Physical fitness in morbidly obese patients: effect of gastric bypass surgery and exercise training

Background There is a growing consensus that bariatric surgery is currently the most efficacious and long-term treatment for clinically severe obesity. However, it remains to be determined whether poor physical fitness, an important characteristic of these patients, improves as well. The purpose of this pilot study is to investigate the effect of gastric bypass surgery on physical fitness and to determine if an exercise program in the first 4 months is beneficial. Methods Fifteen morbidly obese patients (BMI 43.0 kg/m(2)) were tested before and 4 months after gastric bypass surgery. Eight of them followed a combined endurance and strength training program. Before and after 4 months the operation, anthropometrical characteristics were measured, and an extensive assessment of physical fitness (strength, aerobic, and functional capacity) was performed. Results Large-scale weight loss through gastric bypass surgery results in a decrease in dynamic and static muscle strength and no improvement of aerobic capacity. In contrast, an intensive exercise program could prevent the decrease and even induced an increase in strength of most muscle groups. Together with an improvement in aerobic capacity, functional capacity increased significantly. Both groups evolved equally with regard to body composition (decrease in fat mass and fat-free mass). Conclusions An exercise training program in the first 4 months after bariatric surgery is effective and should be promoted, considering the fact that physical fitness does not improve by weight loss only

Combination therapy with oral treprostinil for pulmonary arterial hypertension. A double-blind placebo-controlled clinical trial

Rationale: Oral treprostinil improves exercise capacity in patients with pulmonary arterial hypertension (PAH), but the effect on clinical outcomes was unknown. Objectives: To evaluate the effect of oral treprostinil compared with placebo on time to first adjudicated clinical worsening event in participants with PAH who recently began approved oral monotherapy. Methods: In this event-driven, double-blind study, we randomly allocated 690 participants (1:1 ratio) with PAH to receive placebo or oral treprostinil extended-release tablets three times daily. Eligible participants were using approved oral monotherapy for over 30 days before randomization and had a 6-minute-walk distance 150 m or greater. The primary endpoint was the time to first adjudicated clinical worsening event: death; hospitalization due to worsening PAH; initiation of inhaled or parenteral prostacyclin therapy; disease progression; or unsatisfactory long-term clinical response. Measurements and Main Results: Clinical worsening occurred in 26% of the oral treprostinil group compared with 36% of placebo participants (hazard ratio, 0.74; 95% confidence interval, 0.56–0.97; P = 0.028). Key measures of disease status, including functional class, Borg dyspnea score, and N-terminal pro–brain natriuretic peptide, all favored oral treprostinil treatment at Week 24 and beyond. A noninvasive risk stratification analysis demonstrated that oral treprostinil–assigned participants had a substantially higher mortality risk at baseline but achieved a lower risk profile from Study Weeks 12–60. The most common adverse events in the oral treprostinil group were headache, diarrhea, flushing, nausea, and vomiting. Conclusions: In participants with PAH, addition of oral treprostinil to approved oral monotherapy reduced the risk of clinical worsening. Clinical trial registered with www.clinicaltrials.gov (NCT01560624)

Mechanical properties of aluminium foam derived from infiltration casting of salt dough

This paper addresses the mechanical properties of Corevo® aluminium foam. The effective Young’s modulus, Poisson’s ratio, and material yield stress are determined. To this end, samples are tested using uni-axial compressive testing. In addition, micro-computed tomography data of the complex material geometry are obtained and converted into finite element calculation models. The numerical analysis further enables the testing of mechanical material anisotropy and plastic deformation within the material’s meso-structure

Outcomes of Adult Heart Transplantation Using Hepatitis C–Positive Donors

Background This study evaluated the impact of hepatitis C–positive ( HCV +) donors on outcomes of heart transplantation in the United States. Methods and Results Adults undergoing isolated heart transplantation in the United States between January 1, 2016, and December 31, 2018, were included. The primary outcome was 1‐year post‐transplant survival. Multivariable Cox regression and 2:1 propensity matching were used to compare outcomes between transplants with HCV + and hepatitis C–negative ( HCV −) donors. A subanalysis was performed to evaluate the impact of nucleic acid amplification test positivity on outcomes. Of 7889 isolated heart transplants performed during the study period, 343 (4.4%) used HCV + donors. Overall unadjusted 1‐year posttransplant survival was not statistically different between HCV − versus HCV + donors (91.1% versus 90.2%; P =0.86), a finding that persisted after risk adjustment (hazard ratio, 1.05; 95% CI, 0.70–1.58; P =0.80). Propensity matching resulted in 675 well‐balanced patients (437 HCV − and 238 HCV +). Overall 1‐year posttransplant survival was not statistically different in propensity‐matched analysis (89.8% HCV − versus 89.2% HCV +; P =0.88). Rates of 1‐year drug‐treated rejection (21.1% versus 22.1%; P =0.84), postoperative dialysis (11.4% versus 14.7%; P =0.22), and stroke (4.6% versus 2.1%; P =0.10) were also not statistically different between HCV − and HCV + groups, respectively. Outcomes were not statistically different between nucleic acid amplification test–negative and nucleic acid amplification test–positive HCV + donors. Conclusions Adult heart transplants using HCV + donors, including those that are nucleic acid amplification test positive, can be performed without an adverse impact on 1‐year survival. Wider implementation of protocols for using HCV + donors and an assessment of longer‐term outcomes including seroconversion rates will be important in maximizing the effect of HCV + donors on national donor shortages. </jats:sec

786-3 Adenosine Causes Flow-Mediated Epicardial Vessel Dilation in Humans

The predominant effect of intracoronary adenosine (Ad) is vasodilation of the microcirculation, but Ad also increases epicardial coronary artery diameter. It is not known whether epicardial dilation is a direct action of Ad or an indirect effect mediated by increased flow or shear stress. We reasoned that changes in the diameter of the left anterior descending (LAD) artery upstream to the site of Ad delivery must reflect an indirect effect. whereas downstream vasodilation would reflect the sum of direct and indirect effects. We therefore compared changes in upstream and downstream LAD diameter in 11 patients without significant coronary artery disease in whom LAD flow increased at least three-fold (n=6) or remained unchanged (n=5) in response to Ad 10-4 M infused via a 3F Doppler catheter. LAD diameter was assessed by quantitative angiography 2.5 upstream and 2.5mm downstream to the site of Ad delivery. LAD flow was calculated as the product of downstream cross-sectional area and Doppler velocity. LAD diameter (mm) is shown as mean±standard error of the mean.Flow IncreasedFlow UnchangedBaselineAdenosinepBaselineAdenosinepDownstream2.08±0.22248±0.300.061.97±0.161.99±0.140.16Upstream2.38±0.202.65±0.210.0042.28±0.262.18±0.260.23Thus, epicardial vessel dilation in response to Ad occurs only in the presence of an increase in coronary blood flow, and there is significant dilation upstream from the site of Ad infusion.ConclusionsAdenosine causes flow-mediated epicardial vessel dilation in humans, with little or no direct effect on epicardial vessel diameter