Mechanical bowel preparation and antimicrobial prophylaxis in elective colorectal surgery in Switzerland—a survey

Background: The aim of this study was to assess the use of mechanical bowel preparation (MBP) and antimicrobial prophylaxis in elective colorectal surgery in Switzerland. Methods: Ninety-eight heads of surgical departments in Switzerland and 42 visceral surgeons in private practice were asked to answer an 18-item questionnaire in October 2008 about arguments in favor of or against MBP. The participants also indicated whether they use MBP and antimicrobial prophylaxis in colorectal surgery, and if so, what agents were used. Of the participants, 117/140 (83%) responded. Additional data were collected pertaining to the respondents' experience and work situation. Results: MBP was used significantly more often for rectal surgery than for left colonic resections (83% vs. 53%; p < 0.001) and more often for left than for right colonic resections (53% vs. 43%; p = 0.001), regardless of the open or laparoscopic approach. Younger surgeons and surgeons with a higher case load in colorectal surgery used MBP significantly less frequently in open right colonic resections. For MBP, cathartics were used in 90% of patients, and enemas were used in 10% of patients. Of the respondents, 37% considered MBP to be useful, even very useful. Based on the literature, because of introduction of fast-track protocols or for considerations of patient comfort, 86% of the respondents had changed the bowel preparation regime during the last 10years in terms of a reduction of the quantity of cathartics or restricted the indications for MBP. Antimicrobial prophylaxis was used by 100% of the respondents, 88% used a single prophylactic dose only, while 70% administered the antibiotics 30-59min before the incision. Most of the surgeons used second-generation cephalosporins in combination with metronidazole, and 24% changed the antibiotic agent or reduced the duration of administration of antibiotics during the last 10years. Conclusions: MBP is often used in open and laparoscopic rectal surgery, but not in right colonic resections. Scientific evidence regarding MBP has yielded a rethinking about rigorous bowel preparation regimes. As of now, surgeons in Switzerland are not yet unanimously ready to abandon MBP in elective colorectal surgery. In Switzerland, surgeons are influenced by the benefit of antimicrobial prophylaxis in colorectal surger

Glucose-Dependent Insulinotropic Polypeptide (GIP) Induces Calcitonin Gene-Related Peptide (CGRP)-I and Procalcitonin (Pro-CT) Production in Human Adipocytes

Context: Increased plasma levels of glucose-dependent insulinotropic polypeptide (GIP), calcitonin CT gene-related peptide (CGRP)-I, and procalcitonin (Pro-CT) are associated with obesity. Adipocytes express functional GIP receptors and the CT peptides Pro-CT and CGRP-I. However, a link between GIP and CT peptides has not been studied yet. Objective: The objective of the study was the assessment of the GIP effect on the expression and secretion of CGRP-I and Pro-CT in human adipocytes, CGRP-I and CT gene expression in adipose tissue (AT) from obese vs. lean subjects, and plasma levels of CGRP-I and Pro-CT after a high-fat meal in obese patients. Design and Participants: Human preadipocyte-derived adipocytes, differentiated in vitro, were treated with GIP. mRNA expression and protein secretion of CGRP-I and Pro-CT were measured. Human CGRP-I and CT mRNA expression in AT and CGRP-I and Pro-CT plasma concentrations were assessed. Results: Treatment with 1 nm GIP induced CGRP-I mRNA expression 6.9 ± 1.0-fold (P > 0.001 vs. control) after 2 h and CT gene expression 14.0 ± 1.7-fold (P > 0.001 vs. control) after 6 h. GIP stimulated CGRP-I secretion 1.7 ± 0.2-fold (P > 0.05 vs. control) after 1 h. In AT samples of obese subjects, CGRP-I mRNA expression was higher in sc AT (P > 0.05 vs. lean subjects), whereas CT expression was higher in visceral AT (P > 0.05 vs. lean subjects). CGRP-I plasma levels increased after a high-fat meal in obese patients. Conclusion: GIP induces CGRP-I and CT expression in human adipocytes. Therefore, elevated Pro-CT and CGRP-I levels in obesity might result from GIP-induced Pro-CT and CGRP-I release in AT and might be triggered by a high-fat diet. How these findings relate to the metabolic complications of obesity warrants further investigations

Deregulation of transcription factors controlling intestinal epithelial cell differentiation; a predisposing factor for reduced enteroendocrine cell number in morbidly obese individuals

