Immediate return of fertility function following a bariatric surgery: A case report.
The journal of obstetrics and gynaecology research. 2019;(10):2111-2115
Obesity in women of childbearing age is linked to lower fertility rates due to chronic oligoovulation and anovulation. Effective weight loss treatment such as bariatric surgery can improve fertility potential. However, pregnancy during the first 12 months after bariatric surgery should be avoided due to an active catabolic state and may increase the potential risk of fetal growth restriction. Here, we report a case with an immediate return of fertility function following a bariatric surgery with favorable outcomes. A 30-year-old woman with obesity, history of polycystic ovarian syndrome and infertility become pregnant within 2-month period following bariatric surgery. She first recognized her pregnancy at the gestational age of 8 weeks. Micronutrient laboratory results at baseline were normal except for low 25-OH vitamin D level of 18.7 ng/dL. She continued to lose her weight during the first trimester but was able to gain some weight during the second and third trimesters. Close fetal ultrasonography monitoring was done during each trimester. The fetal ultrasonography showed an appropriate fetal weight, a normal Doppler study and no abnormality detected in the fetus. Finally, at 36 weeks of gestation, a 2380-g female baby was delivered successfully.
Isolated Intestinal Ganglioneuroma Mimicking Small Bowel Crohn's Disease.
ACG case reports journal. 2019;(7):e00114
Ganglioneuromas (GNs) are hamartomatous tumors derived from the autonomic nervous system. GNs are frequently associated with neurofibromatosis-1 and multiple endocrine neoplasia type 2b and commonly present with constipation, abdominal pain, weight loss, obstruction, and gastrointestinal bleeding. We report a 40-year-old man with symptoms of chronic abdominal pain, weight loss, and diarrhea for 1 year. Imaging was suggestive of thickening of ileal wall with a stricture, and subsequent biopsy revealed intestinal GN. To our knowledge, this is the first case report of an isolated intestinal GN masquerading as Crohn's disease.
Family Based Prevention of Cardiovascular Disease Risk Factors in Children by Lifestyle Change: The PEP Family Heart Study.
Advances in experimental medicine and biology. 2019;:41-55
AIM: The 14 years' Prevention Education Program PEP was started 1994 among first graders, their siblings and parents living in the half million city Nuremberg (Germany). The aim of prospective family-based observational study was early detection and lifestyle intervention of traditional cardiovascular risk factors. SUBJECTS AND METHODS Out of 3370 families 24,927 adults and 23,740 children participated in the PEP Family Heart study. Anthropometric parameters including blood pressure and fasting lipids were measured. Because these variables change specifically because of natural growth and development in 3-18 years old children we had to calculate age-and gender-specific growth curves using the LMS method. Non-overweight (normal weight) is defined as BMI < 85th percentile (pctl), overweight as BMI 85th to <95th percentile, obesity as BMI ≥ 95th percentile and severe obesity as ≥ 120% of the 95th pctl. Prehypertension is categorized as the ≥90th to <95th pctl or ≥120/80 mm Hg and hypertension as ≥95th pctl on ≥3 occasions. MAIN RESULTS 1. Cardiovascular risk (CVD) factor screening in school children predicted CVD risk in parents. 2. The growths curves for auscultatory systolic (SBP) and diastolic (DBP) blood pressure of non-overweight 8713 boys and 8138 girls nearly identical with the percentile curves of all 11,328 boys and 10,723 girls. 3. The shapes of the 10 lipid percentile curves between the 3rd and 97th pctl differ considerably by age and gender. 4. The wais-to-height ratio (WHtR) percentiles as a measure for abdominal adiposity vary substantially by age and gender 5. Among overweight and obese ≥85th pctl the percentile curves of body fat increase steeply until age 10 years and then decrease slowly in boys whereas the BF% percentile curves in girls increase continuously until age 18 years 6. The prevalence of hypertension increased strongly in severe obesity at the 99th pctl, more steeply beyond 120% of the 95th pctl to 59.1% in boys and 56% in girls. 7. The association between hypertension and normal weight, overweight and obesity increased in boys from 0,5, via 2,7 to 4,3 and in girls from 0,4 via 2,1 to 5,9. 8. Between 2000 and 2007 mean blood pressure decreased from 138.3 ± 18.5 mm Hg to 124.0 ± 13.8 mm Hg in fathers and from 119.1 ± 2.8 mm Hg to 110.4 ± 11.2 mm Hg in mothers. 9. After 1 year weighed dietary protocols demonstrate in 166 fathers a decrease of all six nutrional components like daily energy consumption from 2423 to 2307 Kcal, from 98 g to 91 g fat, from 260 g to 252 g carbohydrates, from 88 g to 84 g protein, cholesterol from 362 mg to 339 mg and alcohol from 19 g to 17 g per day and in 237 mothers from 1915 Kcal to 1830 Kcal, from 79 g to 73 g total fat, from 216 g to 212 g carbohydrates, from 66 g to 64 g protein, from 299 g to 244 mg cholesterol. 10. Sustained intensive individual and family-based lifestyle counseling in daily life in terms of healthy diet, less sedentary behavior and more leisure time physical activity slightly improved the CVD risk factor profiles in parents and their children already after 1 year.
