Correlation of ultrasonographic measurement of intrarenal arterial resistance index with microalbuminuria in nonhypertensive, nondiabetic obese patients

Purpose

To determine whether intrarenal arterial resistance index (RI) value is related to increased urinary albumin excretion and whether RI value is an independent good indicator to evaluate early renal damage in nonhypertensive, nondiabetic obese subjects.

Methods

Sixty-four nonhypertensive, nondiabetic obese patients (OB) and 35 age- and sex-matched normal healthy subjects were involved in this study. Clinical characteristics and blood biochemistry of all the subjects were measured. Urinary albumin/creatinine ratio (ACR) and sonographic evaluation of renal blood flow were determined.

Results

ACR and interlobar arterial RI were significantly higher in obese patients than those of normal healthy subjects. Interlobar arterial RI value was higher in patients with microalbuminuria than those with normoalbuminuria. Correlation analysis showed interlobar artery RI value had a positive correlation with ACR (r = 0.615, p < 0.01) and plasma free fatty acids (FFAs, r = 0.407, p < 0.01). ACR had a positive correlation with BMI (r = 0.380, p < 0.01), waist circumference (r = 0.414, p < 0.01), plasma FFAs (r = 0.537, p < 0.01). Multivariate regression analyses showed that ACR was best predicted by interlobar artery RI value even when body mass index, waist circumference, FFAs, and high-sensitive C reaction protein were added in the statistical analysis.

Conclusions

Interlobar arterial RI may be an independent predictor of microalbuminuria in nonhypertensive, nondiabetic obese patients, and interlobar arterial RI could be a useful tool for assessment early renal damage in obese patients.     

Urinary and glomerular podocytes in patients with chronic kidney diseases

Backgrounds

Podocytes are highly differentiated epithelial cells involved in glomerular filtration. This study determines the clinical and histological significance of podocyte detachment and excretion in urine in patients with chronic kidney diseases.

Methods

Renal biopsy was performed in 59 patients (30 males, 29 females; mean age 48 ± 2 years), including 24 patients with immunoglobulin (Ig)A nephropathy, six each with focal segmental glomerulosclerosis, membranous nephropathy, and minimal change nephrotic syndrome, and 17 with other renal disorders. The number of glomerular podocytes and severity of morphological damage were evaluated in renal biopsy samples. Urinary podocytes were detected by anti-human podocalyxin antibody. The urinary IgG/albumin ratio and urinary peroxide products were assessed by gel electrophoresis and the 2′,7′-dichlorodihydrofluorescein-diacetate method, respectively.

Results

A decrease in glomerular podocytes was associated with age (r = ?0.33; P < 0.05), glomerulosclerosis (r = ?0.43; P < 0.01), tubulointerstitial lesions (r = ?0.46; P < 0.01), and low estimated glomerular filtration rates (r = 0.32; P < 0.05). Increased urinary podocyte excretion correlated with proteinuria (r = 0.36; P < 0.01), and was observed more frequently in patients with active histological lesions. Podocyte loss correlated with lower selectivity of proteinuria in patients with minimal change nephrotic syndrome and focal segmental glomerulosclerosis (r = ?0.90; P < 0.001). Moreover, urinary peroxide products increased in association with glomerulosclerosis (r = 0.39; P < 0.05).

Conclusions

Urinary podocyte excretion reflects ongoing glomerular injury in various kidney diseases, and podocyte loss correlated with glomerulosclerosis and impaired selectivity of proteinuria.     

Serum level of soluble (pro)renin receptor is modulated in chronic kidney disease

Background

Prorenin, the precursor of renin, binds to the (pro)renin receptor [(P)RR] and triggers intracellular signaling. The ligand binding sites of (P)RR are disconnected and are present in the soluble form of the receptor in serum. Given that the clinical significance of serum prorenin and soluble (P)RR in chronic kidney disease (CKD) is unclear, we investigated the relationship between serum prorenin, soluble (P)RR, and various clinical parameters in patients with CKD.