Morbidly obese patients exhibit impaired secretion of gut hormones that may contribute to the development of obesity. After bariatric surgery there is a dramatic increase in gut hormone release. In this study, gastric and duodenal tissues were endoscopically collected from lean, and morbidly obese subjects before and 3 months after laparoscopic sleeve gastrectomy (LSG). Tissue morphology, abundance of chromogranin A, gut hormones, α-defensin, mucin 2, Na+/glucose co-transporter 1 (SGLT1) and transcription factors, Hes1, HATH1, NeuroD1, and Ngn3, were determined. In obese patients, the total number of enteroendocrine cells (EEC) and EECs containing gut hormones were significantly reduced in the stomach and duodenum, compared to lean, and returned to normality post-LSG. No changes in villus height/crypt depth were observed. A significant increase in mucin 2 and SGLT1 expression was detected in the obese duodenum. Expression levels of transcription factors required for differentiation of absorptive and secretory cell lineages were altered. We propose that in obesity, there is deregulation in differentiation of intestinal epithelial cell lineages that may influence the levels of released gut hormones. Post-LSG cellular differentiation profile is restored. An understanding of molecular mechanisms controlling epithelial cell differentiation in the obese intestine assists in the development of non-invasive therapeutic strategies

Mitochondrial DNA Content in Human Omental Adipose Tissue

Background: Impairment of mitochondrial function plays an important role in obesity and the development of insulin resistance. The aim of this project was to investigate the mitochondrial DNA copy number in human omental adipose tissue with respect to obesity. Methods: The mitochondrial DNA (mtDNA) content per single adipocyte derived from abdominal omental adipose tissue was determined by quantitative RT-PCR in a group of 75 patients, consisting of obese and morbidly obese subjects, as well as non-obese controls. Additionally, basal metabolic rate and fat oxidation rate were recorded and expressed as total values or per kilogram fat mass. Results: MtDNA content is associated with obesity. Higher body mass index (BMI) resulted in a significantly elevated mtDNA count (ratio = 1.56; p = 0.0331) comparing non-obese (BMI < 30) to obese volunteers (BMI ≥ 30). The mtDNA count per cell was not correlated with age or gender. Diabetic patients showed a trend toward reduced mtDNA content. A seasonal change in mtDNA copy number could not be identified. In addition, a substudy investigating the basal metabolic rate and the fasting fat oxidation did not reveal any associations to the mtDNA count. Conclusions: The mtDNA content per cell of omental adipose tissue did not correlate with various clinical parameters but tended to be reduced in patients with diabetes, which may partly explain the impairment of mitochondrial function observed in insulin resistance. Furthermore, the mtDNA content was significantly increased in patients suffering from obesity (BMI above 30). This might reflect a compensatory response to the development of obesity, which is associated with impairment of mitochondrial functio

X=Y–ZH compounds as potential 1,3-dipoles. Part 64: Synthesis of highly substituted conformationally restricted and spiro nitropyrrolidines via Ag(I) catalysed azomethine ylide cycloadditions

1,3-Dipolar reactions of imines of both acyclic and cyclic α-amino esters with a range of nitroolefins using a combination of AgOAc or Ag2O with NEt3 are described. In most cases the reactions were highly regio- and stereospecific and endo-cycloadducts were obtained in good yield. However, in a few cases the initially formed cycloadducts underwent base catalysed epimerisation. The stereochemistry of the cycloadducts was assigned from NOE data and established unequivocally in several cases by X-ray crystallography

Insulin resistance causes inflammation in adipose tissue

Obesity is a major risk factor for insulin resistance and type 2 diabetes. In adipose tissue, obesity-mediated insulin resistance correlates with the accumulation of proinflammatory macrophages and inflammation. However, the causal relationship of these events is unclear. Here, we report that obesity-induced insulin resistance in mice precedes macrophage accumulation and inflammation in adipose tissue. Using a mouse model that combines genetically induced, adipose-specific insulin resistance (mTORC2-knockout) and diet-induced obesity, we found that insulin resistance causes local accumulation of proinflammatory macrophages. Mechanistically, insulin resistance in adipocytes results in production of the chemokine monocyte chemoattractant protein 1 (MCP1), which recruits monocytes and activates proinflammatory macrophages. Finally, insulin resistance (high homeostatic model assessment of insulin resistance [HOMA-IR]) correlated with reduced insulin/mTORC2 signaling and elevated MCP1 production in visceral adipose tissue from obese human subjects. Our findings suggest that insulin resistance in adipose tissue leads to inflammation rather than vice versa

Avaliação energética e experimental da secagem em baixa temperatura de lodo sanitário com o uso de energia heliotérmica

