levels decreased and lathosterol levels increased only in BIBP subjects, not in AGB subjects. A significant increase in 7-α-OH-cholesterol occurred only with BIBP; serum 27-OH-cholesterol decreased in both groups. CONCLUSIONS Malabsorptive surgery specifically affects cholesterol levels, independent of weight loss and independent of glucose metabolism and insulin resistance. Decreased sterol absorption leads to decreased cholesterol and LDL cholesterol levels, accompanied by enhanced cholesterol synthesis and enhanced cholesterol catabolism. Compared with AGB, BIBP provides greater cholesterol lowering.

Published
2013

48. The METABOLIC Study: Multidimensional assessment of health and functional status in older patients with type 2 diabetes taking oral antidiabetic treatment

Author

Maggi, S., Noale, M., Pilotto, A., Tiengo, A., Cavallo Perin, P., Crepaldi, G., Metabolic Working Group Collaborators:, Andrea C., Aglioloro, A., Allochis, G., Arico, C. N., Balbo, M., Marangoni, A., Balzano, S., Battisti, B., Testa, I., Brandoni, G., Bruno, A., Degiovanni, M., Buzzetti, Raffaella, Foffi, C., Calatola, P., Cantarella, S. A., Rondena, M., Cimpanelli, M. G., Confortin, L., Consoli, A., Baldassarre, M., Invitti, C., Conti, A., Del Prato, S., Crisci, I., Derosa, G., Maffioli, P., Devangelio, E., Di Bartolo, P., Ruggeri, P., Di Lembo, S., Di Mauro, M., Battiato, R., Farci, F., Fisicaro, M., Pontiroli, A., Folini, L., Gargiulo, A., Vinciguerra, A., Giorgino, F., Laviola, L., Clementina, C., Guerini, S., Tonolo, G., Iwaniszyn, D., Lambiase, C., Leotta, S., Mangeri, F., Mangili, R., Mattiuzzo, C., Mollo, F., Novara, F., Gucciardi, P., Orsi, E., Palmieri, E., Pacifico, A. A., Burruni, A., Pagani, G., Albizzi, M., Pasquini, C., Cavallo, P. P., Perotto, M., Piccolo, P., D'Ambrosio, P., Maolo, G., Polenta, B., Purrello, F., Tomaselli, T., Tardio, M. S., Quarantelli, C., Ragusa, G. S., Borzi, V., Rapisardi, R., Richini, D., Rosco, M., Serra, R., Marchesini, R. G., Soverini, V., Tomasi, F., De Angelis, M., Turco, A., Tolaini, P., Vangucci, S., and Zavaroni, I.

Subjects
Male, Drug, medicine.medical_specialty, Activities of daily living, Health Status, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, media_common.quotation_subject, Administration, Oral, Type 2 diabetes, Cohort Studies, Diabetes Complications, Endocrinology, Surveys and Questionnaires, Internal medicine, Diabetes mellitus, Internal Medicine, Humans, Hypoglycemic Agents, Medicine, Metabolic study, Aged, media_common, Aged, 80 and over, business.industry, Insulin, Age Factors, General Medicine, medicine.disease, Hypoglycemia, Malnutrition, Diabetes Mellitus, Type 2, Physical therapy, Female, business, Cohort study
Abstract

Aim The objective of the METABOLIC Study was to evaluate overall health status, with particular focus on assessment of functional status of older patients taking oral antidiabetic drug (OAD) treatment. Methods The study included 1342 type 2 diabetes patients aged ≥ 65 years treated with OADs, with or without insulin, who had been referred to outpatients clinics across Italy. Information on diabetes (duration, medications taken during the last 3 months, hypoglycaemic events and diabetic complications) was collected by questionnaire, and the patients’ overall health status was assessed using a multidimensional prognostic index. Results The sample recruited (mean age: 73.3 ± 5.5 years) had a mean duration of diabetes of 11.3 ± 8.2 years. Half were taking sulphonylureas alone or together with other medications, 9.7% were taking insulin in combination with other OADs, almost 30% were using biguanides and 6.2% were taking dipeptidyl peptidase-4 (DPP-4) inhibitors. Also, 12% of patients reported hypoglycaemic events, 90% of whom were taking insulin or sulphonylureas. In addition, 81% of the participants were completely independent in their activities of daily living, while 19% were mildly, moderately or severely disabled. Age, female gender, hypoglycaemic events, neuropathy and low diastolic blood pressure were the main variables associated with disability. Conclusion Disability is common in older diabetic patients and some associated factors, such as hypoglycaemia and low diastolic blood pressure, have been identified. Also identified was malnutrition as a specific factor associated with hypoglycaemic events independent of the use of insulin and sulphonylureas.

