Changes in Serum Fatty Acid Levels During the First Year After Bariatric Surgery

Background

We have assessed the effects of laparoscopic sleeve gastrectomy (LSG) and biliopancratic diversion with a duodenal switch (BPDDS) on fatty acid (FA) levels in serum. In particular, we examine the impact of surgery on the ratio of the FAs eicosapentaenoic acid (EPA) to arachidonic acid (AA) which impacts, e.g., cardiovascular health. Our hypothesis is that LSG and BPDDS influence the FA levels but that BPDDS may have a more persistent impact since BPDSS superimposes intestinal malabsorption on gastric restriction.

Methods

Serum samples after overnight fasting were collected 3 months and 1 day before surgery and 3 days, 3 months, and 12 months after surgery from 10 BPDDS patients and 23 LSG patients. The levels of 16 FAs were quantified by gas chromatography. Preoperative and postoperative concentrations of EPA and AA and the ratio of EPA to AA were compared by Wilcoxon signed-rank test corrected for multiple testing using false discovery rate.

Results

The ratio of EPA/AA at each of the three postoperative sampling points was lower than at the two preoperative sampling points for BPDDS with p?<?0.05 after correcting significance levels for multiple testing. For LSG, the ratio was lower with p?<?0.05 at 3 days and at 3 months after surgery, but not after 12 months.

Conclusion

Both LSG and BPDDS lower the ratio of EPA/AA significantly and below recommended values, but LSG patients resurge toward normal values after approximately 12 months, while BPDDS patients do not.

     

Relationship between serum cystatin C and serum adiponectin level in type 2 diabetic patients

Background

To investigate the relationship between serum levels of cystatin C and adiponectin in patients with type 2 diabetes.

Methods

We examined serum cystatin C and adiponectin levels in 234 patients with type 2 diabetes who visited our hospital.

Results

The serum level of cystatin C was positively correlated with age (P?P?=?0.013), serum creatinine (P?P?P?P?Conclusions Serum adiponectin level was correlated with serum cystatin C level on simple and multiple regression analyses in patients with type 2 diabetes. Although circulating adiponectin is increased in advanced kidney disease, it might be biologically inactive due to binding to cystatin C and thus not display an anti-arteriosclerotic effect.     

Association of 276G>T adiponectin gene polymorphism to plasma adiponectin and albuminuria in type 2 diabetic patients

Purpose

The 276G>T polymorphism of the adiponectin (ADIPOQ) gene has been correlated with plasma adiponectin, type 2 diabetes (T2D) and its complications. Studies of the role of 276G>T polymorphism in the prevalence of T2D kidney disease are few and contradictory; ethnic differences might play a role. We aimed to assess the relationship of this polymorphism with albuminuria in a cohort of Caucasian T2D patients.

Methods

Consecutive T2D outclinic patients were screened and included upon informed consent; exclusion criteria were glomerular filtration rate (GFR) <30?ml/min, acute intercurrent illness and urinary tract infection. History, standard laboratory evaluation, total plasma adiponectin and genotyping for the 276 ADIPOQ locus were obtained.

Results

One hundred and three T2D patients were included. Forty-three (41.7%) of them had GG genotype, 50 (48.5%) had GT and 10 (9.7%) had TT genotype. Plasma adiponectin was significantly higher in TT-allele carriers (19.03?±?3.46???g/ml) than in GT (10.14?±?1.78???g/ml) and GG carriers (8.71?±?1.60???g/ml), P?=?0.003. Adiponectin was higher in albuminuric (13.97?±?2.07???g/ml) than in normoalbuminuric patients (6.91?±?0.88???g/ml), P?=?0.004. The prevalence of T allele was higher in normoalbuminuric patients [36 (69.2%) GT?+?TT carriers] than in albuminuric ones [24 (47.1%)], P?=?0.02. Logistic regression identified the following as predictors of albuminuria: GG genotype: P?=?0.003 (OR 4.2; CI 1.61?C10.96); low GFR: P?=?0.003 (OR 0.97; CI 0.95?C0.99); and high plasma adiponectin: P?=?0.012 (OR 1.07; CI 1.01?C1.14).

Conclusions

Our data suggest that 276G>T polymorphism of the ADIPOQ gene is associated with plasma adiponectin levels. By influencing adiponectinemia, 276G>T polymorphism might predict the presence of albuminuria in Caucasian T2D patients.     

