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1.
Background
Asian eyelids are characterized by the presence of an epicanthal fold and the absence of a supratarsal fold. Because many Asians desire wide, open, large eyes, elimination of the medial epicanthal fold along with double-eyelid operation frequently are performed for cosmetic improvement. Medial epicanthoplasty enhances the aesthetic result by lengthening the palpebral fissure horizontally, thus producing larger-looking, open eyes. This study describes the author’s method for correcting the medial epicanthal fold.Methods
Simple epicanthoplasty with minimal scar, the author’s method, was performed to correct the epicanthal folds of 52 patients from December 2001 to August 2005 at the Catholic University of Korea Kangnam St. Mary’s Hospital.Results
This technique yielded excellent results in terms of inconspicuous scar and long-lasting open medial canthal area during a 3-year follow-up period. Of the 52 patients, 2 showed a depressed scar on the lower eyelid, which was corrected satisfactorily.Conclusion
Many procedures have been introduced to correct the epicanthal fold, but scarring or undercorrection remains as a dilemma for surgeons to overcome. Simple epicanthoplasty with minimal scar is a simple, easy-to-follow, and effective method that can be applied to various cases of medial epicanthal fold.2.
Kuan Wang MD Chenghua Jiang PhD Lejun Wang PhD Huihao Wang MD Wenxin Niu PhD 《The spine journal》2018,18(12):2288-2296
BACKGROUND CONTEXT
Anterior vertebral body osteophytes are common with degeneration but their biomechanical influence on the whole lumbar spine remains unclear.PURPOSE
To investigate the biomechanical influence of anterior vertebral body osteophytes on the whole lumbar spine.STUDY DESIGN/SETTING
This is a study using finite element analysis.OUTCOME MEASURES
Intersegmental rotation, maximum Mises stress, and intradiscal pressure on the intervertebral discs of different lumbar levels were calculated.METHODS
A finite element model of an intact lumbar spine was constructed and validated against in vitro studies. The modified models, which had different degrees of anterior vertebral body osteophyte formation (OF) in combination with disc space narrowing, were applied with physiological loadings.RESULTS
The lumbar levels with various degrees of OF altered the kinematics of these levels, which also affected the whole lumbar spine. In flexion and lateral bending, the segment that was one level inferior to the vertebra with OF showed a trend towards increased range of motion. On the intervertebral discs that were one level inferior to the OF level, a trend towards increase in the maximum von Mises stress was found on the annulus.CONCLUSIONS
Segments adjacent to levels with anterior vertebral body osteophytes showed increased intersegmental rotation and maximum stress. Further clinical observation should be performed to verify the results in vivo. 相似文献3.
Peter W. Lundberg Samantha Wolfe Jacqueline Seaone Jill Stoltzfus Leonardo Claros Maher El Chaar 《Surgery for obesity and related diseases》2018,14(9):1240-1245
Background
The use of robotic platforms in performing laparoscopic Roux-en-Y gastric bypass (LRYGB) is increasing, though their safety compared with the conventional laparoscopic approach remains unclear.Objective
The objective of this study was to evaluate perioperative data and 30-day outcomes of conventional and robot-assisted LRYGB using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry.Setting
University health network, United States.Methods
We reviewed all conventional and robot-assisted LRYGB cases entered between January 1 and December 31, 2016 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Demographic characteristics and 30-day outcomes were analyzed based on separate Mann-Whitney rank sums tests, χ2, or Fisher's exact tests as appropriate, with P ≤ .05 denoting statistical significance with no adjustment for multiple testing.Results
Of the 39,425 patients who underwent LRYGB, 2822 were robot-assisted. The robot-assisted approach required significantly more time (138 versus 108 min, P < .0001). Rates of organ space infection, bleeding, and other significant adverse events after the conventional and robot-assisted approaches were .3% versus .5% (P?=?.13), 1.1% versus .8% (P?=?.11), and 2.3% versus 2.3% (P?=?.96), respectively. There were also no significant differences in the rates of mortality, length of stay, reoperation, or readmission between the 2 groups.Conclusions
Robot-assisted LRYGB is an increasingly popular alternative to the conventional laparoscopic approach. According to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, the early safety of these 2 techniques is equal, although the robotic approach requires more operative time. 相似文献4.
