Ileal interposition effectively improves glucose tolerance in streptozotocin-diabetic and euglycemic rats. Enhanced insulin secretion can explain the lowered glucose concentrations in euglycemic rats following ileal interposition. Ileal interposition is associated with dramatically elevated ileal hormones, GLP-1, PYY, and glucagon (p < 0.01) with no change in the duodenal hormone GIP.

Goodin SZ, Keichler AR, Smith M, Wendt D, Strader AD. Effect of gonadectomy on AgRP-induced weight gain in rats. Am J Physiol Regul Integr Comp Physiol 295: R1747-R1753, 2008. First published October 15, 2008 doi:10.1152/ajpregu.90345.2008.-Agouti-related peptide (AgRP), the endogenous antagonist to the melanocortin 3 and 4 receptors, elicits robust hyperphagia and weight gain in rodents when administered directly into the central nervous system. The relative influence of AgRP to cause weight gain in rodents partially depends on the activity level of the melanocortin agonist-producing proopiomelanocortin neurons. Both proopiomelanocortin and AgRP neurons within the arcuate nucleus receive energy storage information from circulating peripheral signals such as leptin and insulin. Another modulator of AgRP activity includes the cell surface molecule syndecan-3. Because leptin and insulin affect food intake in a sexually dimorphic way in rodents and syndecan-3-deficient mice regulate adiposity levels through distinct physiological mechanisms, we hypothesized that AgRP-induced weight gain would also be sexually dimorphic in rats. In the present study, the behavioral and physiological effects of centrally-administered AgRP in male and female were investigated. In male rats, AgRP (1 nmol) induced 5 days (P Ͻ 0.0001) of significantly elevated feeding compared with vehicletreated controls, while females displayed 3 days of hyperphagia (P Ͻ 0.05). However, 1 wk after the injection, both male and female rats gained the same percent body weight (6%). Interestingly, female rats exhibited a greater reduction in energy expenditure (VO 2) following AgRP compared with male rats (P Ͻ 0.05). Removal of the gonads did not alter cumulative food intake in male or female rats but did attenuate the dramatic reduction in VO 2 exhibited by females. Both intact and gonadectomized rats demonstrated significantly increased respiratory quotient supporting the anabolic action of AgRP (P Ͻ 0.01). These findings are novel in that they reveal sex-specific underlying physiology used to achieve weight gain following central AgRP in rats.AgRP; melanocortin; energy expenditure; sex; food intake THE HYPOTHALAMUS OF THE CENTRAL nervous system contains multiple circuits that are critical for the regulation of energy balance. Behavioral, genetic, and anatomical data all point to the melanocortin system as being one of the most important of the hypothalamic pathways that regulate body weight (8,16,20). Despite the wealth of research on the melanocortin regulatory system, little effort has been dedicated to male and female differences in melanocortin signaling. Nearly all previous work on energy balance and the melanocortin system has focused on male rodents.It is widely accepted that the hypothalamus receives input from the periphery that relates to the current adiposity level of an animal. Primarily, these peripheral signals are the adiposederived hormone leptin and the pancreatic hormone insulin (7,22). These adiposity signals are relayed to the hyp...

Background Retinopathy is associated with increased mortality risk in general populations. We evaluated the joint effect of retinopathy and chronic kidney disease (CKD) on mortality in a representative sample of US adults. Study Design Prospective cohort study. Setting & Participants 7,640 adults from the National Health and Nutrition Examination Survey (NHANES) 1988–1994 with mortality linkage through 12/31/2006. Predictors CKD, defined as low estimated glomerular filtration rate (eGFR; <60 ml/min/1.73 m2) or albuminuria (urine protein-creatinine ratio ≥30mg/g), and retinopathy, defined as presence of microaneurysms, hemorrhages, exudates, microvascular abnormalities, or other evidence of diabetic retinopathy by fundus photograph. Outcomes All-cause and cardiovascular mortality. Measurements Multivariable-adjusted Cox proportional hazards. Results Overall, 4.6% of participants had retinopathy and 15% had CKD. Mean age was 56 years, 53% were women and 81% non-Hispanic white. Prevalence of retinopathy in CKD was 11%. We identified 2,634 deaths during 14.5 years’ follow-up. In multivariable analyses, compared with individuals with neither CKD nor retinopathy, the HRs for all-cause mortality were 1.02 (95% CI, 0.75–1.38), 1.52 (95% CI, 1.35–1.72), and 2.39 (95% CI, 1.77–3.22) for individuals with retinopathy only, for those with CKD only, and for those with both CKD and retinopathy, respectively. Corresponding HRs for cardiovascular mortality were 0.96 (95% CI, 0.50–1.84), 1.72 (95% CI, 1.47–2.00) and 2.96 (95% CI, 2.11–4.15), respectively. There was a significant synergistic interaction between retinopathy and CKD on all-cause mortality (p=0.04). Limitations Presence of retinopathy was evaluated only once. Small sample size of some of the subpopulations studied. Conclusions In the presence of CKD, retinopathy is a strong predictor of mortality in this adult population.

The spleen is the most commonly injured organ after blunt abdominal trauma. Nonoperative management with splenic arterial embolization (SAE) is the current standard of care for hemodynamically stable patients. Current data favor the use of proximal and coil embolization techniques in adults, while observation is suggested in the pediatric population. In this review, the authors describe the most recent evidence informing the clinical indications, techniques, and complications for SAE.

Background:Management of aneurysms associated with deep collateral vessels in moyamoya disease is challenging both from an endovascular and a surgical standpoint. Difficulties with access or localization, and compromise of the collateral circulation with subsequent ischemia are the primary concerns, making direct obliteration potentially unfeasible or risky. Alternatively, superficial temporal artery–middle cerebral artery bypass is another potential strategy for resolution of these aneurysms.Case Description:Presented are the findings and management for a patient with moyamoya disease and bilateral deep collateral vessel aneurysms, successfully treated with endovascular obliteration following a right-sided hemorrhage and subsequently with bypass for an unruptured but growing contralateral aneurysm.Conclusions:A rationale and approach to management is outlined, as derived from review of the current literature and the illustrative case with bilateral collateral vessel aneurysms.