Methods

A total of 374 patients with CKD were enrolled. Serum samples were collected, and the levels of soluble (P)RR and prorenin were measured using ELISA kits. Serum creatinine (Cr), blood urea nitrogen (BUN), uric acid (UA), hemoglobin (Hb), soluble secreted α-Klotho, and the urine protein/Cr ratio were also measured. Similarly, clinical parameters were also evaluated using serum and urine sample collected after 1 year (n = 204).

Results

Soluble (P)RR levels were positively associated with serum Cr (P < 0.0001, r = 0.263), BUN (P < 0.0001, r = 0.267), UA (P < 0.005, r = 0.168) levels, CKD stage (P < 0.0001, r = 0.311) and urine protein/Cr ratio (P < 0.01, r = 0.157), and inversely with estimated glomerular infiltration rate (eGFR) (P < 0.0001, r = ?0.275) and Hb (P < 0.005, r = ?0.156). Soluble (P)RR levels were inversely associated with α-Klotho levels (P < 0.001, r = ?0.174) but did not correlate with prorenin levels. With respect to antihypertensive drugs, soluble (P)RR levels were significantly lower in patients treated with an angiotensin II receptor blocker (ARB) than in those without ARB therapy (P < 0.005). Soluble (P)RR levels were significantly lower in CKD patients with diabetes mellitus or primary hypertension than in those without these conditions (P < 0.05). In contrast, serum levels of prorenin did not correlate with parameters related to renal function. Serum prorenin levels were significantly higher in CKD patients with diabetes mellitus than in nondiabetic patients (P < 0.05), but not in CKD patients with hypertension (P = 0.09). Finally, with respect to the relationship between basal soluble (P)RR levels and the progression rates of renal function, soluble (P)RR levels were positively associated with ΔCr (P < 0.05, r = 0.159) and inversely associated with ΔeGFR (P < 0.05, r = ?0.148).

Conclusion

Serum levels of soluble (P)RR correlated with the stage of CKD. Our findings suggest that soluble (P)RR may be involved in renal injury and influence the progression of CKD.     

Study of tonsillectomy for IgA nephropathy patients: short- and longer-term observation

Objective

We observed serum parameters and urinary findings of IgA nephropathy (IgAN) patients in the short and longer time after tonsillectomy, to provide evidences to clarify the role of tonsils in the pathogenesis of IgAN and the feasibility of tonsillectomy for IgAN patients.

Methods

For the short-term study, 19 patients with both IgAN and chronic tonsillitis (group A) and 19 patients with chronic tonsillitis (group B) were performed bilateral tonsillectomy and 19 healthy people as normal controls (group C). Another 115 patients with IgAN and chronic tonsillitis including 61 patients for tonsillectomy combined with drug therapy and 54 for drug therapy alone followed up for 12 months.

Results

Fourteen patients of group A showed a deterioration of urinary findings, while only 2 patients of group B showed deterioration (P < 0.01). Both serum IgA and IgA1 levels were significantly higher in group A than that in group B or group C (P < 0.05, respectively). Levels of serum IgA and IgA1 of group A increased after tonsillectomy and did not increase instantly, but increased at day 3, then decreased at day 5. Both serum IgA and IgA1 levels were positively related to urinary red blood cell count (P < 0.01, r _s = 0.362, r _s = 0.347, respectively). For longer-term study, urinary findings of IgAN patients underwent tonsillectomy were improved significantly than that of patients without tonsillectomy (P < 0.05).

Conclusion

Tonsils play an important role in the development of IgAN, and tonsillectomy may be a feasible treatment method for IgAN patients with chronic tonsillitis.     

Correlation Between Fluid–Fluid Levels on Initial MRI and the Response to Chemotherapy in Stage IIB Osteosarcoma

Background

The presence of fluid–fluid levels (FFLs) on osteosarcoma magnetic resonance imaging (MRI) is underestimated as a nonspecific finding; however, we hypothesized that FFL in conventional osteosarcoma may be indicative of chemoresistance.