Ramon V. Cortez Tarissa Petry Pedro Caravatto Rodrigo Pessôa Sabri S. Sanabani Marina B. Martinez Thais Sarian João E. Salles Ricardo Cohen Carla R. Taddei 《Surgery for obesity and related diseases》2018,14(11):1748-1754
Background
In recent years, studies indicate gut microbiota as an important modulator in the pathophysiology of type 2 diabetes. Environmental and genetic factors interact to control the host's intestinal microbiota, triggering metabolic disorders such as obesity and insulin resistance.Objectives
The objective of this study was to identify the fecal microbiota in adult type 2 diabetes patients and to assess changes in composition after metabolic surgery.Setting
University Hospital of the University of São Paulo.Methods
Twenty-one patients were enrolled in a randomized controlled study divided into 2 arms. One group underwent duodenal-jejunal bypass surgery with minimal gastric resection, and fecal samples were collected before the operation and after 6 and 12 months. The other group received medical care (standard care group) and was followed for 12 months. Fecal samples were collected at baseline and after 6 and 12 months. Fecal microbiota was analyzed using high-throughput sequencing with V4 16 S rRNA primers.Results
The fecal microbiota in duodenal-jejunal bypass surgery with minimal gastric resection group (Bacteroides, Akkermansia, and Dialister) exhibited increased abundance and diversity compared with that in the standard care group; however, the increase in A. muciniphila was only statistically significant in the surgical group, probably due to the study's small sample size.Conclusions
The data presented suggest that duodenal-jejunal bypass surgery with minimal gastric resection increases microbial richness and abundancy, mainly for those bacteria related to weight loss and metabolic control (Akkermansia), providing a better understanding of the role of microbiota in type 2 diabetes regulation and its changes after metabolic surgery. 相似文献5.
Victoria E. Sanborn Mary-Beth Spitznagel Ross Crosby Kristine Steffen James Mitchell John Gunstad 《Surgery for obesity and related diseases》2018,14(9):1396-1401
Background
Both poor quality of life (QoL) and cognitive impairment are common in persons with severe obesity. Work in other patient populations show that cognitive impairment is associated with poorer QoL, though this possibility has not been examined in bariatric surgery candidates.Objectives
We sought to determine the association between cognitive performance and QoL, both total and work related, in a sample of bariatric surgery candidates.Setting
Three sites were used for data collection, including the Neuropsychiatric Research Institute in Fargo, North Dakota, Columbia University in New York, and Cornell University in New York.Methods
Sixty participants from the Longitudinal Assessment of Bariatric Surgery project were assessed at preoperative baseline.Results
Hierarchical regression analyses showed that poorer cognitive function was independently associated with lower total QoL and that both reported and objectively measured cognitive impairment were associated with poorer work-related QoL.Conclusions
These preliminary findings suggest that cognitive impairment may contribute to poorer total and work-related QoL in bariatric surgery candidates. Future studies should examine whether interventions to improve cognitive function can improve QoL and other outcomes in this population. 相似文献6.