Laparoscopic Adjustable Gastric Banding Reduces Subcutaneous Adipose Tissue and Blood Inflammation in Nondiabetic Morbidly Obese Individuals

Background

Significant and sustained excess weight loss (EWL) appears to reduce the risk of obesity-related comorbidities (insulin resistance, hyperlipidemia, and inflammation), but this has been primarily shown in adult diabetic obese patients. We evaluated whether the EWL obtained 3 years after laparoscopic adjustable gastric banding (LAGB) improves the metabolic phenotype in nondiabetic morbidly obese (NDMO) individuals from south Italy.

Methods

Serum and subcutaneous adipose tissue (SAT) samples from 20 obese individuals (median BMI?=?41.5 kg/m²) before (T0) and after LAGB (T1) and from 10 controls (median BMI?=?22.8 kg/m²) were taken. Serum leptin, adiponectin, C reactive protein (CRP), and main analyte levels were evaluated by routine methods or immunoassay. In SAT, adipocyte size was measured by hematoxylin/eosin staining, cluster of differentiation 68 (CD68) macrophage infiltration marker by immunohistochemistry, and adiponectin, adiponectin receptors 1 and 2, and interleukin 6 (IL6) messenger RNAs by qRT-PCR.

Results

The average EWL was 66.7 %, and CRP, triglycerides, hepatic markers, leptin levels, homeostasis model assessment, and the leptin/adiponectin ratio were lower (p?p?p?R ²?=?0.905) of EWL (dependent variable) was explained by CD68, adiponectinemia, triglyceridemia, CRP, and total protein levels.

Conclusions

The EWL obtained 3 years after LAGB resulted in an improvement of lipid metabolism and a reduction of inflammation in NDMO patients, thereby decreasing the risk of obesity-associated diseases.     

Hypoadiponectinemia and its Association with Liver Fibrosis in Morbidly Obese Patients

Background

Reduced serum levels of adiponectin have been associated with insulin resistance and non-alcoholic fatty liver disease (NAFLD). However, the relationship between serum adiponectin levels and hepatic histology in NAFLD is controversial. The aim of this study was to explore associations between plasma adiponectin concentrations and liver histology in morbidly obese patients.

Methods

We conducted a case–control study including obese patients undergoing bariatric surgery and normal controls. Anthropometric, standard biochemical variables as well as plasma adiponectin and leptin levels were determined. Liver biopsy was performed in all patients at the time of surgery.

Results

Seventy morbidly obese patients (mean BMI, 40.6?±?5.6 kg/m²) met the inclusion criteria and were compared with 69 controls (mean BMI, 22.8?±?1.6 kg/m², p?=?0.0001). Thirty patients (43%) had NAFLD and 20 (28%) of them fulfilled the histological criteria for steatohepatitis. Obesity was associated with increased leptin and decreased adiponectin levels. NAFLD patients exhibited decreased levels of serum adiponectin compared with matched controls [median (Q1–Q3), 3.9 (3.2–4.3) vs. 8.6 (6.5–9.2) μg/mL, p?<?0.0001]. In univariate analysis, age, gender, type 2 diabetes mellitus, BMI, HOMA-IR, aspartate aminotransferase (AST), alanine aminotransferase, serum glucose, and adiponectin levels were independently associated with hepatic fibrosis. In multivariate analysis, AST [OR?=?1.082 (1.000–1.170)], age [OR?=?1.119 (1.023–1.225)], and serum adiponectin levels [OR?=?0.529 (0.299–0.936)] were significantly associated with the presence of liver fibrosis.

Conclusions

NAFLD patients have lower plasma adiponectin concentrations than control subjects. Low adiponectin levels are associated with more severe liver histology. Serum adiponectin may be useful to estimate the severity of liver damage in obese patients with NAFLD.     