Methods

In 567 stage IIB osteosarcoma patients, we evaluated the following: the incidence of FFL and their correlation with other clinicopathological variables; tumor volume change after chemotherapy and survival according to the presence of FFL; and the relationship between survival and the extent of FFL.

Results

One hundred eight (19 %) tumors showed FFL on initial MRI. FFL were correlated with proximal humeral location (P = 0.017), osteolytic on plain radiographs (P < 0.001), tumor enlargement after chemotherapy (P < 0.001), and poor histological response (P = 0.005). Large tumor (P < 0.01), proximal tumor location (P = 0.01), and presence of FFL (P < 0.01) were independent predictors of poor survival. Compared to the extensive FFL (more than one third of the tumor), small foci of FFL (less than one third of the tumor) showed a high tendency for tumor enlargement after chemotherapy (P < 0.001), poor histologic response (P = 0.001), and worse survival (P < 0.001).

Conclusions

FFL on initial MRI could predict tumor progression after chemotherapy. Notably, tumors with small foci of FFL (less than one third of the tumor) have a high propensity for poor outcome. Patients with this finding should be considered for risk-adapted therapy.     

A randomized controlled trial of preinsertion ultrasound guidance for spinal anaesthesia in pregnancy: outcomes among obese and lean parturients

Purpose

The present study was conducted to examine if preinsertion lumbar ultrasound scanning helps with performance of spinal puncture, as a tool for decreasing the number of puncture attempts and spinal procedure time and increasing the success rate. We hypothesized that ultrasound can facilitate neuraxial blockade, particularly in pregnant women with difficult topographic anatomy.

Methods

One hundred (50 lean, BMI <30 kg/m², and 50 obese, BMI ≥30 kg/m²) parturients scheduled for cesarean delivery were divided into ultrasound and control groups. Subarachnoid block was performed with prepuncture ultrasound examination in lean parturients (group 1, n = 25) and in obese parturients (group 2, n = 25), and subarachnoid block was performed without prepuncture ultrasound examination in lean parturients (group 3, n = 25) and in obese parturients (group 4, n = 25). The number of puncture attempts and puncture levels were recorded.

Results

A lower number of puncture attempts and fewer puncture levels were detected in ultrasound (US) groups (p < 0.001). First attempt success rate under US guidance was 92 % in comparison to 44 % using a conventional technique in obese parturients (p < 0.001). In 52 % of the lean patients and in 54.2 % of the obese patients, the intercristal line was at the L3–L4 and at the L2–L3 interspace, respectively. The duration of spinal procedure was shorter in US groups (22 vs. 52 s, p = 0.031). We found a high correlation between ultrasound and needle depth (r = 0.709, p < 0.001).

Conclusions

We found a high level of success in the prepuncture ultrasound-determined insertion point. The ultrasound imaging technique can be a reliable guide to facilitate spinal anesthesia, especially in obese parturients.     

An Elevated Body Mass Index Does Not Reduce Survival After Esophagectomy for Cancer

Background

Incidences of esophageal cancer and obesity are both rising in the United States. The aim of this study was to determine the influence of elevated body mass index on outcomes after esophagectomy for cancer.

Methods

Overall and disease-free survivals in obese (BMI ≥ 30), overweight (BMI 25–29), and normal-weight (BMI 20–24) patients undergoing esophagectomy constituted the study end points. Survivals were calculated by the Kaplan–Meier method, and differences were analyzed by log rank method.

Results

The study included 166 obese, 176 overweight, and 148 normal-weight patients. These three groups were similar in terms of demographics and comorbidities, with the exception of younger age (62.5 vs. 66.2 vs. 65.3 years, P = 0.002), and higher incidence of diabetes (23.5 vs. 11.4 vs. 10.1%, P = 0.001) and hiatal hernia (28.3 vs. 14.8 vs. 20.3%, P = 0.01) in obese patients. Rates of adenocarcinoma histology were higher in obese patients (90.8 vs. 90.9 vs. 82.5%, P = 0.03). Despite similar preoperative stage, obese patients were less likely to receive neoadjuvant treatment (47.6 vs. 54.5 vs. 66.2%, P = 0.004). Response to neoadjuvant treatment, type of surgery performed, extent of lymphadenectomy, rate of R0 resections, perioperative complications, and administration of adjuvant chemotherapy were not influenced by BMI. At a median follow-up of 25 months, 5-year overall and disease-free survivals were longer in obese patients (respectively, 48, 41, 34%, P = 0.01 and 48, 44, 34%, P = 0.01).

