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Mancusi R, Nosso G, Pecoraro S, Barricelli M, Russo A. Photodynamic Therapy With RLP068 and 630-nm Red LED Light in Foot Ulcers in Patients With Diabetes: A Case Series. INT J LOW EXTR WOUND 2024; 23:99-103. [PMID: 34693762 DOI: 10.1177/15347346211053403] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management and healing of lower extremity ulcers have always been a complex health problem because the clinical course is typically chronic, the results are often poor, and the socioeconomic impact is considerable. The healing process of foot ulcers of people with diabetes is further hindered by the concomitant presence of obstructive arterial disease, neuropathy, and foot malformation. It is frequently associated with multiresistant infections and often results in micro/macro amputations. Photodynamic therapy employs a photosensitizer activated by light of a specific wavelength able to generate reactive oxygen species, which initiate further oxidative responses locally with components of the bacteria. The experience of the treatment center for the lower extremity ulcers in 17 persons with diabetes in Acerra (Italy) with photoactivated RLP068, reported here, corroborates the results of the clinical trials and of the previous case reports. In all cases, examined photodynamic therapy with photosensitizer RLP068 and red light at 630 nm was found to reduce lesion area and inflammation and to ensure the decrease of bacterial load, hence reducing treatment times and antibiotics use, improving patient outcomes, and reducing the incidence of amputations. The simultaneous combination of photodynamic therapy with other ancillary physical-based treatments such as therapeutic magnetic resonance or Bio-Electro-Magnetic-Energy-Regulation was observed to be safe, time-saving, and able to lead to faster healing.
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Affiliation(s)
| | | | | | | | - Andrea Russo
- Private Clinic Villa dei Fiori, Acerra, Naples, Italy
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2
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Guarini P, Saia F, Sidiropulos M, Silverio A, Dellegrottaglie S, Scatteia A, Tedeschi C, Cappelletti AM, Regazzoli D, Benassi A, Donatelli F, America R, Nosso G, Capranzano P, Oliva A, Piccolo R, Testa L, Attisano T, Castiglioni B, Contarini M, De Marco F, Fineschi M, Menozzi A, Musto C, Stefanini G, Tarantini G, Caiazza F, Esposito G. [SICI-GISE/SICOA Consensus document: Clinical follow-up of patients after acute coronary syndrome or percutaneous coronary intervention]. G Ital Cardiol (Rome) 2023; 24:5-15. [PMID: 37158025 DOI: 10.1714/4035.40099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
In the last decades, advances in percutaneous coronary intervention (PCI) strategies have significantly reduced the risk of procedural complications and in-hospital mortality of patients with acute coronary syndromes (ACS), thus increasing the population of stable post-ACS patients. This novel epidemiological scenario emphasizes the importance of implementing secondary preventive and follow-up strategies. The follow-up of patients after ACS or elective PCI should be based on common pathways and on the close collaboration between hospital cardiologists and primary care physicians. However, the follow-up strategies of these patients are still poorly standardized. This SICI-GISE/SICOA consensus document was conceived as a proposal for the long-term management of post-ACS or post-PCI patients based on their individual residual risk of cardiovascular adverse events. We defined five patient risk classes and five follow-up strategies including medical visits and examinations according to a specific time schedule. We also provided a short guidance for the selection of the appropriate imaging technique for the assessment of left ventricular ejection fraction and of non-invasive anatomical or functional tests for the detection of obstructive coronary artery disease. Physical and pharmacological stress echocardiography was identified as the first-line imaging technique in most of cases, while cardiovascular magnetic resonance should be preferred when an accurate evaluation of left ventricular ejection fraction is needed. The standardization of the follow-up pathways of patients with a history of ACS or elective PCI, shared between hospital doctors and primary care physicians, could result in a more cost-effective use of resources and potentially improve patient's long-term outcome.