Omar A. Khan Emma Rose McGlone William Maynard James Hopkins Simon Dexter Ian Finlay David Hewin Peter Sedman Peter Walton Shaw Somers Marcus Reddy Peter Small Marco Adamo Richard Welbourn 《Surgery for obesity and related diseases》2018,14(10):1516-1520
Background
For patients in whom laparoscopic adjustable gastric band has failed, conversion to Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy are both options for further surgical treatment. There are limited data comparing these 2 procedures. The National Bariatric Surgery Registry is a comprehensive United Kingdom–wide database of bariatric procedures, in which preoperative demographic characteristics and clinical outcomes are prospectively recorded.Objectives
To compare perioperative complication rate and short-term outcomes of patients undergoing single-stage conversion of gastric band to Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy.Setting
United Kingdom national bariatric surgery database.Methods
From the National Bariatric Surgical Registry data set, we identified 141 patients undergoing single-stage conversion from gastric band to either gastric bypass (113) or sleeve gastrectomy (28) between 2009 and 2014, and analyzed their clinical outcomes.Results
With respect to perioperative outcomes gastric bypass was associated with a higher incidence of readmission or reintervention postoperatively (16 versus 0; P?=?.04). There was no difference in percentage excess weight loss between sleeve gastrectomy and gastric bypass at final follow-up at 1 year (52.1% versus 57.1% respectively; P?=?.4).Conclusions
Conversion from band to sleeve or bypass give comparable good early excess weight loss; however, conversion to sleeve is associated with a better perioperative safety profile. 相似文献7.
Colette S. Inaba Christina Y. Koh Sarath Sujatha-Bhaskar Marija Pejcinovska Ninh T. Nguyen 《Surgery for obesity and related diseases》2018,14(10):1448-1453
Background
Laparoscopic sleeve gastrectomy (LSG) is associated with low morbidity and mortality and a short length of stay. Studies on the safety of same-day discharge after LSG are limited.Objective
To compare outcomes between same-day versus first-postoperative-day (POD1) discharge after LSG.Setting
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program national database.Methods
The 2015 to 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was analyzed for elective LSG cases with same-day or POD1 discharge. Open, revisional, and converted cases were excluded. Multivariate analysis was performed to compare adjusted 30-day mortality, morbidity, readmission, and reoperation for same-day versus POD1 discharge.Results
We examined 85,321 LSG cases, including 4728 same-day discharges and 80,593 POD1 discharges. Compared with POD1 discharges, same-day discharges were associated with higher overall morbidity (1.31% versus .84%, respectively; adjusted odds ratio [AOR] 1.72; P?=?.0002), a higher readmission rate (2.14% versus 1.64%, respectively; AOR 1.40; P?=?0.0034), and a higher reoperation rate (.61% versus .27%, respectively; AOR 2.35; P < .0001). There was no difference in mortality (.08% versus .04%, respectively; AOR 2.62; P?=?.0923).Conclusion
Same-day discharge after LSG is associated with increased complications, readmissions, and reoperations compared with POD1 discharge. Further studies are needed to examine objective criteria for safe same-day discharge after LSG. 相似文献8.
Jerry T. Dang Noah J. Switzer Warren Y.L. Sun Faizal Raghavji Daniel W. Birch Shahzeer Karmali 《Surgery for obesity and related diseases》2018,14(9):1340-1347
Background
Laparoscopic bariatric surgery (LBS) is effective for severe obesity but is invasive and costly. Intragastric balloons (IGBs) are increasingly popular as an alternative to LBS with modest short-term weight loss. However, IGBs are associated with complications and a comparison of the safety of IGB to LBS is warranted.Objectives
The objective of this study was to compare the safety profile of IGB with LBS through analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.Setting
The MBSAQIP collects data from 791 bariatric surgery centers in the United States and Canada.Methods
A propensity-matched analysis was performed between IGB and LBS. Multivariable logistic regression analysis was performed to determine if IGBs were independently associated with adverse outcomes.Results
A total of 145,408 patients were included, of which 144,627 (99.5%) underwent LBS and 781 (0.5%) underwent IGB therapy. With one-to-one propensity score matching, 684 pairs of IGB and LBS patients were selected. Multivariable logistic regression found that IGB (odds ratio 1.97, confidence interval 1.10–3.52, P?=?.023) was independently predictive of 30-day adverse outcomes. This was due to a significantly higher nonoperative reintervention rate in the IGB cohort (4.2% versus 1.0%, P < .001) from early balloon removal (2.8%).Conclusions
In this propensity-matched analysis, IGBs were associated with a higher adverse event rate than LBS, due to a 4-times higher nonoperative reintervention rate. The utility of IGB as a primary weight loss intervention should be reconsidered due to its poor safety profile compared with LBS. 相似文献9.