Conclusions

In our experience, an elevated BMI did not reduce overall and disease-free survivals after esophagectomy for cancer.     

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).

Determinants of plasma brain natriuretic peptide levels in untreated hypertensive patients

Background

Plasma brain natriuretic peptide (BNP) level is elevated in patients with left ventricular (LV) hypertrophy reflecting not only altered LV geometry but LV systolic and/or diastolic dysfunction. However, the values and limitations of BNP measurements are unclear in patients with untreated hypertension. In this study, plasma BNP level was compared with LV geometric and functional characteristics in patients with untreated hypertension.

Methods

Plasma BNP level was measured in 115 patients with untreated hypertension (72 males, 43 females, aged 60 ± 12 years). Routine echo parameters of LV geometry and LV systolic and diastolic performance were also determined.

Results

LV ejection fraction was 67 ± 6% and plasma BNP level was 32 ± 30 pg/ml. Plasma BNP levels correlated with age, LV mass index (LVMI), and mitral E velocity, respectively (r = 0.46, p < 0.05; r = 0.21, p < 0.05; r = 0.29, p < 0.05, respectively), but not with systolic blood pressure or relative wall thickness (r = 0.01; r = ?0.02). Plasma BNP level correlated with E/E′ ratio (r = 0.27, p < 0.05, n = 77). When a stepwise multivariate analysis was performed, E velocity was selected in addition to age and LVMI as significant correlates of plasma BNP level.

Conclusions

LVMI and E velocity were independent determinants of plasma BNP level in patients with untreated hypertension. Plasma BNP level is substantially useful for the screening of abnormalities of LV geometry and/or function in patients with untreated hypertension. Additional echocardiography is useful to assess the mechanism of the elevation of plasma BNP level in untreated hypertensive patients.     

Effects of obesity on the outcome of laparoscopic surgery for colorectal cancer

Purpose

This study evaluated the feasibility and safety of laparoscopic colorectal surgery for cancer in obese patients based on the short-term outcomes.

Methods

We conducted a retrospective analysis of 561 patients with colorectal cancer treated from April 2007 to October 2010. The surgical outcomes were compared between non-obese (BMI <25 kg/m²) and obese (BMI ≥25 kg/m²) patients.

Results

All of the enrolled patients were classified as non-obese (n = 421) or obese (n = 140). The obese group had a significantly higher proportion of male patients (72.1 vs. 57.0 %; P = 0.002), a higher incidence of left colon cancer (49.3 vs. 36.8 %; P = 0.033), and more systematic comorbidities (P < 0.001) than did the non-obese group. The length of the surgery was significantly longer in obese than in non-obese patients (221 vs. 207 min; P = 0.025). There was no significant difference in the overall incidence of postoperative complications between the two groups; however, surgical wound infections were more common in obese patients (12.1 vs. 5.2 %; P = 0.005). Obesity was not a significant-independent risk factor for total postoperative complications (odds ratio 1.330; P = 0.289).

Conclusion

Laparoscopic colorectal surgery is technically feasible and safe for obese patients and provides all the benefits of a minimally invasive approach.     

Influence of anthropometric features on graft diameter in ACL reconstruction

Background

There is a paucity of literature regarding the influence of anthropometric features on the hamstring graft obtained in ACL reconstruction. This study was undertaken to assess the influence of anthropometric measurements on the graft diameter obtained at ACL reconstruction surgery within the European population. We hypothesise that anthropometric features do influence graft thickness in ACL reconstruction.

