Gastrointestinal Complications of Obesity Camilleri, Michael, M.D; Malhi, Harmeet, M.B.B.S; Acosta, Andres, M.D., Ph.D
Gastroenterology (New York, N.Y. 1943),
05/2017, Volume:
152, Issue:
7
Journal Article
Peer reviewed
Open access
Abstract Obesity is usually associated with morbidity related to diabetes mellitus and cardiovascular diseases. However, there are many gastrointestinal and hepatic diseases for which obesity is the ...direct cause e.g. non-alcoholic fatty liver diseases (NAFLD) or is a significant risk factor, such as reflux esophagitis and gallstones. When obesity is a risk factor, it may interact with other mechanisms and result in earlier presentation or complicated diseases. There are increased odds ratios or relative risks of several gastrointestinal complications of obesity: gastroesophageal reflux disease (GERD), erosive esophagitis, Barrett’s esophagus, esophageal adenocarcinoma, erosive gastritis, gastric cancer, diarrhea, colonic diverticular disease, polyps, cancer, liver disease including NAFLD, cirrhosis, hepatocellular carcinoma, gallstones, acute pancreatitis, and pancreatic cancer. Gastroenterologists are uniquely poised to participate in the multidisciplinary management of obesity as physicians caring for people with obesity-related diseases, in addition to their expertise in nutrition and endoscopic interventions.
•Government success in reducing stunting resulted from greater policy coordination.•Pooled nutrition funding enhanced incentives for institutional coordination.•Longer term commitment to nutrition ...was reinforced through electoral campaigning.•Civil society pushed nutrition advocacy and monitoring efforts through a coordination platform.•Nutrition targets became binding when linked to poverty reduction strategies.
The dramatic reduction in children’s chronic malnutrition in Peru observed in recent years has defied the patterns of stunting reduction worldwide. After nearly a decade of stalled progress, the government reported a reduction in stunting rates of nearly 10 points, from 29.8% in 2005 to 18.1% in 2011. The specialized literature has acknowledged the critical role that immediate (e.g. increasing breastfeeding promotion) and underlying (e.g. investments to improve household food security) interventions have played in reducing stunting (Black et al., 2013), as well as the contributing role of enabling factors related to economic performance. This paper offers an alternative explanation to success by looking at the shift in the government’s nutrition strategy after 2006 with the formation of the Child Malnutrition Initiative (CMI), a civil society working platform, and the adoption of a national poverty reduction strategy prioritizing nutrition interventions (known as CRECER) and conditional cash transfers (JUNTOS). The paper uses veto players theory to explain how these changes effectively contributed to policy change by reducing the effective number of nutrition stakeholders involved and facilitating policy agreements around a common policy platform and established goals. The Peruvian case also highlights the importance of the government’s public commitment to reduce chronic malnutrition in children under five by 5 percent in 5years (“5 by 5 by 5”) and the accompanying role, advocacy and monitoring from civil society organizations.
The paper looks at the success of implementing the nutrition strategy in three dimensions. Horizontally, it looks at the coordination between government and non-government agencies to converge around a common policy discourse;vertically, it looks at the implementation of the nutrition strategy across national, regional and municipal governments;and financially, it looks at the coordinated and conditional allocation of nutrition funding and how this created greater incentives for horizontal and vertical coordination. The paper draws some theoretical and policy implications for improving the effective and accountable delivery of nutrition interventions in Peru and other countries outside Latin America.
The rapid growth in the past decade in transparency and accountability initiatives (TAIs) in the extractive industries sector reflects attempts to devise institutional mechanisms to make governments ...accountable for the extraction, allocation and use of revenues that, if well invested, could alleviate socio‐economic inequalities among citizens. Understanding and measuring the impact and effectiveness of these initiatives is a matter of proposing and empirically validating a causal link between interventions and governance improvements. To do this requires improved data collection, reporting and analysis; a stronger focus on the allocation and use of government expenditures that come from natural‐resource wealth; and a better understanding of importance of incentives and sanctions for ensuring effective impact.
Testicular cancer is rare overall but comprises the most common solid malignancy diagnosed in young men aged ∼20–40 years. Most testicular neoplasms generally fall into 2 broad categories: germ cell ...tumors (GCTs; ∼95%) and sex cord-stromal tumors (SCSTs ∼5%). Given the relative rarity of these tumors, diagnostic biomarkers are highly relevant for their diagnosis. Over the past several decades, diagnostic biomarkers have improved dramatically through targeted immunohistochemical and molecular characterization. Despite these recent advances, most markers are not perfectly sensitive or entirely specific. Therefore, they need to be used in combination and interpreted in context. In this review, we summarize tissue-based biomarkers relevant to the pathologist, with a focus on practical diagnostic issues that relate to testicular GCT and SCST.