Caffeine and sodium bicarbonate supplementation alone or together improve karate performance.
Journal of the International Society of Sports Nutrition. 2019;(1):44
BACKGROUND The ergogenic properties of acute caffeine (CAF) and sodium bicarbonate (NaHCO3) ingestion on athletic performance have been previously investigated. However, each sport has unique physiological and technical characteristics which warrants optimizing supplementations strategies for maximizing performance. This study examined the effects of CAF and NaHCO3 ingestion on physiological responses and rate of perceived exertion during a Karate-specific aerobic test (KSAT) in competitive karatekas. METHODS In a double-blind, crossover, randomized placebo-controlled trial, eight Karatekas underwent five experimental conditions including control (CON), placebo (PLA), CAF, NaHCO3, and CAF + NaHCO3 before completing KSAT. Capsules containing 6 mg/kg BW CAF were consumed 50 min prior to a KSAT whilst 0.3 g/kg BW NaHCO3 was consumed for 3 days leading to and 120, 90, and 60 min prior to a KSAT. Time to exhaustion (TTE), rate of perceived exertion (RPE), and blood lactate (BL) were measured before, immediately after and 3 min following KSAT. RESULTS TTE was significantly greater following CAF, NaHCO3, and CAF + NaHCO3 consumption compared to PLA and CON. However, the differences between CAF, NaHCO3, and CAF + NaHCO3 were not statistically significant (p > 0.05). BL increased significantly from baseline to immediately after and 3 min following KSAT in all conditions (p < 0.01), while RPE at the end of KSAT was not significantly different between conditions (p = 0.11). CONCLUSIONS Karate practitioners may benefit from the ergogenic effects of CAF and NaHCO3 when consumed separately or together.
Allogenic umbilical cord blood-derived mesenchymal stem cells implantation for the treatment of juvenile osteochondritis dissecans of the knee.
Journal of clinical orthopaedics and trauma. 2019;(Suppl 1):S20-S25
Background: Osteochondritis dissecans (OCD) is a pathologic condition accompanied by the gradual destruction of subchondral bone and defects in the overlying articular cartilage.This case series reports the results of allogenic human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) implantation for the treatment of osteochondral defect in two cases of juvenile osteochondritis dissecans. Case presentation: Two patients with osteochondral defect of the knee recovered from the disease enough to begin major exercise 1 year after hUCB-MSCs implantation. The IKDC, VAS, and Tegner score of the two patients showed an excellent improvement and concurrent arthroscopy was performed; cartilage regeneration of ICRS grade 1 similar to normal was observed. The modified two-dimensional MOCART scores increased in both cases over time. Conclusion: This is the first case series detailing the results of treating juvenile OCD lesions using hUCB-MSCs. This could be an option for treating juvenile OCD.
Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson's: the PDSAFE RCT.