Materials and methods

Data from 121 consecutive patients who had undergone ACL reconstruction by the same surgeon using quadruple hamstring grafts were analysed. The body mass index (BMI), height and weight of these patients were correlated with the graft diameter obtained during surgery. Regression analysis was undertaken to assess the influence of individual anthropometric variables on the graft diameter.

Results

There were 121 patients with mean age of 32 years (14–55). There was a statistically significant positive correlation individually between the height and graft diameter (r = 0.38, p < 0.01) as well as between the body weight and graft diameter (r = 0.29, p < 0.01). However, when the body mass index was calculated, the correlation was not statistically significant (r = 0.08, p > 0.1). Regression analysis confirmed that BMI was not statistically significant as a predictor of hamstring graft diameter whereas height was statistically the most important predictor (F = 20.1; p < 0.01).This yielded the predictive equation, graft diameter = 4.5 + 0.02 x Ht (in cm).

Conclusion

Although body mass index did not significantly correlate, body height may be a predictive variable in predicting the graft diameter in ACL reconstruction and provide useful pre operative information.     

Weight loss independently predicts urinary albumin excretion normalization in morbidly obese type 2 diabetic patients undergoing bariatric surgery

Background

Despite obesity being closely associated with two common risk factors for albuminuria, namely type 2 diabetes mellitus (T2DM) and hypertension, information on the impact of weight loss on albumin excretion rate in morbidly obese (MO) subjects is scarce.

Objective

To evaluate the independent contribution of weight loss following bariatric surgery (BS) to the improvement of the albumin-to-creatinine ratio (ACR) in MO subjects with T2DM.

Subjects and methods

Observational prospective study, including consecutive (n = 255) patients undergoing Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) of whom 37.6 % (n = 96) presented with T2DM. Stepwise logistic regression analysis was used to assess the contribution of T2DM-related, hypertension-related, and weight loss-related variables, and type of surgery to normalization of ACR (<30 mg/g) at 12 and 24 months follow-up.

Results

In T2DM subjects, baseline ACR was 85.7 ± 171 mg/g with ACR ≥30 mg/g being present in 45.7 % of the cohort. At 12 months, the ACR significantly decreased in T2DM subjects (42.2 ± 142.8 mg/g; p < 0.005) with no further reduction at 24 months after surgery (44.4 ± 227.7; p = 0.862). Among T2DM subjects with ACR ≥30 mg/g at baseline, the ACR became <30 mg/g in 58.5 % and 76.9 % at 12 and 24 months, respectively (p < 0.001 relative to baseline). Body mass index (BMI) change from baseline was the only independent predictor of ACR normalization at 12 months [Exp(B) 1.373, 95 % confidence interval 1.075–1.703; p < 0.05]. None of the evaluated variables appeared as an independent predictor of ACR normalization at 24 months.

Conclusions

Our data suggest that, in MO subjects with T2DM, interventions aiming at slowing the progression of nephropathy should not only focus on optimization of glucose and blood pressure control but also include effective weight loss strategies.     

Impact of specialty and level of training on CT measurement of femoral version: an interobserver agreement analysis

Background

To determine the interobserver agreement on femoral version measurements between an orthopedic attending, orthopedic senior and junior residents, and an attending radiologist.

Materials and methods

Postoperative computed tomography (CT) scanograms of 267 patients who underwent femoral intramedullary (IM) nailing with corresponding radiology attending reads for femoral version were collected and de-identified. Femoral version measurements performed by a trauma fellowship-trained attending orthopedic surgeon (ORTHO), a senior orthopedic resident (PGY4), a junior orthopedic resident (PGY1), and a musculoskeletal fellowship-trained attending radiologist (RADS) were compared via Pearson’s interclass correlation coefficient to assess interobserver level of agreement.

Results

Version measurements provided by the two attending physicians exhibited the highest level of agreement (r = 0.661, p < 0.01). The orthopedic attending and the senior resident had the next highest level of agreement (r = 0.543, p < 0.01). The first-year orthopedic resident had the weakest agreement across the board: with the orthopedic attending, the radiology attending, and the senior resident.

