Citations

Atrial natriuretic peptide (ANP) is suggested to stimulate lipolysis, which has been demonstrated using supraphysiological doses of ANP. We explored the effects of physiological doses of ANP, as observed during an acute exercise bout, on lipolysis, ketogenesis, and glucose metabolism. Ten healthy men was randomized to infusion of ANP vs. placebo using stable isotope labeled tracers. The present study indicates that lipid metabolism does not seem to be regulated by ANP in men.

INTRODUCTION: The study aimed to develop consensus recommendations for the safe and appropriate use of liquid nitrogen spray cryotherapy in Barrett's esophagus and esophageal cancer. METHODS: Statements were initially formulated and grouped into categories of indications, training, preprocedure, intraprocedure, and postprocedure recommendations, frequency/timing of repeat procedures, and contraindications. Two investigators assessed the strength of the evidence for each statement using Grading of Recommendations Assessment, Development, and Evaluation methodology. Nineteen experts were invited to participate in a modified Delphi process. For statements that received >80% agreement, minor iterative edits were performed until there was unanimous consensus. If a threshold of 80% agreement was not reached, the statement was modified based on feedback and included in the next Delphi round. Statements were rejected if no consensus was reached after 3 rounds. RESULTS: After 3 Delphi rounds, 41 of 42 statements were accepted either in their original version (n = 11) or after modification based on expert input (n = 30). DISCUSSION: Through a modified Delphi process, we developed expert and evidence-based consensus recommendations to guide safe and appropriate use of liquid nitrogen spray cryotherapy in Barrett's esophagus and esophageal cancer.

Since the discovery of the first psychoactive medications, their psychiatric and medical uses have overlapped. Designating a medication psychiatric or psychotropic is thus arbitrary, based on its most common usage, but labeling it so obscures the full range of its pharmacologic activity and clinical utility. Psychotropic medications (PMs) are frequently used to treat medical conditions or symptoms in the areas of neurology (e.g., migraine, seizure disorder), dermatology (e.g., itching), gastroenterology, and chronic pain, among many others. It is important for both primary care and specialty physicians to be aware of the potential non-psychiatric indications for the use of common PMs such as antidepressants, antipsychotics, and anxiolytics. This review examines the potential benefits and risks of PMs when used for non-psychiatric indications, highlighting how their pharmacologic effects on neurotransmitters contribute to both therapeutic outcomes and adverse effects. It also provides guiding principles for prescribers, including the importance of adjusting doses based on the specific indication, monitoring for harmful side effects, considering age-related factors, and addressing the risks associated with polypharmacy.

Background and objective: Heart failure (HF) is associated with high morbidity, mortality, and healthcare costs. Its prevalence continues to rise, particularly in the context of ageing populations and increasing rates of metabolic comorbidities such as type 2 diabetes and obesity. We aimed to assess the therapeutic potential of repurposing PPARα agonists for the treatment of HF. Method: We conducted a comprehensive literature review to evaluate preclinical and clinical evidence investigating the potential of PPARα agonist drugs in reducing HF. We did not apply any restrictions on the study design. Results: The current body of evidence consists of preclinical mechanistic studies, emerging pharmacogenetic data, and post hoc analyses of large randomised clinical trials (RCTs) that included HF endpoints. No dedicated, HF-specific RCTs of PPARα agonists were identified. These studies support the hypothesis that PPARα agonists may link metabolic modulation with cardiac remodelling. Preclinical models demonstrate potential therapeutic benefits, such as enhanced myocardial energy metabolism and attenuation of fibrosis and inflammation, as well as context-dependent risks, including possible deleterious effects in advanced HF or off-target mechanisms. Prior failures of fibrates to improve cardiovascular outcomes in some trials and concerns in PPARα-deficient states underscore the complexity of metabolic therapies in HF. These findings support a more stratified, phenotype-driven approach to therapy. RCTs specifically designed to evaluate HF outcomes are essential to clarify whether PPARα agonists can complement established neurohormonal treatments, particularly in the context of the rising burden of HFpEF associated with obesity and type 2 diabetes. Conclusions: PPARα agonists represent a promising class within the emerging therapeutic framework of metabolic heart failure. They are inexpensive, generally well tolerated, and address several pathophysiological mechanisms of HF. Preliminary evidence suggests that fenofibrate may delay or prevent HF in high-risk diabetic populations. However, rigorous, dedicated trials are needed to establish their clinical utility.

Abstract Background: Vagal nerve injury can cause non-specific symptoms and is challenging to assess. Pancreatic polypeptide (PP) release after sham feeding is a surrogate marker of vagal function. This study evaluated vagal integrity using sham feeding-induced PP measurement, and examined associations between symptoms, PP levels, and gastric emptying. Method: This was a retrospective study of patients who underwent sham feeding from 2018 to present. We collected demographic and clinical data, sham feeding results, indication for study, gastric emptying data. A 50% increase in PP level within 30 mins compared to baseline was considered normal. A gastric emptying scan was classified as delayed if < 75% of the material emptied at 4 hours. Results: 53 patients were included (58.5% women) with a mean age of 57.2 years. The main GI symptoms were nausea and vomiting (21, 40.0%) and diarrhea (14, 26.4%). 36 of 53 patients had a history of abdominal surgery, with Nissen fundoplication including open and laparoscopic being the most common surgeries (10, 27.8%). The fold of PP changes between abnormal and normal groups are significantly different (p = 0). In 23 patients with symptoms of nausea and vomiting, symptoms of nausea and vomiting were found to have a robust correlation with a positive sham feeding result (21, 91.3%), compared with gastric emptying scintigraphy (14, 60.9%). Conclusion: Sham feeding is consistently abnormal in patients with predominant symptoms of nausea and vomiting while the correlation between gastric scintigraphy result and gastroparesis symptoms was not significant. Sham feeding may be a valuable test when assessing patients with symptoms of nausea and vomiting.