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Affiliation(s)
| | - Francesco Saia
- U.O. Cardiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna
| | | | - Angelo Silverio
- Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università degli Studi di Salerno, Baronissi (SA)
| | | | - Alessandra Scatteia
- Unità di Imaging Cardiovascolare Avanzato, Clinica Villa dei Fiori, Acerra (NA)
| | - Carlo Tedeschi
- U.O. Cardiologia, ASL Napoli 1 Centro, Presidio Intermedio Napoli Est, Napoli
| | | | | | | | | | | | | | | | - Angelo Oliva
- IRCCS Istituto Clinico Humanitas, Rozzano-Milano
| | - Raffaele Piccolo
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli "Federico II", Napoli
| | - Luca Testa
- Dipartimento di Cardiologia, IRCCS Policlinico San Donato, San Donato Milanese (MI)
| | - Tiziana Attisano
- Dipartimento Cardio-Toraco-Vascolare, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno
| | | | | | - Federico De Marco
- U.O. Cardiologia Interventistica Valvolare e Strutturale, Centro Cardiologico Monzino, Milano
| | - Massimo Fineschi
- Cardiologia Interventistica, A.O. Universitaria Senese, Policlinico Le Scotte, Siena
| | - Alberto Menozzi
- S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia
| | - Carmine Musto
- U.O.S. Cardiologia Interventistica, Azienda Ospedaliera San Camillo Forlanini, Roma
| | | | - Giuseppe Tarantini
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Policlinico Universitario, Padova
| | - Francesco Caiazza
- Dipartimento di Cardiologia, Pineta Grande Hospital, Castel Volturno (CE)
| | - Giovanni Esposito
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli "Federico II", Napoli
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Griffo E, Cotugno M, Nosso G, Saldalamacchia G, Mangione A, Angrisani L, Rivellese AA, Capaldo B. Effects of Sleeve Gastrectomy and Gastric Bypass on Postprandial Lipid Profile in Obese Type 2 Diabetic Patients: a 2-Year Follow-up. Obes Surg 2018; 26:1247-53. [PMID: 26435537 DOI: 10.1007/s11695-015-1891-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bariatric surgery (BS) is known to favorably impact fasting lipid profile. Fasting and postprandial lipids were evaluated before and 2 years after BS in obese type 2 diabetic (T2DM) patients. METHODS A prospective study was conducted in 19 obese T2DM patients: ten undergoing sleeve gastrectomy (SG) and nine undergoing Roux-en-Y gastric bypass (RYGB). Before and 2 years after BS, clinical parameters and the response of lipid and incretin hormones to a mixed meal (MM) were assessed. RESULTS The two groups had similar characteristics at baseline. After BS, weight loss was similar in the two groups (p ≤ 0.01). Fasting glucose, insulin, and triglycerides decreased while HDL cholesterol increased in a similar way (p < 0.05); in contrast, fasting LDL cholesterol decreased only after RYGB (p < 0.05). Post-meal glucose concentrations decreased while early insulin response significantly improved after both procedures (p < 0.001 for both). Postprandial triglycerides decreased after both procedures (p < 0.05) while postprandial LDL cholesterol decreased only after RYGB (p < 0.05). Meal-GLP-1 increased postoperatively in both groups although to a greater extent after RYGB (p < 0.001 vs. SG). GIP decreased after both procedures, especially after RYGB (p = 0.003). At multivariate analysis, GLP-1 peak was the best predictor of LDL reduction (β = -0.552, p = 0.039) while the improvement of HOMA-IR (β = 0.574, p = 0.014) and weight loss (β = 0.418, p = 0.036) predicted triglycerides reduction. CONCLUSIONS Both surgical procedures markedly reduce fasting and postprandial triglycerides and increase HDL cholesterol levels. LDL cholesterol decreases only after RYGB through a mechanism likely mediated by the restoration of GLP-1.