Conclusion

Regardless of specialty, experience and higher levels of training produce stronger agreement when measuring femoral version. Residents in training, especially those who are junior, produce weak agreement when compared to their senior colleagues.

Level of evidence

Level III, diagnostic study.     

Factors affecting mortality after hip fracture surgery: a retrospective analysis of 578 patients

Purpose

To determine the effect of patient and surgical factors on mortality after hip fracture surgery.

Design

Retrospective study.

Setting

Level-one trauma and tertiary referral centers.

Methods

Patients were eligible if they were aged 65 years or older and had undergone surgery for a non-pathological femoral neck or intertrochanteric hip fracture between 2008 and 2011. The primary outcome was mortality: within the first year after surgery, after the first year, and survival as of the last questioning date. Of the 578 eligible patients, 399 (69 %) were women; mean age was 79 years; and mean follow-up was 17 months.

Results

Mortality during the first year was significantly more frequent in patients aged 80 years or older (67 vs. 33 %; P < 0.001). Estimated overall survival was significantly longer in women (43 vs. 37 %; P = 0.01). The type of fracture had no impact on mortality (P = 0.96). Patients with high ASA class had a significant effect on mortality (P < 0.001). Surgery timing did not affect mortality in univariate analysis (P = 0.25). The mortality rate for hemiarthroplasty was higher than osteosynthesis options (P = 0.03). The effect of the type of anesthesia on mortality was not significant (P = 0.74).

Conclusions

Older men had the highest risk of mortality within the first year. Patients with ASA ratings of class 3 or 4 need to be evaluated carefully because they appear to be at higher risk of early mortality. Osteosynthesis has a lower mortality than does arthroplasty for hip fracture and thus should be preferred if either treatment is possible.

Level of evidence

IV.     

Baseline glycated hemoglobin levels are associated with duodenal-jejunal bypass liner-induced weight loss in obese patients

Introduction

Endoscopic treatment with the duodenal-jejunal bypass liner (DJBL) leads to significant weight loss in obese patients. We sought to identify clinical factors associated with weight loss in obese patients treated with the DJBL for 1 year.

Methods

Subjects with morbid obesity were enrolled in a single-arm, open-label, prospective trial and implanted with the DJBL. Patient demographics along with baseline comorbidities, anthropometrics, and biochemical variables were selected for univariate and multivariate analysis.

Results

The DJBL was implanted in 79 subjects and 61 completed 12 months of follow-up. There were 18 early removals. Baseline mean age and body mass index (BMI) were 35.4 ± 9.7 years and 43 ± 5.6 kg/m², respectively. Forty-four (72 %) were women. This population included 22 subjects with type 2 diabetes (T2DM). Twelve months after treatment, patients had a mean excess body weight loss (%EBWL) of 46 ± 18 %. Univariate analysis identified that fasting glycemia (r ² = ?0.303, p < 0.013), insulin-resistance determined by HOMA-IR (r ² = ?0.457, p < 0.019), and glycated hemoglobin (HbA1c) (r ² = ?0.471, p < 0.013) were associated inversely with %EBWL at 1 year. In this cohort of patients, the multivariate analysis indicated that only baseline HbA1c levels were associated inversely with %EBWL after 1 year of treatment (β adjusted coefficient ?0.758, p < 0.016). Importantly, no differences at 1 year in %EBWL were observed between patients with or without T2DM (%EBWL T2D 46.7 ± 20 % vs. non-T2DM 46.8 ± 18.6 %, p = 0.988).

Conclusions

This analysis indicates that higher baseline HbA1c levels are associated independently with diminished body weight loss in obese patients treated with the DJBL independent of their diabetic status. These results show that DJBL induces clinically significant weight loss in both T2DM and non-T2DM patients.     

Comparative effects of gastric bypass and sleeve gastrectomy on plasma osteopontin concentrations in humans

Background

Bariatric surgery (BS) has proven to be an effective treatment for morbid obesity. Osteopontin (OPN) is a proinflammatory cytokine involved in the development of obesity. The aim of our study was to determine the effect of weight loss following BS on circulating levels of OPN in humans.