The omega-6 arachidonic fatty acid, but not the omega-3 fatty acids, inhibits osteoblastogenesis and induces adipogenesis of human mesenchymal stem cells: potential implication in osteoporosis

Summary

Arachidonic fatty acid (AA) induces adipogenesis in human mesenchymal stem cells cultures, and high concentrations inhibit osteoblastogenesis; whereas eicosapentaenoic and docosahexaenoic fatty acids do not induce adipogenesis and do not inhibit osteoblastogenesis. In mesenchymal stem cells, omega-6 arachidonic polyunsaturated fatty acid promotes the differentiation of adipocytes and inhibits the osteoblast differentiation. While omega-3 fatty acids do not affect the adipogenic differentiation their effects on osteoblastogenesis are less relevant. An increased ratio of omega-3/omega-6 fatty acid consumption can prevent bone mass loss.

Introduction

Consumption of omega-3 may protect against osteoporosis since they may inhibit osteoclastogenesis. However, with aging, MSC in bone marrow are increasingly differentiated into adipocytes, reducing the number of osteoblasts. Products derived from omega-6 and omega-3 metabolism may affect MSC differentiation into osteoblasts and adipocytes.

Methods

Human MSC have been differentiated into osteoblasts or adipocytes in the presence of omega-6 (AA), or omega-3 (DHA and EPA), and osteoblastic and adipocytic markers have been analyzed.

Results

AA decreases the expression of osteogenic markers and the osteoprotegerin/receptor activator of nuclear factor kappa β ligand gene expression ratio (opg/rankl). High concentrations of AA inhibit the mineralization and cause the appearance of adipocytes in MSC differentiating into osteoblasts to a higher extent than DHA or EPA. In MSC differentiated into adipocytes, AA increases adipogenesis, while DHA and EPA do not affect it. AA caused the appearance of adipocytes in undifferentiated MSC. The lipoxygenase gene (alox15b) is induced by omega-3 in MSC induced to osteoblasts, and by omega-6 in MSC induced to adipocytes.

Conclusions

An increase in the intake of omega-3 respect to omega-6 may provide protection against the loss of bone mass, since omega-6 favors the osteoclastic activity by diminishing the opg/rankl gene expression in osteoblasts and promotes MSC differentiation into adipocytes, thus diminishing the production of osteoblasts.     

The Relationships Between IGF-1 and CRP, NO, Leptin, and Adiponectin During Weight Loss in the Morbidly Obese

Background

The relationship between C-reactive protein (CRP), nitric oxide (NO), leptin, adiponectin, and insulin growth factor 1 (IGF-1) is poorly defined in morbidly obese patients before and after gastric bypass and, in some cases, is controversial.

Methods

We examined the plasma of 34 morbidly obese patients before and 1, 6, and 12 months after Roux-en-Y gastric bypass surgery.

Results

Obese people had more CRP (21.3?±?1.8 μg/ml) and leptin (36.9?±?4.0 ng/ml) than those in the control group (nonobese people: CRP?= 6.9?±?0.9 μg/ml, p?<?0.0001; leptin?= 7.5?±?0.4 ng/ml, p?<?0.0001). However, they had less NO (30.4?±?2.7 nmol/ml), IGF-1 (77.5?±?6.6 ng/ml), and adiponectin (11.1?±?1.0 μg/ml) than those in the control group (NO?= 45.8?±?3.9 nmol/ml, p?=?0.0059; IGF-1?= 202.0?±?12.0 ng/ml, p?<?0.0001; adiponectin?= 18.0?±?2.0 μg/ml, p?<?0.0001). During weight loss, the amount of CRP and leptin decreased until they reached the nonobese values, but the level of NO remained lower than in nonobese people, even 1 year after surgery. The linear regression slopes were negative and very significant for leptin (p?=?0.0005) and CRP (p?=?0.0018) but were less significant for NO (p?=?0.0221). IGF-1 displayed a very good linear regression (both negative and significant) with some anthropometric parameters, including body mass index (p?=?0.0025), total fat (p?=?0.0177), and the percentage of fat (p?<?0.0001).

Conclusion

For the first time, we report the relationship between IGF-1 and CRP, NO, leptin, and adiponectin. For all these parameters, the best and most widely demonstrated improvements in comorbidities before and during weight loss in morbid obesity were associated with CRP and leptin.     

Single institution’s experience in laparoscopic appendectomy as a suitable therapy for complicated appendicitis

Purpose

Although laparoscopic appendectomy (LA) for acute appendicitis (AA) is widely performed, the value of LA for the treatment of complicated appendicitis (CA) is still controversially discussed.