Published
2013

49. Female Sexual Dysfunction and Diabetes: A Systematic Review and Meta‐Analysis

Author

Alberto Morabito, Antonio E. Pontiroli, and Donatella Cortelazzi

Subjects
medicine.medical_specialty, Urology, Endocrinology, Diabetes and Metabolism, Female sexual dysfunction, Type 2 diabetes, Cochrane Library, Body Mass Index, Diabetes Complications, Endocrinology, Internal medicine, Diabetes mellitus, medicine, Humans, Sexual Dysfunctions, Psychological, Depression, business.industry, Age Factors, Beck Depression Inventory, medicine.disease, Sexual Dysfunction, Physiological, Psychiatry and Mental health, Sexual dysfunction, Reproductive Medicine, Meta-analysis, Female, medicine.symptom, business, Body mass index
Abstract

Introduction Sexual dysfunction is reported in diabetic women (female sexual dysfunction [FSD]). Aim To examine the frequency of FSD in diabetic women, and its clinical or metabolic correlates, through meta‐analysis of available studies. Methods We searched in MEDLINE, EMBASE, Cochrane Library, and in reference lists of articles and systematic reviews; we considered human clinical studies published as full articles reporting on FSD in diabetic and control women. In total, we considered 26 studies, including 3,168 diabetic and 2,823 control women. Main Outcome Measures Frequency of FSD and score of Female Sexual Function Index (FSFI) as a function of study size, patient details (age, body mass index [BMI], duration of diabetes, metabolic control [HbA1c], chronic complications, Beck Depression Inventory [BDI] score). Results Frequency of FSD was higher in type 1 (OR [95%CI] 2.27 [1.23, 4.16]), in type 2 diabetes (2.49 [1.55, 3.99]), and in “any diabetes” (type 1 and 2) women (2.02 [1.49, 2.72]) than in controls for any duration of diabetes. FSFI was lower in type 1 (−0.27 [−0.41, −0.12]), in type 2 diabetes (−0.65 [−0.75, −0.54]), and in “any diabetes” women (−0.80 [−0.88, −0.71]) than in controls. Depression was significantly more frequent in diabetic than in control women. At meta‐regression only BMI was significantly associated with effect size (P = 0.005). At weighed regression, the only significant association was found between age and FSFI (P = 0.059). The limitations were as follows: only studies of observational nature were available, and heterogeneity was seen among studies. Conclusions FSD is more frequent in diabetic than in control women, but it is still poorly understood; low FSFI is associated with high BMI. Further studies are necessary to better understand risk factors for FSD in diabetic women.

Published
2013

50. Stage of change and motivation to healthy diet and habitual physical activity in type 2 diabetes

Author

Antonio E. Pontiroli, F. Strollo, Marina Trento, S. Vigili de Kreutzenberg, Elena Centis, A. Dei Cas, Anna Simona Sasdelli, M. Di Mauro, Cecilia Invitti, Giuseppe Pugliese, Franco Arturi, P. De Feo, A. Bruno, Giulio Marchesini, A. Molteni, P. Di Bonito, E. Centi, M. Trento, A. Dei Ca, A. E. Pontiroli, P. De Feo, A. Bruno, A. S. Sasdelli, F. Arturi, F. Strollo, S. Vigili de’ Kreutzenberg, C. Invitti, P. Di Bonito, M. Di Mauro, G. Pugliese, A. Molteni, and G. Marchesini

Subjects
Adult, Male, Endocrinology, Diabetes and Metabolism, Population, Stage-of-change, Psychological intervention, physical activity, Type 2 diabetes, Motor Activity, Type 2 diabete, Body Mass Index, Endocrinology, motivation, stage-of-change, diet, lifestyle, type 2 diabetes, Surveys and Questionnaires, Diabetes mellitus, 80 and over, Diabetes Mellitus, Internal Medicine, medicine, Humans, education, Life Style, Aged, Aged, 80 and over, education.field_of_study, exercise, business.industry, Behavior change, Type 2 Diabetes Mellitus, Diet, Lifestyle, Motivation, Physical activity, Diabetes Mellitus, Type 2, Female, Middle Aged, General Medicine, Odds ratio, medicine.disease, sense organs, business, Body mass index, Type 2, Demography
Abstract

Lifestyle changes to healthy diet (HD) and habitual physical activity (HPA) are recommended in type 2 diabetes mellitus (T2DM). Yet, for most people with diabetes, it may be difficult to start changing. We investigated the stage of change toward healthier lifestyles according to Prochaska’s model, and the associated psychological factors in T2DM patients, as a prerequisite to improve strategies to implement behavior changes in the population. A total of 1,353 consecutive outpatients with T2DM attending 14 tertiary centers for diabetes treatment completed the validated EMME-3 questionnaire, consisting of two parallel sets of instruments to define the stage of change for HD and HPA, respectively. Logistic regression was used to determine the factors associated with stages that may hinder behavioral changes. A stage of change favoring progress to healthier behaviors was more common in the area of HD than in HPA, with higher scores in action and maintenance. Differences were observed in relation to gender, age and duration of disease. After adjustment for confounders, resistance to change toward HD was associated with higher body mass index (BMI) (odds ratio (OR) 1.05; 95 % confidence interval (CI) 1.02–1.08). Resistance to improve HPA also increased with BMI (OR 1.06; 95 %CI 1.03–1.10) and decreased with education level (OR 0.74; 95 % CI 0.64–0.92). Changing lifestyle, particularly in the area of HPA, is not perceived as an essential part of treatment by many subjects with T2DM. This evidence must be considered when planning behavioral programs, and specific interventions are needed to promote adherence to HPA.

Published
2014

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