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Affiliation(s)
- E Griffo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy.
| | - M Cotugno
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - G Nosso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - G Saldalamacchia
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - A Mangione
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - L Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - A A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - B Capaldo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
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Nosso G, Lupoli R, Saldalamacchia G, Griffo E, Cotugno M, Costabile G, Riccardi G, Capaldo B. Diabetes remission after bariatric surgery is characterized by high glycemic variability and high oxidative stress. Nutr Metab Cardiovasc Dis 2017; 27:949-955. [PMID: 28969883 DOI: 10.1016/j.numecd.2017.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM To evaluate glycemic variability (GV) and oxidative stress in patients who achieved type 2 diabetes (T2DM) remission after bariatric surgery (BS). METHODS AND RESULTS Twenty-two patients (M/F10/12, age 50 ± 9 years, BMI 31 ± 6 kg/m2) who were in remission of T2DM (T2DM remitters) after BS since at least 1 year and 22 age-, sex- and BMI-matched control subjects were studied. Of the BS group, eleven subjects had undergone Roux-en-Y gastric bypass (RYGB) and eleven subjects sleeve gastrectomy (SG). Oral glucose tolerance test (OGTT), 7 days-continuous glucose monitoring, 24-h urinary excretion of 8-isoprostaglandin F2α (8-isoPGF2α) and dietary intake evaluation were performed. According to general linear model for repeated measures, glucose and insulin response during OGTT were significantly different in T2DM remitter than in control subjects (p < 0.001, for both). All measures of GV (standard deviation, coefficient of variation and mean amplitude of glucose excursions) were significantly higher in T2DM remitters than in controls, (p < 0.001 for all). These indexes were higher among RYGB than SG patients (p < 0.05). The time spent out of the 60-160 mg/dl range was significantly longer in T2DM remitters undergoing RYGB than in controls (p < 0.02). Mean 24-h urinary 8-isoPGF2α excretion was significantly higher in T2DM remitters than that of control subjects (p = 0.04). All GV indexes were directly correlated with blood glucose levels at 30 and 60 min during OGTT (p < 0.05-0.001). CONCLUSION Remission of T2DM after BS is characterized by high GV and high oxidative stress in the face of fasting blood glucose and HbA1c within the normal range.
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Affiliation(s)
- G Nosso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - R Lupoli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - G Saldalamacchia
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - E Griffo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - M Cotugno
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - G Costabile
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - G Riccardi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - B Capaldo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy.
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Angrisani L, Santonicola A, Hasani A, Nosso G, Capaldo B, Iovino P. Five-year results of laparoscopic sleeve gastrectomy: effects on gastroesophageal reflux disease symptoms and co-morbidities. Surg Obes Relat Dis 2016; 12:960-968. [PMID: 26775051 DOI: 10.1016/j.soard.2015.09.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/02/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is becoming the most performed bariatric procedure; however, data available on long-term follow-up are scanty. OBJECTIVES The aim of the present study was to evaluate the 5-year efficacy of LSG on weight loss, gastroesophageal reflux disease (GERD) symptoms, and obesity-associated co-morbidities. SETTING Tertiary-care referral hospital. METHODS This study retrospectively analyzed 105 obese patients undergoing LSG from January 2006 to December 2009. The preoperative evaluation included demographic characteristics, evaluation of co-morbidities, a double-contrast barium swallow, and an upper-gastrointestinal endoscopy. The following data were collected at 1, 3, and 5 years after surgery: weight, improvement/remission of co-morbidities, complications, and revisional surgery. RESULTS According to preoperative body mass index (BMI), patients were divided into Group 1 (n = 61) with BMI≤50 kg/m(2) and Group 2 (n = 44) with BMI>50 kg/m(2). The follow-up rate was 94% after 5 years (n = 99). Delta BMI (BMI at follow-up-preoperative BMI) was significantly higher in Group 2 than in Group 1 at 1-3 years and 5 years (P<.001). Furthermore, at 5 years, Group 2 showed a significantly higher percentage total weight loss (%TWL) (26.6%±18.3% versus 33.5%±12.9%, P = .006) than Group 1, whereas percentage excess weight loss was similar (58.4%±21.8% versus 55.3%±19.5%, P = .5).Younger age at surgery and absence of postoperative GERD were associated with a better %TWL at 5 years (P<.001 and P = .03). CONCLUSION LSG is an effective procedure at long-term, with good weight loss outcomes and with a considerable improvement of obesity-associated co-morbidities. Younger age at surgery and absence of postoperative GERD were associated with a better %TWL at 5 years.