Methods

In a retrospective study, we analyzed the clinical records of 404 patients who underwent LA or conversion (intention-to-treat group) or open appendectomy (OA) for AA or CA at the Alfried Krupp Hospital Essen-Rüttenscheid, Germany between January 2007 and December 2010.

Results

AA was treated in 64.2 % by LA and in 35.8 % by OA; the LA-to-OA conversion rate amounts to 3.7 %. CA was treated in 56 % by LA and in 44 % by OA. The LA-to-OA conversion rate here is 13.1 %, and compared to AA, it is significantly (P?<?0.01) higher. Comparing LA with OA in both patient groups, we find no significant difference in the overall complication rate, the rate of postoperative intraabdominal abscesses and postoperative ileus. However, in both patient groups, the wound infection rate was significantly lower in patients who had undergone LA (AA P?<?0.05 versus CA P?<?0.01). In contrast to patients suffering from AA, patients with CA needed significantly less resurgery when treated by LA as compared to OA (P?<?0.001). While the duration of surgery for the treatment of AA and CA was similar, the hospitalization time was significantly shorter with LA than with OA (AA P?<?0.05 versus CA P?<?0.001).

Conclusions

The data suggest that LA is advantageous not only in the treatment of AA, but also in the therapy of CA. Thus, LA may become a proper and safe routine method if performed by an experienced surgeon.     

Obesity and Inflammation: Change in Adiponectin, C-Reactive Protein, Tumour Necrosis Factor-Alpha and Interleukin-6 After Bariatric Surgery

Background

Obesity is associated with a low-grade inflammatory state. A causal association between inflammation and atherosclerosis has been suggested. The aim of this study was to evaluate changes in the proinflammatory profile of morbidly obese patients after weight loss following bariatric surgery.

Methods

In this study, we measured levels of adiponectin, high-sensitivity C-reactive protein (hs-CRP), tumour necrosis factor-alpha (TNF-??) and interleukin-6 (IL-6) and their relation to insulin resistance and lipid parameters in 60 morbidly obese women at baseline and 3, 6 and 12?months after gastric bypass.

Results

Twelve months after surgery, there was a significant increase in plasma levels of adiponectin (p?p?p?p?p?p?p?p?p?p?r?=?0.53, p?r?=?0.51, p?r?=?0.55, p?r?=?0.40, p?=?0. 004), triglycerides (r?=?0.34, p?=?0.017), insulin (r?=?0.50, p?=?0.001) and HOMA (r?=?0.46, p?=?0.002).

Conclusions

In patients with morbid obesity, significant weight loss is followed by a significant improvement in the inflammatory state, insulin sensitivity and lipid profile. A relationship exists between improved inflammatory profile and insulin sensitivity.     

Association between high-molecular-weight adiponectin and bone mineral density in hemodialysis patients

Background

Chronic kidney disease-mineral and bone disorder is a regular complication seen in hemodialysis patients and leads to substantial increases in the fracture rate, morbidity, and mortality. Discovered a few years ago, several clinical studies have shown a negative correlation between adiponectin and bone mineral density (BMD) independently of confounding factors. The relationship between adiponectin and bone metabolism in hemodialysis patients has not been fully described yet. We conducted this study to investigate the relationship between serum adiponectin concentration and the BMD in hemodialysis patients.

Methods

We enrolled 92 hemodialysis patients who were receiving maintenance hemodialysis therapy at Towa Hospital. A peripheral blood sample was obtained, and standard biological data and the serum high-molecular-weight (HMW) adiponectin level were measured. BMD was assessed using dual-energy X-ray absorptiometry scans.

Results

In male hemodialysis patients, BMD was negatively related to age (r = ?0.299, P = 0.012), duration of hemodialysis therapy (r = ?0.31, P = 0.009), and log [HMW-adiponectin] (r = ?0.31, P = 0.009) and positively related to body weight (r = 0.332, P = 0.004) and BMI (r = 0.297, P = 0.013). In female hemodialysis patients, BMD was negatively related to age (r = ?0.499, P = 0.018) and log [HMW-adiponectin] (r = ?0.46, P = 0.030) and positively related to triglyceride (r = 0.491, P = 0.020).

Einheilung vaskularisierter Knochenallotransplantate

Background

Living bone allotransplants (ATs) currently require long-term immunosuppression (IS), but this is impractical for extremity-preserving procedures. An alternative method to maintain viability of the transplant uses host-derived neoangiogeneic vessels combined with short-term IS.