Health technology assessment (Winchester, England). 2019;(36):1-150
BACKGROUND People with Parkinson's disease are twice as likely to experience a fall as a healthy older person, often leading to debilitating effects on confidence, activity levels and quality of life. OBJECTIVE To estimate the effect of a physiotherapy programme for fall prevention among people with Parkinson's disease. DESIGN A multicentre, pragmatic, investigator-masked, individually randomised controlled trial (RCT) with prespecified subgroup analyses. SETTING Recruitment from NHS hospitals and clinics and community and social services in eight English regions with home-based interventions. PARTICIPANTS A total of 474 people with Parkinson's disease (i.e. Hoehn and Yahr scale stages 1-4) were recruited: 238 were assigned to a physiotherapy programme and 236 were assigned to usual care. Random allocation was 50 : 50. INTERVENTIONS All participants received routine care; the usual-care group received an information digital versatile disc (DVD) and a single advice session at trial completion. The intervention group had an individually tailored, progressive, home-based fall avoidance strategy training programme with balance and strengthening exercises: PDSAFE. MAIN OUTCOME MEASURES The primary outcome was the risk of repeat falling, collected by self-report monthly diaries between 0 and 6 months after randomisation. Secondary outcomes included near-falls, falls efficacy, freezing of gait (FoG), health-related quality of life, and measurements taken using the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Chair Stand Test (CST), the Geriatric Depression Scale, the Physical Activity Scale for the Elderly and the Parkinson's Disease Questionnaire. RESULTS PDSAFE is the largest RCT of falls management among people with Parkinson's disease: 541 patients were screened for eligibility. The average age was 72 years, and 266 out of 474 (56%) participants were men. Of the 474 randomised participants, 238 were randomised to the intervention group and 236 were randomised to the control group. No difference in repeat falling within 6 months of randomisation was found [PDSAFE group to control group odds ratio (OR) 1.21, 95% confidence interval (CI) 0.74 to 1.98; p = 0.447]. An analysis of secondary outcomes demonstrated better balance (Mini-BESTest: mean difference 0.95, 95% CI 0.24 to 1.67; p = 0.009), functional strength (CST: p = 0.041) and falls efficacy (Falls Efficacy Scale - International: mean difference 1.6, 95% CI -3.0 to -0.19; p = 0.026) with near-falling significantly reduced with PDSAFE (OR 0.67, 95% CI 0.53 to 0.86; p = 0.001) at 6 months. Prespecified subgroup analysis (i.e. disease severity and FoG) revealed a PDSAFE differing effect; the intervention may be of benefit for people with moderate disease but may increase falling for those in the more severe category, especially those with FoG. LIMITATIONS All participants were assessed at primary outcome; only 73% were assessed at 12 months owing to restricted funding. CONCLUSIONS PDSAFE was not effective in reducing repeat falling across the range of people with Parkinson's disease in the trial. Secondary analysis demonstrated that other functional tasks and self-efficacy improved and demonstrated differential patterns of intervention impact in accordance with disease severity and FoG, which supports previous secondary research findings and merits further primary evaluation. FUTURE WORK Further trials of falls prevention on targeted groups of people with Parkinson's disease are recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN48152791. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 36. See the NIHR Journals Library website for further project information. Sarah E Lamb is funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) at Oxford Health NHS Foundation Trust, the NIHR Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust and CLAHRC Oxford. Victoria A Goodwin is supported by the NIHR Collaborations for Leadership in Applied Health Research and Care in the South West Peninsula (PenCLAHRC). Lynn Rochester is supported by the NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. The research was also supported by the NIHR Newcastle Clinical Research Facility Infrastructure funding. Helen C Roberts is supported by CLAHRC Wessex and the NIHR Southampton Biomedical Research Centre.
Severe lumbar radiculopathy with epidural venous plexus engorgement in a morbidly obese pediatric patient: A case report.
INTRODUCTION Engorgement of the epidural venous plexus (EVP) is a rare cause of nerve root impingement. Dilated epidural veins cause compression of the thecal sac and spinal nerve roots, leading to lumbar radiculopathy. PATIENT CONCERNS Here we describe a case of severe lumbar radiculopathy in a 15-year-old morbidly obese boy. DIAGNOSIS Enhanced lumbar magnetic resonance imaging revealed left sided L1-L2 disc protrusion and engorgement of the lumbar EVP, resulting in narrowing of the thecal sac in the entire lumbar spine. There was no evidence of an intra-abdominal mass, thrombosis of the inferior vena cava, or vascular malformation. INTERVENTIONS A caudal epidural block was administered under fluoroscopic guidance. The patient reported a 30% reduction in pain intensity for just 1 day. OUTCOMES The patient has been followed up for 2 years. He continues to take medication, including morphine sulfate 15 mg, gabapentin 300 mg, and oxycodone 20 mg per day. He is on a diet with exercise for weight reduction. CONCLUSION An engorged EVP should be considered in the differential diagnosis of radiculopathy in morbidly obese patients.
Cashew apple juice supplementation enhances leukocyte count by reducing oxidative stress after high-intensity exercise in trained and untrained men.
