RESUMEN

Precision medicine makes it possible to classify patients into groups on the basis of molecular and genetic biomarkers, as well as clinical characteristics, in order to optimize therapeutic response. For example, several types of type 2 diabetes seem to coexist with classic insulin-dependent, autoimmune type 1 diabetes : diabetes with insulinopenia (generally severe), diabetes linked to aging or obesity (less severe), and diabetes with insulin resistance, whose patients will be those with the most numerous complications, notably macrovascular. In this article, we examine the possibilities offered by this new classification of diabetes with a view to personalized medicine.

La médecine de précision permet de classer les patients en groupes sur la base de biomarqueurs moléculaires et génétiques ainsi que de caractéristiques cliniques afin d'optimiser la réponse thérapeutique. Ainsi, plusieurs types de diabètes de type 2 semblent coexister à côté du classique diabète de type 1, insulinoprive et avec auto-immunité : des diabètes avec insulinopénie (généralement sévères), des diabètes liés au vieillissement ou à l'obésité (moins sévères), et des diabètes avec insulinorésistance dont les patients porteurs seront ceux qui auront le plus de complications, en particulier macrovasculaires. Dans cet article, nous abordons les possibilités offertes par cette nouvelle classification du diabète vers la perspective d'une médecine personnalisée.

Asunto(s)

RESUMEN

PURPOSE: Surgery remains the only treatment allowing for a significant and sustainable weight loss in case of severe obesity. Patients undergo a specific multidisciplinary preparation and selection before the operation. This study aims to correlate the psychosocial profile with the likelihood of undergoing bariatric surgery in patients enrolled in the preparation program of a Swiss reference center. METHODS: All patients referred to an obesity center between January 1, 2016, and June 30, 2017, seeking a first bariatric procedure were included. Socio-demographic data, BMI, preoperative psychological and dietary evaluations were collected. Usually, the preoperative process lasts 1 year. Patients who left the preparation or who had not undergone surgery after more than 2 years of follow-up were considered withdrawers. Surgery completion predictors were reviewed with bivariate analysis and socio-demographic clusters established using the K-means method. RESULTS: Out of a total of 221 patients, 99 (45%) patients had not undergone bariatric surgery 2 years after their first consultation. The patients were divided into four distinct socio-demographic clusters, among which a particularly deprived one. Criteria such as unfavorable psychological (p < 0.001) and dietary (p < 0.001) evaluations, and male gender (p < 0.05) were significantly associated with non-operation, unlike socio-demographic indicators and clusters (p > 0.1). CONCLUSION: Almost half of the patients starting a bariatric program are not operated on, which is related to an unfavorable psychological or dietary evaluation and to the male gender. This study also demonstrates that a significant share of patients combines several factors of social deprivation, without influencing the likelihood of surgery completion. LEVEL OF EVIDENCE: Level V: Descriptive study.

Asunto(s)

RESUMEN

OBJECTIVES: Relationships between weight and fertility are well known. The aim of this study is to assess the prevalence of lifetime eating disorder (ED) in a sample of infertile women seeking a specific infertility treatment, pulsatile gonadotropin-releasing hormone (pGnRH) treatment, and to compare it to the prevalence of lifetime ED in a sample of infertile women seeking other types of assisted reproductive technology (ART) treatments. DESIGN: Non-randomized, observational study including infertile female patients. Two-group design including consecutive women treated with GnRH pump (pGnRH) or with other types of ART. SETTING: Multi-centric infertility centers, France METHODS: Twenty one consecutive women treated with pGnRH treatment were compared to 21 consecutive women receiving other types of infertility treatment. Diagnosis of ED was based on DSM-IV and the Composite International Diagnostic Interview (CIDI). RESULTS: Twenty patients (95.2%) from the sample of women treated with pulsatile GnRH treatment and 5 patients (23.8%) from the patients receiving other types of infertility treatment met the criteria of lifetime ED diagnosis (p < 0.000). CONCLUSION: This study highlights the fact that the prevalence of ED is considerably higher in women receiving GnRH pulsatile treatment, when compared to women receiving other kinds of infertility treatment. In our study population ED were under-diagnosed, particularly in women receiving pulsatile GnRH treatment. Fertility clinicians should use reliable diagnostic tools to identify promptly ED in women presenting with hypothalamic amenorrhea and difficulties in conceiving. Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Asunto(s)