Materials and Methods

Diaphyseal femoral defects in Dutch-Belted rabbits were reconstructed with a free microvascular AT from New Zealand White rabbits. Additionally, a host-derived intramedullary pedicled fascial flap was placed and short-term IS administered to two of four groups. Neovascularization and bone healing were quantified by microangiography and a custom radiographic score.

Results

Bone ATs with perfused fascial flaps achieved bone healing equivalent to autotransplant controls, even when they received IS only until host-derived neoangiogenesis replaced the original perfusion. Vascularized ATs without this combination achieved significantly inferior results.

Summary

This rabbit model demonstrated that increased bone turnover allows good healing but may temporarily weaken the allotransplant. However, by the more intense replacement of the graft with host-derived cells, this process may, in the long-term, ultimately result in a better transplant than an avascular graft.     

Free fatty acid storage in human visceral and subcutaneous adipose tissue: role of adipocyte proteins

OBJECTIVE

Because direct adipose tissue free fatty acid (FFA) storage may contribute to body fat distribution, we measured FFA (palmitate) storage rates and fatty acid (FA) storage enzymes/proteins in omental and abdominal subcutaneous fat.

RESEARCH DESIGN AND METHODS

Elective surgery patients received a bolus of [1-¹⁴C]palmitate followed by omental and abdominal subcutaneous fat biopsies to measure direct FFA storage. Long chain acyl-CoA synthetase (ACS) and diacylglycerol acyltransferase activities, CD36, fatty acid-binding protein, and fatty acid transport protein 1 were measured.

RESULTS

Palmitate tracer storage (dpm/g adipose lipid) and calculated palmitate storage rates were greater in omental than abdominal subcutaneous fat in women (1.2 ± 0.8 vs. 0.7 ± 0.4 μmol ⋅ kg adipose lipid⁻¹ ⋅ min⁻¹, P = 0.005) and men (0.7 ± 0.2 vs. 0.2 ± 0.1, P < 0.001), and both were greater in women than men (P < 0.0001). Abdominal subcutaneous adipose tissue palmitate storage rates correlated with ACS activity (women: r = 0.66, P = 0.001; men: r = 0.70, P = 0.007); in men, CD36 was also independently related to palmitate storage rates. The content/activity of FA storage enzymes/proteins in omental fat was dramatically lower in those with more visceral fat. In women, only omental palmitate storage rates were correlated (r = 0.54, P = 0.03) with ACS activity.

CONCLUSIONS

Some adipocyte FA storage factors correlate with direct FFA storage, but sex differences in this process in visceral fat do not account for sex differences in visceral fatness. The reduced storage proteins in those with greater visceral fat suggest that the storage factors we measured are not a predominant cause of visceral adipose tissue accumulation.Excess visceral fat is associated with greater metabolic risk (1,2), whereas preferential lower body fat accumulation is not (3). The mechanisms by which some individuals gain fat in one depot at the expense of another are unknown, but surely relate to an imbalance between storage and release of fatty acids (FAs). The patterns of regional free FA (FFA) release suggest that lipolysis defects cannot explain adipose tissue distribution patterns (4–6). Likewise, meal fat storage patterns do not completely explain regional variations in adipose tissue accumulation (7–11).The direct FFA storage pathway, which is lipoprotein lipase (LPL) independent, exists in both animal (12) and human (13–15) adipose tissue in vivo. Furthermore, qualitative patterns of postabsorptive, direct adipose tissue FFA storage mirror that of body fat distribution (14). Direct FFA storage in men, but not women, is greater in the upper body than lower body subcutaneous fat, and women store FFA more efficiently in subcutaneous fat than men. Hannukainen et al. (16), using positron emission tomography scan technology, found that FFA storage rates are greater in visceral than subcutaneous fat in nonobese men, similar to what we observed in nonobese women (15).Because the direct FFA storage pathway seems to help determine body fat distribution, gaining insight into the adipocyte factors regulating FA incorporation into triacylglycerols may help explain depot differences in fat storage. Potential adipocyte specific rate-limiting steps include 1) facilitated FA transport across the plasma membrane, mediated by proteins such as CD36, plasma membrane-associated fatty acid-binding protein (FABP[pm]), and fatty acid transport protein 1 (FATP1); 2) acylation, which leads to activation/trapping of intracellular FAs, mediated by the activity of a number of fatty acyl-CoA synthetases (ACSs); and 3) the final step of triacylglycerol formation, mediated by diacylglycerol acyltransferase (DGAT).In this study, we measured direct FFA storage into visceral and abdominal subcutaneous adipose tissue using isotope tracer/adipose biopsy techniques. Our hypothesis was that men, typically having more visceral fat than women, would have greater direct FFA storage in omental than abdominal subcutaneous adipose tissue and greater direct omental FFA storage than women. We also measured factors related to the FA storage steps described above and studied their relation to direct FFA storage into adipocyte triglyceride. We hypothesized that depot differences in these factors would correlate with regional, sex-specific FFA storage differences. The results provide evidence for major between-depot and between-individual differences in the FA storage factors that relate to direct FFA storage.     