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Affiliation(s)
- Luigi Angrisani
- General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy
| | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Ariola Hasani
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - Gabriella Nosso
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Nosso G, Griffo E, Cotugno M, Saldalamacchia G, Lupoli R, Pacini G, Riccardi G, Angrisani L, Capaldo B. Comparative Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Glucose Homeostasis and Incretin Hormones in Obese Type 2 Diabetic Patients: A One-Year Prospective Study. Horm Metab Res 2016; 48:312-7. [PMID: 26788926 DOI: 10.1055/s-0041-111505] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of the work was to compare the hormonal and the metabolic mechanisms involved in weight loss and remission of T2DM one year after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) in morbidly obese type 2 diabetic (T2DM) patients. Insulin sensitivity, insulin secretion, and the gastrointestinal (GI) hormone response to a mixed meal test (MMT) were evaluated before and one year after BS (14 RYGB and 19 VSG). RYGB and VSG groups had similar characteristics at baseline. Weight loss at one year was similar in the 2 groups (ΔBMI%: - 32±10 and - 30±7%, p=0.546). Insulin sensitivity and insulin secretion improved similarly after either procedures with a similar rate in T2DM remission (86% in RYGB and 76% in VSG). Meal-stimulated GLP-1 levels increased after both procedures reaching significantly higher levels after RYGB (p=0.0001). GIP response to MMT decreased to a similar extent after the 2 interventions (p=0.977). Both fasting and post-meal ghrelin concentrations were markedly suppressed after VSG and significantly lower than RYGB (p=0.013 to p=0.035). The improvement of insulin sensitivity and beta-cell function was significantly associated with weight loss (p=0.014 to p=0.035), while no relation was found with the changes in GI hormones. In conclusion, in morbidly obese T2DM patients, RYGB and VSG result in similar improvements of the glucose status in the face of different GI hormonal pattern. Weight loss is the key determinant of diabetes remission one year after surgery.
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Affiliation(s)
- G Nosso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - E Griffo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - M Cotugno
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - G Saldalamacchia
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - R Lupoli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - G Pacini
- Metabolic Unit, CNR Neuroscience Institute, Padova, Italy
| | - G Riccardi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - L Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - B Capaldo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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Nosso G, Capaldo B, Cocozza S, Vaccaro O. A 19 year follow-up of a woman with lipoprotein lipase deficiency treated with biliopancreatic diversion. Clin Case Rep 2016; 3:1030-3. [PMID: 26734140 PMCID: PMC4693709 DOI: 10.1002/ccr3.433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/14/2015] [Accepted: 10/02/2015] [Indexed: 11/12/2022] Open
Abstract
We show the long‐term efficacy and safety of modified biliopancreatic diversion for the treatment of LPL‐deficiency. How this option compares with gene therapy is difficult to evaluate due to limited experience. Surgery may be the first option in patients in whom medical therapy is ineffective and gene therapy not applicable.