Methods

Body composition and circulating concentrations of OPN and markers of bone metabolism were determined in obese patients who underwent Roux-en-Y gastric bypass (RYGB; n = 40) or sleeve gastrectomy (SG; n = 11).

Results

Patients who underwent RYGB or SG showed decreased body weight (P < 0.001) and body fat percentage (P < 0.001) as well as lower insulin resistance. However, plasma OPN levels were significantly increased after RYGB (P < 0.001) but remained unchanged following SG (P = 0.152). Patients who underwent RYGB also showed significantly increased C-terminal telopeptide of type-I collagen (ICTP) (P < 0.01) and osteocalcin (P < 0.001) while bone mineral density tended to decrease (P = 0.086). Moreover, OPN concentrations were positively correlated with the bone resorption marker ICTP after surgery. On the other hand, patients who underwent SG showed significantly increased ICTP levels (P < 0.05), and the change in OPN was positively correlated with the change in ICTP and negatively with the change in vitamin D after surgery (P < 0.05).

Conclusions

RYGB increased circulating OPN levels, while they remained unaltered after SG. The increase in OPN levels after RYGB could be related to the increased bone resorption in relation to its well-known effects on bone of this malabsorptive procedure in comparison to the merely restrictive SG.     

Obesity was associated with a decreased postoperative recurrence of rectal cancer in a Japanese population

Purpose

Obesity contributes to the technical difficulty of rectal surgery and is considered to be a risk factor for postoperative complications. The impact of obesity on the long-term outcomes of rectal cancer surgery remains unclear.

Methods

A total of 263 consecutive rectal cancer patients who underwent surgery were categorized into two groups according to the body mass index (BMI) based on the Asian BMI classification: non-obese (BMI <25 kg/m²) and obese (BMI ≥25 kg/m²). The postoperative survival and recurrence rates and oncological surgical quality indicators were compared between groups using the univariate and multivariate analyses. The differences in recurrence patterns were assessed by a competing risk regression analysis.

Results

64 (24 %) patients were included in the obese group. The number of retrieved lymph nodes was significantly greater in the non-obese group than in the obese group (22.4 vs. 16.0, P < 0.01). The 5-year disease-free survival (DFS) rates were 86.5 and 68.8 % in the obese and non-obese groups, respectively (P = 0.01). The multivariate analysis demonstrated that obesity significantly decreased the postoperative recurrence rate (P = 0.04). Moreover, the BMI was significantly associated with distant metastasis (P = 0.04).

Conclusions

Obese rectal cancer patients have high DFS rates and a decreased incidence of distant metastases compared to non-obese patients. The BMI may be a key factor for predicting the postoperative prognosis and determination of an appropriate strategy for the treatment of rectal cancer patients.     

Upregulation of Protein Tyrosine Phosphatase Type IVA Member 3 (PTP4A3/PRL-3) is Associated with Tumor Differentiation and a Poor Prognosis in Human Hepatocellular Carcinoma

Background

Protein tyrosine phosphatase type IVA member 3 (PTP4A3/PRL-3), a metastasis-associated phosphatase, plays multiple roles in cancer metastasis. We investigated PTP4A3/PRL-3 expression and its correlation with the clinicopathological features and prognosis in hepatocellular carcinoma (HCC).

Methods

Gene expression profiles of PTP4A3/PRL-3 were obtained in poorly differentiated HCC tissues. The results were validated independently by TaqMan gene expression assays and immunohistochemical analysis.