Trace Element Status and Inflammation Parameters after 6?Months of Roux-en-Y Gastric Bypass

Background

Knowledge about the practical consequences of the nutritional status of Fe, Zn, and Cu and inflammation in obesity is limited. The objective of this study was to evaluate changes on trace element status and their potential associations with selected inflammation parameters in patients after Roux-en-Y gastric bypass (RYGBP).

Methods

Sixty-three women (mean age, 36.9?±?9.2 years, body mass index, 43.8?±?4.3 kg/m²) were evaluated at baseline and 6 months after RYGBP. Anthropometric (weight, waist circumference), body composition (fat mass and fat-free mass), dietary (nutrient intakes), and metabolic and inflammation (glucose, insulin, HOMA-IR, adiponectin, HDL-cholesterol, LDL-cholesterol, triglycerides, hs-CRP, leukocytes, polymorphonuclear neutrophils (PMN)) parameters were determined in addition to selected indices of Fe, Zn, and Cu status.

Results

All but one (HDL-cholesterol) metabolic and inflammation parameters had significant differences when compared before and after RYGBP. Hemoglobin, serum ferritin, the size of the rapidly exchangeable zinc pool, and plasma copper decreased after RYGBP. Plasma and hair zinc, as well as zinc protoporphyrin increased. The change in Hb was significantly associated (p?r?=?0.33) and adiponectin (r?=??0.44). Zinc protoporphyrin change was associated to the change in PMN (r?=?0.32) and HDL-cholesterol (r?=??0.29). No other associations between the changes of the rest of Fe, Zn, and Cu parameters with the changes of any of the metabolic and inflammation parameters were observed.

Conclusion

RYGBP produced significant weight and fat mass losses, with improvement of metabolic and inflammation parameters. Iron, zinc, and copper status were impaired after the surgery.     

Routine Anterior Approach During Right Hepatectomy: Results of a Prospective Randomised Controlled Trial

Trial Design

A prospective randomised controlled trial was designed to evaluate the advantages of routine application of the anterior approach during right hepatectomy.

Methods

The study was conducted between March 2005 and April 2009 in a tertiary hepatobiliary?Cpancreatic centre. Patients scheduled for right hepatectomy for primary or metastatic tumours, without infiltration of segment 1, inferior vena cava or main bile duct, were randomly assigned to right hepatectomy using either an anterior or a classic approach. The primary study endpoint was overall blood loss.

Results

Sixty-six patients were randomly allocated to undergo right hepatectomy with an anterior (AA group n?=?33) or a classic approach (CA group n?=?33). Sixty-five patients were included in the analysis (33 in AA group and 32 in CA group). There was no significant difference in patient age, diagnosis, preoperative hepatic biochemistry and tumour size between the two groups. Overall blood loss (437?ml?±?664 in AA group vs.500?ml?±?532.3 in CA group; p?=?0.960) and bleeding during transection (p?=?0.973) were similar between two groups. Perioperative blood transfusion rates were 18?% in the AA group and 9.3?% in the CA group (p?=?0.253). Time of parenchymal transsection was significantly longer in AA group (75.1?±?26.6?min vs. 56.7?±?17.5?min, p?=?0.01). There was no difference between both groups for postoperative prothrombin time, serum transaminase and total bilirubin levels. One patient died in each group (p?=?0.746). The two groups had similar morbidity rates.