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Affiliation(s)
- Gabriella Nosso
- Department of Clinical Medicine and Surgery Federico II University of Naples Via S. Pansini 5 Naples 80131 Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery Federico II University of Naples Via S. Pansini 5 Naples 80131 Italy
| | - Sara Cocozza
- Department of Clinical Medicine and Surgery Federico II University of Naples Via S. Pansini 5 Naples 80131 Italy
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery Federico II University of Naples Via S. Pansini 5 Naples 80131 Italy
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Lupoli R, Cotugno M, Griffo E, Nosso G, Riccardi G, Capaldo B. Role of the Entero-Insular Axis in the Pathogenesis of Idiopathic Reactive Hypoglycemia: A Pilot Study. J Clin Endocrinol Metab 2015; 100:4441-6. [PMID: 26502359 DOI: 10.1210/jc.2015-3309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
CONTEXT Idiopathic reactive hypoglycemia (IRH) is characterized by recurrent episodes of symptomatic hypoglycemia occurring within 4 hours after meals. The underlying mechanisms remain obscure. OBJECTIVE This study aimed to investigate the response of the glucoregulatory and gastrointestinal hormones to an oral glucose load (OGTT) in individuals with documented IRH. DESIGN AND SETTING This was a cross-sectional study composed of outpatients referred to "Federico II" University of Naples. PATIENTS We enrolled subjects with IRH documented by a mixed meal under ordinary life conditions and healthy subjects as controls. MAIN OUTCOME MEASURE We measured plasma glucose, insulin, glucagon-like peptide 1 (GLP-1), GIP, and glucagon response to a 75-g OGTT in cases and controls. RESULTS Ten IRH and eight control subjects were enrolled. During the OGTT, mean plasma glucose tended to be lower in IRH than in control subjects, reaching a statistically significant difference at 240 minutes (T240) (43 ± 1.6 vs 72 ± 0.3 mg/dL; P = .001). Accordingly, the insulin response was higher in IRH than in control subjects (P < .019) with a statistically significant difference (46%) at T90 (P = .045) and was associated with significantly lower glucagon levels in the late phase of the OGTT: at T120 (P = .031) and T180 (P = .048) in IRH than in control subjects. A greater GLP-1 response was found among IRH compared with control subjects (P = .005); GLP-1 peak was 2-fold higher in IRH individuals (9.77 ± 2.52 pmol/L) than in the control group (4.19 ± 0.53 pmol/L; P = .041). In the IRH group, GLP-1 peak inversely correlated with the nadir of plasma glucose (r = -0.66; P = .039). A multivariate analysis confirmed that GLP-1 peak independently predicted the plasma glucose nadir (β = -0.593; P = .026). CONCLUSIONS GLP-1 may play a significant role in the pathogenesis of idiopathic IRH.
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Affiliation(s)
- Roberta Lupoli
- Department of Clinical Medicine and Surgery, "Federico II" University, 80131 Naples, Italy
| | - Mariella Cotugno
- Department of Clinical Medicine and Surgery, "Federico II" University, 80131 Naples, Italy
| | - Ettore Griffo
- Department of Clinical Medicine and Surgery, "Federico II" University, 80131 Naples, Italy
| | - Gabriella Nosso
- Department of Clinical Medicine and Surgery, "Federico II" University, 80131 Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, "Federico II" University, 80131 Naples, Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery, "Federico II" University, 80131 Naples, Italy
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Cotugno M, Nosso G, Saldalamacchia G, Vitagliano G, Griffo E, Lupoli R, Angrisani L, Riccardi G, Capaldo B. Clinical efficacy of bariatric surgery versus liraglutide in patients with type 2 diabetes and severe obesity: a 12-month retrospective evaluation. Acta Diabetol 2015; 52:331-6. [PMID: 25218924 DOI: 10.1007/s00592-014-0644-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/25/2014] [Indexed: 12/22/2022]
Abstract
AIMS To evaluate the clinical efficacy of bariatric surgery vs medical therapy with liraglutide on weight loss, glycemic control and cardiovascular risk profile in patients with type 2 diabetes and severe obesity. METHODS A retrospective evaluation was conducted in 31 patients with type 2 diabetes and severe obesity who had undergone bariatric surgery and in 31 patients with type 2 diabetes and comparable body weight who had added liraglutide to their background medical treatment in the period 2009-2013. Anthropometric parameters, glycemic control, treatment of diabetes and other comorbidities, safety and side effects before and 12 months after treatment were assessed. RESULTS Age was 47 ± 8 years (mean ± SD) in bariatric surgery and 56 ± 9 years in medical treatment group (p < 0.001); body mass index before treatment was 44 ± 7 and 40 ± 4 kg/m(2) in bariatric surgery and medical treatment, respectively (p = 0.03). Twelve months after treatment, average weight loss was 38 ± 15 kg among bariatric surgery patients, and 5 ± 8 kg in medical treatment group (p < 0.001). Glycemic control improved in both groups with greater improvement in bariatric surgery patients. The UKPDS risk score decreased in both groups, although it remained higher in medical treatment than in bariatric surgery patients (p < 0.001). Of note, almost 60 % of patients on liraglutide met the target of glycated hemoglobin <7 % (53 mmol/mol) and lost ≥5 % of body weight. CONCLUSIONS In severely obese type 2 diabetic patients, bariatric surgery reduced body weight and improved overall metabolic control to a greater extent than medical treatment. Randomized clinical studies are necessary.