Results

According to the microarray profiles, PTP4A3/PRL-3 was upregulated in patients with poorly differentiated disease compared to patients with well-differentiated disease with hepatic backgrounds associated with hepatitis B or C. Validation analysis showed that the PTP4A3/PRL-3 mRNA and protein levels were significantly associated with poor differentiation (P < 0.0001), high serum α-fetoprotein (P < 0.01), high serum protein induced by vitamin K absence/antagonist-II (PIVKA-II), and hepatic vascular invasion (P < 0.05). The expression of PTP4A3/PRL-3 protein was also correlated with advanced cancer stages (P < 0.01); this resulted in a significantly poorer prognosis in both overall (P = 0.0024) and recurrence-free survival (P = 0.0227). According Cox regression univariate analysis, the positive expression of PTP4A3/PRL-3 was a poor risk prognostic factor (OS, P = 0.0031; recurrence-free survival, P = 0.0245). Cox regression multivariate analysis indicated that high PTP4A3/PRL-3 expression was an independent, unfavorable prognostic factor for overall survival (hazard ratio 0.542; P = 0.048).

Conclusions

PTP4A3/PRL-3 might be closely associated with HCC progression, invasion, and metastasis. Its high expression had a negative impact on the prognosis of HCC patients. This strongly suggests that PTP4A3/PRL-3 should be considered as a prognostic factor. Further analysis should be pursued to evaluate it as a novel prognostic target.     

Lymph-Vascular Space Invasion as a Significant Risk Factor for Isolated Para-aortic Lymph Node Metastasis in Endometrial Cancer: A Study of 203 Consecutive Patients

Background

The purpose of this study was to investigate various pathologic risk factors associated with para-aortic lymph node metastasis (LNM) in surgically staged patients with endometrial cancer.

Materials and Methods

We performed a retrospective analysis of 203 consecutive patients with endometrial cancer who were surgically staged from 2000 to 2009. The association among the various pathologic variables for para-aortic LNM was determined with univariate and multivariate analyses.

Results

Of 203 patients, 29 patients (14.3%) had LNM. Also, 10 patients (4.9%) had only pelvic LNM, 14 (6.9%) had both pelvic and para-aortic LNM, and 5 (2.5%) had para-aortic LNM without pelvic LN involvements. Histologic type (P = .001), tumor grade (P < .001), tumor size (P = .003), depth of myometrial invasion (P < .001), cervical invasion (P < .001), parametrial invasion (P = .002), lymph-vascular space invasion (LVSI) (P < .001), serosal/adnexal invasion (P < .001), positive cytology (P = .002), peritoneal seeding (P < .001), and pelvic LNM (P < .001) were significant pathologic factors for para-aortic LNM. On multivariate analysis, cervical invasion (P = .032), LVSI (P = .018), and positive pelvic LNs (P = .002) were independent factors for para-aortic LNM. With regard to isolated para-aortic LNM, tumor grade (P = .017) and LVSI (P = .002) were significant factors for LN involvements. On multivariate analysis, LVSI (P = .004) was the only significant independent factor.

Conclusions

LVSI correlates significantly with the risk of isolated para-aortic LNM in endometrial cancer patients.     

Assessment of atrial septal defect size and residual rim using real-time 3D transesophageal echocardiography

Background

Accurate preoperative determination of defect location and size is important for successful transcatheter closure of atrial septal defects (ASD). Real-time 3D transesophageal echocardiography (3DTEE) has the potential to delineate the shape of ASD in 3D space.

Methods

Full volume and 3D zoom datasets by 3DTEE were acquired in 17 ASD patients. Using quantitative software, maximal/minimal diameter, defect area and residual rim length were measured and compared to the standard 2D measurements.

Results

Real-time 3DTEE allowed delineation of the en-face view of the ASDs. The defect typically had an oval shape, and its size changed dynamically, having its minimal size at end-diastole and maximal at end-systole. A good correlation was noted between the maximal defect area by 3DTEE and 2DTEE (r = 0.93, p < 0.001). Successful delineation of rim length to the specific cardiac structure was 100% by 3DTEE and 88% by 2DTEE. There was a fair correlation of residual rim length between 3DTEE and 2DTEE (r = 0.69, p < 0.001). Eight patients underwent transcatheter closure of the ASD. Excellent correlation was noted between 3D-derived maximal defect diameter and device diameter (r = 0.97, p < 0.001).

Conclusions

Real-time 3DTEE allows measurements of the temporal and spatial changes of ASD size and shape. This methodology provides detailed information on defect dynamics.