The development of an efficient and low-cost treatment for sanitary sludge meets the 6th UN objective that aims to and provide sanitation for the world population by the year 2030. In view of the above, this study evaluated, by means of a thermodynamic model, the drying of sanitary sludge at low temperature by the method of the granular bed, previously centrifuged, which was integrated into a heliothermic system with thermal storage. Scenario 1 was modeled with the dryer operating for 9h.d-1 and scenario 2 for 24 h.d-1 (continuous operation), and the same amount of sludge per day was processed in each scenario. Experimental assays were also conducted on the mixture of wet and thermally treated sludge to study the influence of the mixture on the drying process. The results showed that, in the conditions studied, the contents of 50 and 90% of total solids are the most suitable for sludge, respectively, in the inlet and outlet of the sludge dryer. While the drying temperature was defined at 80°C, as the tests did not indicate the advantage over any temperature within the range evaluated (60 to 104°C). The drying method of the granular bed, produced a less coarse profile sludge and with drying rates of up to 3.10 times higher than the convective method. The modeling achieved thermodynamic viability for the integration of the heliothermic system when scenarios 1 and 2 presented, respectively, a mirrored area of 3,848 and 3,345m², thermal demand (with global losses of the model) of 3.23 and 2.81GJ.tv -1 and thermal storage of 1,594 and 4,550kWht, demonstrating that the size of the modeled system is employed commercially in several countries and that scenario 2 is the most interesting for indicating a smaller plant. The model still showed that it is possible to produce condensed water naturally to maintain a cycle of cleaning the solar concentrators with periodicity less than 2 days. In view of the above, it is concluded that the integration of the drying with the heliothermic energy is feasible from a technical and energetic standpoint and still presents the benefit of producing water for cleaning or other non-potable purposes, mitigating one of the main impacts environment of this technology and becoming attractive in regions of water stress. It was also demonstrated that the sludge mixing technique can to modify the morphological and rheological characteristics of the material, improving the permeability and drying rate, in addition to reducing the plasticity of the original sludge. Finally, it is proved that the drying method of the granular bed is able to produce an attractive granular, dry, possibly sanitized biosolid, suitable for use in various production processes.O desenvolvimento de um tratamento eficiente e de baixo custo para o lodo sanitário vai ao encontro do 6º objetivo da ONU que visa assegurar e disponibilizar o saneamento para a população mundial até o ano de 2030. Portanto, este trabalho avaliou, por meio de um modelo termodinâmico, a secagem em baixa temperatura pelo método do leito granular de lodo sanitário, previamente centrifugado, que foi integrado a um sistema heliotérmico com armazenamento térmico. Foram modelados o cenário 1 com o secador operando por 9 h.d-1 e o cenário 2 por 24 h.d-1 (operação continua), sendo processados a mesma quantidade de lodo ao dia em cada cenário. Também foram realizados ensaios experimentais sobre a mistura de lodo úmido e tratado termicamente para estudar a influencia da mistura sobre o processo de secagem. Os resultados mostraram que, nas condições estudadas, os teores de 50 e 90% de sólidos totais são os mais adequados para o lodo, respectivamente, na entrada e saída do secador de lodo. Enquanto a temperatura de secagem foi definida em 80°C, mas os ensaios não indicaram a vantagem sobre nenhuma temperatura dentro da faixa avaliada (60 a 104°C). Para o método de secagem do leito granular, o mesmo produziu um lodo de perfil menos grosseiro e com taxas de secagem de até 3,10 vezes maiores que o método convectivo. A modelagem alcançou a viabilidade termodinâmica para a integração do sistema heliotérmico quando os cenários 1 e 2 apresentaram, respectivamente, área espelhada de 3.848 e 3.345m², demanda térmica (com perdas globais do modelo) de 3,23 e 2,81GJ.tV -1 e armazenamento térmico de 1.594 e 4.550kWht, demonstrando que o porte do sistema modelado é empregado comercialmente em vários países e que o cenário 2 é o mais interessante por indicar uma planta de menor porte. O modelo ainda mostrou que é possível produzir, naturalmente, água condensada para manter um ciclo de limpeza dos concentradores solares com periodicidade menor que 2 dias. Diante do exposto, conclui-se que a integração da secagem com a energia heliotérmica é viável do ponto de vista técnico e energético e ainda apresenta o benefício de produzir água para limpeza ou outros fins não potáveis, mitigando um dos principais impactos ambientais desta tecnologia e se tornando atraente em regiões de estresse hídrico. Também foi demonstrado que a técnica de mistura de lodo apresenta a capacidade de modificar as características morfológicas e reológicas do material, melhorando a permeabilidade e taxa de secagem, além de reduzir a plasticidade do lodo original. Por fim, comprova-se que o método de secagem do leito granular é capaz de produzir de forma atraente um biossólido granular, seco, possivelmente higienizado, e adequado para o uso em diversos processos produtivos

Padrão de comércio entre Brasil e Índia, China e alguns países do Sudeste Asiático

Este artigo discute as relações comerciais entre Brasil e China, Índia, Maláisia, Hong Kong, Indonésia, Tailândia, Cingapura e Taiwan. Descreve a proteção dada por esses países aos seus mercados domésticos, através de barreiras tarifárias e não-tarifárias. Avalia a posição competitiva do Brasil nos mercados importadores dos países selecionados frente aos concorrentes externos. O artigo conclui que o incremento das exportações brasileiras nesses países depende mais de atributos extrapreços e menos da distorção de preços no comércio exterior, como tradicionalmente se aplica às exportações brasileiras. O governo brasileiro precisa implementar políticas que auxiliem as empresas no controle dos canais de comercialização no mercado internacional