Conclusion

Routine application of the anterior approach during right hepatectomy does not decrease intraoperative blood loss and morbidity rate.     

Subcuticular Absorbable Suture with Subcutaneous Drainage System Prevents Incisional SSI after Hepatectomy for Hepatocellular Carcinoma

Background

The effectiveness of subcuticular absorbable suture with subcutaneous drainage to decrease the risk of postoperative incisional surgical site infection (SSI) in hepatocellular carcinoma (HCC) patients was evaluated.

Methods

A total of 149 patients with HCC who underwent hepatectomy (Hx) were retrospectively investigated. Patients were divided into two groups: the patients with subcuticular suture combined with subcutaneous drainage (the drainage group; 61 patients) and the patients with nylon suture without subcutaneous drainage (the nylon group; 88 patients). After the operations, the complication rate of postoperative incisional SSI was analyzed and compared between the two groups.

Results

In the drainage group the rate of incisional SSI was significantly lower compared to the nylon group: 14–3?% (p?=?0.033), respectively. Patients with incisional SSI needed significantly longer postoperative hospital care than the patients without incisional SSI: 28 versus 15?days (p?p?=?0.034).

Conclusions

We have demonstrated that the subcuticular suture with subcutaneous drainage is effective in preventing incisional SSI in patients undergoing Hx for HCC.     

Fibronectin Gene Expression in Human Adipose Tissue and Its Associations with Obesity-Related Genes and Metabolic Parameters

Background

Limited data are available on the in vivo expression of fibronectin, one of the main extracellular matrix components. We investigated the expression of fibronectin in abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and the associations of leptin, adiponectin, and vaspin gene expression with metabolic parameters in obese women.

Methods

We recruited female subjects undergoing bariatric surgery for obesity (n?=?24) and patients undergoing benign gynecological surgery as the control group (n?=?23). We measured anthropometric variables, abdominal fat distribution, metabolic parameters, serum concentrations of leptin, adiponectin, and vaspin, and depot-specific mRNA expression of fibronectin, leptin, adiponectin, and vaspin.

Results

Fibronectin expression in both VAT and SAT was significantly lower in the obese group than in the control group. Fibronectin expression in both VAT and SAT were negatively correlated with body mass index or waist circumference, with higher prominence in VAT. In multiple regression analysis, fibronectin expression in both VAT and SAT was negatively correlated with serum leptin concentration. Fibronectin expression in VAT was negatively correlated with leptin expression in VAT. Additionally, fibronectin expression in SAT was negatively correlated with leptin expression in SAT and positively correlated with adiponectin expression in VAT and SAT.

Conclusions

We found significant negative associations between depot-specific fibronectin expression in human adipose tissue and obesity indices and obesity-related biomarkers. Our results suggest that fibronectin expression may contribute to obesity and metabolic dysregulation in humans.     

Differential Changes in Exercise Performance After Massive Weight Loss Induced by Bariatric Surgery

Background

Exercise performance and pulmonary function are often impaired in severely obese subjects. Bariatric surgery represents the most effective therapy for severe obesity, but data on changes in exercise performance after massive weight loss induced by bariatric surgery have rarely been assessed so far.

Methods

Exercise performance was obtained by bicycle spiroergometry in 18 severely obese patients before and at least 1 year after bariatric surgery. Additionally, pulmonary function was assessed by spirometry.

Results

BMI was reduced from 46.3?±?1.6 to 33.5?±?1.4 kg/m² after surgery. Pulmonary function (forced expiratory volume within 1 s; inspiratory vital capacity) improved after weight loss (both p?≤?0.01). At peak exercise, heart rate (HR) peak, absolute oxygen uptake (VO₂) peak, and load peak did not differ between both assessments (all p?>?0.25). However, relative (related to actual body weight) VO₂ peak and workload peak were higher after than before surgery (both p?≤?0.005), while gross efficiency peak and ventilatory equivalent peak remained unchanged (both p?>?0.30). At anaerobic threshold (AT), patients showed lower HR AT and absolute VO₂ AT after than before surgery (both p?<?0.05), while absolute workload AT did not differ (p?=?0.58). In turn, relative VO₂ AT did not change (p?=?0.30), whereas relative workload AT was higher after surgery (p?=?0.04). Also, ventilatory efficiency AT and gross efficiency AT tended to be improved (both p?=?0.08). Before surgery, the patients performed 27.0 % of VO₂ peak above their AT, while this fraction increased to 35.3 % (p?=?0.006).