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Affiliation(s)
- M Cotugno
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
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Griffo E, Nosso G, Lupoli R, Cotugno M, Saldalamacchia G, Vitolo G, Angrisani L, Cutolo PP, Rivellese AA, Capaldo B. Early improvement of postprandial lipemia after bariatric surgery in obese type 2 diabetic patients. Obes Surg 2015; 24:765-70. [PMID: 24374941 DOI: 10.1007/s11695-013-1148-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Bariatric surgery (BS) is able to positively influence fasting lipid profile in obese type 2 diabetic patients (T2DM), but no data is available on the impact of BS on postprandial lipid metabolism neither on its relation with incretin hormones. We evaluated the short-term (2 weeks) effects of BS on fasting and postprandial lipid metabolism in obese T2DM patients and the contribution of changes in active GLP-1. METHODS We studied 25 obese T2DM patients (age = 46 ± 8 years, BMI = 44 ± 7 kg/m2), of which 15 underwent sleeve gastrectomy and 10 underwent gastric bypass. Lipid and incretin hormone concentrations were evaluated for 3 h after ingestion of a liquid meal before and 2 weeks after BS. RESULTS After BS, there was a significant reduction in body weight (p < 0.001), fasting plasma glucose (p < 0.001), fasting plasma insulin (p < 0.05), HOMA-IR (p < 0.001), and fasting plasma lipids (p < 0.05). The meal response of plasma triglycerides, total cholesterol, and HDL cholesterol was significantly lower compared to pre-intervention (p < 0.05, p < 0.001). In particular, the incremental area under the curve (IAUC) of plasma triglycerides decreased by 60% (p < 0.005). The meal-stimulated response of active GLP-1 increased, reaching a statistical significance (p < 0.001). CONCLUSIONS BS leads to an early improvement of fasting and postprandial lipemia. The fall in fasting triglycerides is associated with an improvement of insulin resistance, while the reduction of postprandial lipemia is likely related to reduced intestinal lipid absorption consequent to bariatric surgery.
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Affiliation(s)
- E Griffo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini, 5 80131, Naples, Italy,
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Angrisani L, Cutolo PP, Formisano G, Nosso G, Vitolo G. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 10-year results of a prospective, randomized trial. Surg Obes Relat Dis 2013; 9:405-13. [PMID: 23453785 DOI: 10.1016/j.soard.2012.11.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 11/05/2012] [Accepted: 11/30/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND There are few studies of long-term outcomes for either laparoscopic adjustable gastric banding (LAGB) or laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of this study was to compare outcomes of patients randomly assigned to undergo LAGB or LRYGB at 10 years. METHODS LAGB, using the pars flaccida technique, and standard LRYGB were performed. From January 2000 to November 2000, 51 patients (mean age 34.0 ± 8.9 years; range 20-49) were randomly allocated to undergo either LAGB (n = 27, 5 men and 22 women; mean age 33.3 years; mean weight 120 kg; mean body mass index [BMI] 43.4 kg/m(2)) or LRYGB (n = 24, 4 men and 20 women; mean age 34.7; mean weight 120 kg; mean BMI 43.8 kg/m(2)). Data on complications, reoperations, weight, BMI, percentage of excess weight loss, and co-morbidities were collected yearly. The data were analyzed using Student's t test and Fisher's exact test, with P<.05 considered significant. RESULTS Five patients in the LAGB group and 3 patients in the LRYGB group were lost to follow-up. No patient died. Conversion to laparotomy was performed in 1 (4.2%) of 24 LRYGB patients. Reoperations were required in 9 (40.9%) of 22 LAGB patients and in 6 (28.6%) of the 21 LRYGB patients. At 10-year follow-up, the LRYGB patients had a greater percentage of mean excess weight loss than did the LAGB patients (69±29% versus 46±27%; P = .03). CONCLUSION LRYGB was superior to LAGB in term of excess weight loss results (76.2% versus 46.2%) at 10 years. However, LRYGB exposes patients to higher early complication rates than LAGB (8.3% versus 0%) and potentially lethal long-term surgical complications (internal hernia and bowel obstruction rate: 4.7%).