•Testicular germ cell tumors (GCTs) and sex cord stromal tumors (SCSTs) are infrequent and often require the use of biomarkers for diagnosis.•New tissue-based immunohistochemical and molecular biomarkers have demonstrated potential value for the diagnosis and prognostication of testicular GCTs and SCSTs.•The development of additional biomarkers that identify the small but clinically relevant subset of testicular GCT and SCST that behaves aggressively is needed.
Mixed adenoneuroendocrine carcinomas (MANECs) are composite neoplasms with areas of adenocarcinoma or squamous cell carcinoma intermingled with neuroendocrine carcinoma or neuroendocrine tumor, each ...composing at least 30% of the neoplasm. MANECs are very infrequent overall, and they are more commonly diagnosed in the appendix, colon, and stomach. Biliary MANECs are particularly rare, and their histogenesis is debated because neuroendocrine cells are seldom identified in the normal biliary tract. They can show one of the 3 different architectural patterns described in Lewin's original classification: collision tumors, combined lesions, or amphicrine neoplasms. The neuroendocrine component is usually of a high grade, with small or large cell cytomorphology, whereas the adenocarcinoma component is either an intestinal or biliary type. Clinical presentation is characterized by locally advanced disease at the time of initial diagnosis. Recent studies suggest that treatment should be guided by the most aggressive histologic component.
Localized Surface Plasmon Resonance (LSPR) is an optical method for detecting changes in refractive index by the interaction between incident light and delocalized electrons within specific metal ...thin films' localized "hot spots". LSPR-based sensors possess advantages, including their compact size, enhanced sensitivity, cost-effectiveness, and suitability for point-of-care applications. This research focuses on the development of LSPR-based nanohole arrays (NHAs) as a platform for monitoring probe/target binding events in real time without labeling, for low-level biomolecular target detection in biomedical diagnostics. To achieve this objective, this study involves creating a liquid-phase setup for capturing target molecules. Finite-difference time-domain simulations revealed that a 75 nm thickness of gold (Au) is ideal for NHA structures, which were visually examined using scanning electron microscopy. To illustrate the functionality of the liquid-phase sensor, a PDMS microfluidic channel was fabricated using a 3D-printed mold with a glass slide base and a top glass cover slip, enabling reflectance-mode measurements from each of four device sectors. This study shows the design, fabrication, and assessment of NHA-based LSPR sensor platforms within a PDMS microfluidic channel, confirming the sensor's functionality and reproducibility in a liquid-phase environment.
Vasculogenic mesenchymal lesions (VMLs) of germ cell tumor origin are thought to originate in postpubertal-type yolk sac tumor components and include a spectrum of lesions from teratoma with ...vasculogenic stroma (TVS), to low and high-grade vasculogenic mesenchymal tumors (VMTs). VMLs exhibit rudimentary to well-developed neoplastic vessels within primitive mesenchyme, being considered a neoplastic reiteration of embryonic vasculogenesis in the splanchnic mesoderm of the yolk sac. They occur in patients with primary mediastinal germ cell tumors after chemotherapy, and a subset progresses to “somatic-type” sarcomas including angiosarcoma (AS), with high-grade VMTs likely portending a higher risk. Recently, we encountered a low-grade VMT that progressed to metastatic AS during follow-up. In this case, both the low-grade VMT and the subsequent AS demonstrated p53 overexpression, suggesting that p53 alterations may precede histopathologic transformation. To test this hypothesis, we evaluated neoplasms representing the entire spectrum of VMLs using p53 immunohistochemistry (IHC; clone DO-7, Dako). Overexpression was defined as nuclear positivity in > 80% of neoplastic cells. Because the distinction between high-grade VMT and AS can be subjective in some cases, they were grouped together in a single category. Thirty-nine VMLs were assessed: 16 high-grade VMT/AS, 19 low-grade VMT, and 4 TVS. Patient age ranged from 19 to 46 years (mean, 30 years; male = 97%). Four high-grade VMT/AS and one low-grade VMT showed p53 overexpression (5/39 VMLs, 13%; 4/16 high-grade VMT/AS, 25%). These tumors included 1 unequivocal AS and 1 high-grade VMT/AS with progression to rhabdomyosarcoma. The only low-grade VMT with p53 overexpression demonstrated progression to AS. Another high-grade VMT that progressed to sarcoma demonstrated p53 overexpression in the sarcoma component, but it was excluded because the VMT was not represented in the material available at the time of the study. Lesions with intratumoral grade heterogeneity (classified based the highest grade), demonstrated more pronounced p53 overexpression in the high-grade components. P53 overexpression is associated with disease progression in a subset of VMTs and may precede morphologic transformation to sarcoma. Routine evaluation of VMTs with p53 IHC seems justified, with overexpressors likely requiring an close clinical surveillance.
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