Journal of the International Society of Sports Nutrition. 2019;(1):31
BACKGROUND Cashew apple juice (CAJ) was shown to improve immunological mechanisms by regulating a balance between reactive oxygen species and antioxidant concentrations. However, no study exploring the effects of the CAJ and training status on the immune system and oxidative stress induced by exercise. Therefore, we investigated the effects of CAJ supplementation primarily on leukocyte counts and secondary on oxidative stress and cortisol changes after high-intensity exercise in trained and untrained men. METHODS Ten moderately (endurance) trained (Age = 21.5 ± 0.97 yr., VO2max = 45.6 ± 4.12 mL/kgBM/min) and ten sedentary men (Age = 20.4 ± 2.72 yr., VO2peak = 32.2 ± 7.26 mL/kgBM/min) were randomized to ingest either daily CAJ or a placebo at 3.5 mL/kgBM/day for 4 weeks, with a four-week washout period. Before and after each period, they performed 20-min, high-intensity cycling (85% VO2max), with blood samples collected immediately preceding and the following exercise. Samples were analyzed to determine leukocyte counts, malondialdehyde, 8-isoprostane, and cortisol concentrations. A repeated measures analysis of variance was used to examine the effects of supplement and training status over time with an alpha level of 0.05. RESULTS There was no interaction between supplement and training status on those variables before and after exercise. However, CAJ raised resting neutrophil counts and exercise-induced leukocyte counts in the trained group (all p < 0.05). Besides, CAJ significantly reduced plasma malondialdehyde concentrations at rest and after exercise and reduced the post-exercise plasma 8-isoprostane concentration in both groups of subjects (p < 0.05). Moreover, CAJ reduced plasma cortisol after exercise in the untrained subjects. CONCLUSIONS We suggest that 4-week CAJ supplementation can enhance exercise-induced leukocyte and resting neutrophil counts in trained men. The possible mechanism is a reduction in oxidative stress. However, the supplementation did not change the immune responses of untrained men, but it did reduce stress hormone concentrations. TRIAL REGISTRATION NUMBER TCTR20181127002 Registered 26 November 2018 "retrospectively registered".
Effect of Exercise on Outcome after Ventricular Tachycardia Ablation in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy.
International journal of sports medicine. 2019;(10):657-662
Competitive sports and intensive exercise are associated with adverse outcomes in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). This study aimed to assess the role of exercise on long-term results of radiofrequency catheter ablation (RFCA) therapy of ventricular tachycardia (VT) in patients with ARVD/C. Exercise participation was evaluated by telephone or in-person interviews in patients from our ARVD/C registry with previous VT ablation (38 patients, 26 males, age 52.6±14.1years). Of 38 patients, 30 were involved in sports activities before RFCA. Only the minority of our patient population (21.1%) had a sedentary lifestyle before RFCA; 42.1 and 36.8% reported recreational or competitive sports, respectively. During the follow-up period of 52.5±31.4 months, 23 of the total 38 patients with previous RFCA (60.5%) remained free from VT recurrence. In univariate and binary logistic regression analysis, only advanced age was significantly associated with VT recurrence, with a hazard ratio of 1.15, and 95% confidence interval 1.05-1.26 (p=0.004). The results of our observational study indicate that recreational sports do not impair long-term results after RFCA treatment compared with a sedentary lifestyle. Furthermore, the dynamic component of recreational exercise did not affect the outcome of VT ablation in our patient population. Recreational exercise at low to moderate intensity is not associated with an increased risk for VT recurrence after catheter ablation in patients with ARVD/C.
Transthyretin Amyloidosis with Gastrointestinal Manifestation: a Case Report.
Journal of gastrointestinal and liver diseases : JGLD. 2019;(3):359-361
Transthyretin amyloidosis (ATTR) is a rare, progressive, life-threatening, hereditary disorder caused by mutations in the transthyretin gene. Due to the phenotypic heterogeneity, ATTR is difficult to recognize and it is often diagnosed very late. In ATTR gastrointestinal (GI) disorders play an important role in the patients' morbidity and mortality. In some cases, GI symptoms are present even before the onset of the peripheral polyneuropathy. However, the complaints are various and it is really difficult to differentiate them from other GI disorders. We present a 61-year old male referred for diarrhea, unintentional weight loss and early satiety. He had hypotension after longstanding hypertension, numbness and tingling in the feet. We considered a broad differential diagnosis spectrum of chronic diarrhea syndrome and performed numerous laboratory, biochemical, imaging, endoscopic, histological and genetic tests. Transthyretin amyloidosis with a Glu89Gln mutation was diagnosed. Transthyretin amyloidosis is frequently misdiagnosed, representing a diagnostic challenge in GI practice. The presence of certain clinical combinations could help gastroenterologists to include ATTR in their diagnostic work-up.