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Affiliation(s)
- Luigi Angrisani
- General and Laparoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy.
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Cutolo PP, Nosso G, Vitolo G, Brancato V, Capaldo B, Angrisani L. Clinical efficacy of laparoscopic sleeve gastrectomy vs laparoscopic gastric bypass in obese type 2 diabetic patients: a retrospective comparison. Obes Surg 2013; 22:1535-9. [PMID: 22960950 DOI: 10.1007/s11695-012-0657-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are performed in patients with obesity and type 2 diabetes mellitus (T2DM). The aim of this study is to evaluate retrospectively the clinical efficacy of RYGB and SG in two groups of obese T2DM patients. METHODS From the hospital database, we extracted the clinical records of 31 obese T2DM patients, of whom 15 (7 F/8 M) had undergone laparoscopic SG (LSG) and 16 (7 F/9 M) laparoscopic RYGB (LRYGB) in the period 2005-2008. The groups were comparable for age (range 33-59 years) and BMI (range 38-57 kg/m(2)). LRYGB alimentary limb was 150 cm, and biliopancreatic limb was 150 cm from the Treitz ligament. LSG vertical transection was calibrated on a 40-Fr orogastric bougie. Data were analysed at 6, 12 and 18-24 months with reference to weight loss and remission of comorbidities. RESULTS The reduction in body weight was comparable in the two groups. At 18-24 months the percent BMI reduction was 29 ± 8 and 33 ± 11 % in LSG and LRYGB, respectively. Percent excess weight loss was 53 ± 16 and 52 ± 19 % in LSG and LRYGB, respectively. Thirteen patients in LSG and 14 patients in LRYGB discontinued their hypoglycaemic medications. Five (55 %) patients in LSG and eight (89 %) in LRYGB discontinued antihypertensive drugs. Three out of five patients in LSG and one out of two patients in LRYGB withdrew lipid-lowering agents. CONCLUSIONS LSG and LRYGB are equally effective in terms of weight loss and remission of obesity-related comorbidities. Controlled long-term comparisons are needed to establish the optimal procedure in relation to patients' characteristics.
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Affiliation(s)
- P P Cutolo
- General and Laparoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy.
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Nosso G, Angrisani L, Saldalamacchia G, Cutolo PP, Cotugno M, Lupoli R, Vitolo G, Capaldo B. Impact of sleeve gastrectomy on weight loss, glucose homeostasis, and comorbidities in severely obese type 2 diabetic subjects. J Obes 2011; 2011:340867. [PMID: 21423553 PMCID: PMC3056382 DOI: 10.1155/2011/340867] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 12/17/2010] [Accepted: 01/03/2011] [Indexed: 01/06/2023] Open
Abstract
This study was undertaken to assess medium-term effects of laparoscopic sleeve gastrectomy (LSG) on body weight and glucose homeostasis in severely obese type 2 diabetic (T2DM) subjects. Twenty-five obese T2DM subjects (10 M/15 F, age 45 ± 9 years, BMI 48 ± 8 kg/m(2), M ± SD) underwent evaluation of anthropometric/clinical parameters and glucose homeostasis before, 3 and 9-15 months after LSG. Mean BMI decreased from 48 ± 8 kg/m(2) to 40 ± 9 kg/m(2) (P < .001) at 3 months and 34 ± 6 kg/m(2) (P < .001) at 9-15 months after surgery. Remission of T2DM (fasting plasma glucose < 126 mg/dL and HbA1c < 6.5% in the absence of hypoglycemic treatment) occurred in all patients but one. There was a remarkable reduction in the percentage of patients requiring antihypertensive and hypolipidemic drugs. Our study shows that LSG is effective in producing a significant and sustained weight loss and improving glucose homeostasis in severely obese T2DM patients.