RESUMEN

BACKGROUND-OBJECTIVES: Despite pregnancy being a common event following laparoscopic adjustable gastric banding (LAGB), there is little comprehensive data regarding its effect on postoperative outcome. The aim of this study was to assess the impact of pregnancy on the postoperative changes in quality of life (QOL) and total weight loss 3 years after LAGB. SETTING: Multi-institutional, France. METHODS: This is a study of the subgroup of 561 women of childbearing age included in a 3-year prospective multicenter trial assessing the results of patients undergoing LAGB surgery. Data from the 61 women who got pregnant and delivered during the follow-up period were compared with the 270 who did not. RESULTS: Pregnant women achieved lower final weight loss compared to the non-pregnant group [final body mass index (BMI) 35.4 vs. 31.1 kg/m(2), p < 0.0001; excess weight loss (%EBL) 43.6 vs. 64.7 %, p < 0.0001]. Longitudinal assessment demonstrated pregnancy as a significant and independent factor of poor weight loss (p < 0.0001). The timing of conception after LAGB (between the first 18 months or after) had no significant impact on weight loss changes. There was no significant difference in short form-36 health survey (SF-36) QOL scores between both groups. CONCLUSIONS: Pregnancy following gastric banding affects negatively postoperative final weight loss, even if occurring 18 months postoperatively, but has no effect on QOL improvement.

Asunto(s)

RESUMEN

The glucocorticoid hormone cortisol is released in pulses resulting in a complex and dynamic ultradian rhythm of plasma cortisol that underlies the classical circadian rhythm. These oscillating levels are also seen at the level of tissues such as the brain and trigger pulses of gene activation and downstream signalling. Different patterns of glucocorticoid presentation (constant vs pulsatile) result not only in different patterns of gene regulation but also in different neuroendocrine and behavioural responses. Current 'optimal' glucocorticoid replacement therapy results in smooth hormone blood levels and does not replicate physiological pulsatile cortisol secretion. Validation of a novel portable pulsatile continuous subcutaneous delivery system in healthy volunteers under dexamethasone and metyrapone suppression. Pulsatile subcutaneous hydrocortisone more closely replicates physiological circadian and ultradian rhythmicity.

Asunto(s)

RESUMEN

OBJECTIVE: To investigate the Growth Hormone (GH)/Insulin-like Growth Factor-I (IGF-I) axis and identify the factors that determine IGF-I levels in adult septic patients of variable severity, i.e., with sepsis, severe sepsis or septic shock, in the acute phase of disease. DESIGN: In 107 consecutive septic patients (44 with sepsis, 13 with severe sepsis, and 50 with septic shock), GH, IGF-I, Insulin-like Growth Factor Binding Protein-3 (IGFBP-3), insulin, cortisol, albumin, thyroid hormones, C-reactive protein and interleukin-6 serum levels were measured once within 48 h after onset of a septic episode. Twenty-nine healthy volunteers served as controls. RESULTS: IGF-I and IGFBP-3 levels were decreased in patients with sepsis and severe sepsis (versus controls), decreasing further in patients with septic shock (versus sepsis). IGF-I levels were positively related to IGFBP-3, albumin, triiodothyronine and thyroxine, and inversely related to cortisol, sepsis severity, C-reactive protein, interleukin-6 and age. In multiple regression analysis, IGF-I levels were independently related to IGFBP-3 and albumin (lower in patients with decreased IGFBP-3 and albumin levels) (p<0.001 and p=0.01, respectively), and cortisol (lower in patients with increased cortisol levels) (p=0.04). IGFBP-3 accounted for most of the variance explained by the model (R(2)=0.519). GH levels were not related to IGF-I levels or mortality. IGF-I and IGFBP-3 levels were not associated with mortality. CONCLUSIONS: The GH/IGF-I axis is severely disrupted in septic patients. IGFBP-3 is the major determinant of IGF-I levels.

Asunto(s)