Conclusions

Results indicated differential changes in exercise performance, with the relative but not the absolute peak performance being improved after massive weight loss. Interestingly, anaerobic exercise tolerance was markedly improved after surgery.     

The Association of Caveolin-1 Genotypes with Oral Cancer Susceptibility in Taiwan

Background

Caveolin-1, which has been proposed as a candidate tumor suppressor, plays a regulatory role in several signaling pathways. The aim of this study was to evaluate the association between oral cancer susceptibility and Cav-1 genotypes. In this hospital-based case-control study, the association of Cav-1 polymorphisms with oral cancer risk in a central Taiwanese population was investigated.

Methods

Six hundred patients with oral cancer and 620 age- and sex-matched healthy control subjects were genotyped and analyzed by polymerase chain reaction–restriction fragment length polymorphism.

Results

There were significant differences between oral cancer and control groups in the distributions of their genotypes (P = 1.7 × 10^?18 and 2.6 × 10^?4) and allelic frequencies (P = 3.3 × 10^?19 and 9.5 × 10^?6) in the Cav-1 G14713A (rs3807987) and T29107A (rs7804372) polymorphisms, respectively. As for the combined genotype analysis, those who had GG/AT or GG/AA at Cav-1 G14713A/T29107A showed a 0.72-fold (95% confidence interval = 0.52–0.99) decreased risk of oral cancer compared to those with GG/TT, while those of any other combinations were of increased risk. The presence of metastasis was also correlated to both Cav-1 G14713A AA and Cav-1 T29107A TT genotypes.

Conclusions

Cav-1 is involved in oral cancer, the A allele of the Cav-1 G14713A is risky, the A allele of the Cav-1 T29107A is protective, and AA/TT on these two polymorphisms may be the most risky combined genotype for the development of oral cancer and may be novel risk markers for early detection and prediction of distant metastasis.     

Determinants of undercarboxylated and carboxylated osteocalcin concentrations in type 1 diabetes

Summary

To determine whether undercarboxylated osteocalcin (UC-OC) or gamma-carboxyglutamic-carboxylated-type osteocalcin (GLA-OC) concentrations deviate from normal in type 1 diabetes (T1D), serum levels were compared between 115 subjects with T1D and 55 age-matched healthy controls. UC-OC and GLA-OC concentrations were similar between groups; however, in T1D, UC-OC correlated positively with markers of insulin exposure, either endogenously produced or exogenously administered.

Introduction

A study was conducted to determine whether dysregulation of circulating concentrations of UC-OC or GLA-OC occurs in patients with type 1 diabetes, a condition of insulin deficiency without insulin resistance.

Methods

We measured serum concentrations of UC-OC and GLA-OC in 115 subjects with T1D, ages 14–40?years, and in 55 age-matched healthy control subjects. Relationships between UC-OC and GLA-OC concentrations and patient characteristics (gender and age), indices of glycemic control (hemoglobin A1c (HbA1c), fasting plasma glucose, C-peptide concentration, 3-day average glucose measured by a continuous glucose sensor, total daily insulin dose) and circulating indices of skeletal homeostasis (total calcium, 25-OH vitamin D, parathyroid hormone, insulin-like growth factor 1 (IGF-1), type 1 collagen degradation fragments (CTX), adiponectin, leptin) were examined. Between group differences in the concentrations of UC-OC and GLA-OC were the main outcome measures.

Results

Although adiponectin levels were higher in the T1D group, between-group comparisons did not reveal statistically significant differences in concentration of UC-OC, GLA-OC, CTX or leptin between the T1D and control populations. Instead, by multivariate regression modeling, UC-OC was correlated with younger age (p?p?p?=?0.013), and higher IGF-1 (p?=?0.086). Moreover, within the T1D subgroup, UC-OC was positively correlated with C-peptide/glucose ratio (reflecting endogenous insulin secretion), with IGF-1 (reflecting intra-portal insulin sufficiency), and with total daily insulin dose.

Conclusions

In T1D, UC-OC appears to correlate positively with markers of insulin exposure, either endogenously produced or exogenously administered.