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Affiliation(s)
- G. Nosso
- Department of Clinical and Experimental Medicine, University Federico II, Via A. Pansini 5, 80131 Napoli, Italy
- *G. Nosso:
| | - L. Angrisani
- Department of Surgery, S. Giovanni Bosco Hospital, 80144 Napoli, Italy
| | - G. Saldalamacchia
- Department of Clinical and Experimental Medicine, University Federico II, Via A. Pansini 5, 80131 Napoli, Italy
| | - P. P. Cutolo
- Department of Surgery, S. Giovanni Bosco Hospital, 80144 Napoli, Italy
| | - M. Cotugno
- Department of Clinical and Experimental Medicine, University Federico II, Via A. Pansini 5, 80131 Napoli, Italy
| | - R. Lupoli
- Department of Clinical and Experimental Medicine, University Federico II, Via A. Pansini 5, 80131 Napoli, Italy
| | - G. Vitolo
- Department of Clinical and Experimental Medicine, University Federico II, Via A. Pansini 5, 80131 Napoli, Italy
| | - B. Capaldo
- Department of Clinical and Experimental Medicine, University Federico II, Via A. Pansini 5, 80131 Napoli, Italy
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Capaldo B, Galderisi M, Turco AA, D'Errico A, Nosso G, Sidiropulos M, de Divitiis O, Riccardi G. Coronary vasoreactivity is not altered in young people with type 1 diabetes. Nutr Metab Cardiovasc Dis 2010; 20:748-753. [PMID: 20080039 DOI: 10.1016/j.numecd.2009.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 06/16/2009] [Accepted: 06/16/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Abnormal coronary microvascular circulation has been demonstrated in diabetes and is associated with increased rate of cardiovascular events. Our objective was to evaluate coronary vasoreactivity in young people with type 1 diabetes with and without microvascular complications. METHODS AND RESULTS Twenty-five type 1 diabetic patients without microvascular complications (DC-), 23 with microvascular complications (DC+), and 18 control subjects (C) were studied. Coronary vasoreactivity was assessed by means of coronary flow reserve (CFR). Blood flow velocity in the left anterior descending coronary artery was measured at rest and after high-dose dipyridamole using transthoracic color-guided pulsed Doppler echocardiography. CFR was defined as the ratio of hyperaemic to resting diastolic peak flow velocities. The three groups had similar cardiac function parameters, and also systolic and diastolic blood pressure at rest, which remained unchanged during dipyridamole infusion. Resting coronary flow velocity was comparable in C, DC-, and DC+ (p=ns). Dipyridamole infusion produced a threefold increase in coronary diastolic peak velocity, which reached similar values in C (0.69±0.16 m/s), DC- (0.69±0.18 m/s), and DC+ (0.66±0.11 m/s). Mean CFR ratio was similar in C (3.33±0.66), DC- (3.30±0.51), and DC+ (3.24±0.60). At multiple linear regression analysis, no association was found between CFR and age, sex, HbA(1c), duration of diabetes, and complications. CONCLUSION Coronary vasodilatory function is preserved in young D patients, even those with early microvascular complications, suggesting that coronary vasoreactivity deteriorates at more advanced stages of microvascular complications and/or in the presence of other cardiovascular risk factors.
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Affiliation(s)
- B Capaldo
- Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy.
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Cutolo PP, Angrisani L, Nosso G, Saldalamacchia G, Vitolo G, Persico F, Capaldo B. SHF-07: Laparoscopic sleeve gastrectomy vs laparoscopic roux-en-Y gastric bypass in obese type 2 diabetic patients: Are they comparable? Surg Obes Relat Dis 2010. [DOI: 10.1016/j.soard.2010.03.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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