Muriel Coupaye Hélène Legardeur Ouidad Sami Daniela Calabrese Laurent Mandelbrot Séverine Ledoux 《Surgery for obesity and related diseases》2018,14(10):1488-1494
Background
There is a lack of evidence on whether sleeve gastrectomy (SG), which induces fewer nutritional deficiencies than Roux-en-Y gastric bypass (RYGB), also affects fetal growth (FG).Objectives
To compare neonatal outcomes after RYGB and SG and to assess the impact of maternal nutritional alterations on FG after both procedures.Setting
University Hospital, France.Methods
Women with singleton pregnancies who had at least 1 nutritional evaluation in our institution between 2004 and 2017 were included. FG was assessed with birth weight (BW) and BW-Z score (adjusted for sex and term), and maternal nutritional deficiencies were defined according to standard and pregnancy-specific norms.Results
During the study period 123 pregnancies were included, 77 after RYGB and 46 after SG. Weight loss was higher after RYGB than after SG (45.6 ± 12.4 versus 39.5 ± 13.7 kg, P?=?.02), but mean weight before pregnancy and weight gain during pregnancy were similar. Mean BW (3026 ± 677 versus 3162 ± 712 g), mean BW Z-score and incidence of small for gestational age (24% versus 19%) were not significantly different after RYGB and SG. Mean number of nutritional deficiencies during the second trimester was similar (2.2 ± 1.5 versus 2.1 ± 1.2 with specific norms), but the affected parameters differed between procedures. Urinary urea (R?=?.285, P?=?.04) was positively correlated to BW Z-score after both procedures. In contrast, serum iron parameters were negatively associated to BW Z-score.Conclusion
FG restriction occurs after both SG and RYGB. FG after bariatric surgery is positively associated with protein supply and negatively correlated with maternal iron status. 相似文献10.
Manuel Macías-González Gracia María Martín-Núñez Lourdes Garrido-Sánchez Eduardo García-Fuentes Francisco José Tinahones Sonsoles Morcillo 《Surgery for obesity and related diseases》2018,14(9):1327-1334
Background
Obesity is characterized by a chronic, low-grade inflammation, and bariatric surgery is proposed as an effective treatment for reducing the obesity-related co-morbidities. Epigenetic modifications could be involved in the metabolic improvement after surgery.Objective
The main aim of this study was to evaluate whether DNA methylation pattern from genes related to inflammation and insulin response is associated with the metabolic improvement after bariatric surgery in morbidly obese patients and if these changes depend on the surgical procedure.Setting
University hospital, Spain.Methods
We studied 60 severely obese patients; 31 underwent Roux-en-Y gastric bypass and 29 underwent laparoscopic sleeve gastrectomy. All patients were examined before and at 6 months after bariatric surgery. DNA methylation profile of genes related to the inflammatory response and insulin sensitivity was measured by pyrosequencing.Results
The promoter methylation levels of the NFKB1 gene were increased significantly after surgery (2.16 ± .9 versus 2.8 ± 1.03). The decrease in blood pressure, both systolic and diastolic, after surgery was significantly associated with the changes in the promoter methylation levels of the NFKB1 gene (β?=??.513, P?=?.003 and β?=??.543, P?=?.004, respectively). A decrease in inflammation status, measured by high sensitivity C-reactive protein values, was associated with changes in SLC19A1 methylation levels.Conclusion
Our study shows for the first time an association between NFKB1 methylation levels and blood pressure after bariatric surgery, highlighting the possible function of this gene in the regulation of arterial pressure. Regarding SLC19A1, this gene could position as a potential target linking inflammation and insulin resistance. 相似文献11.
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13.
Taryn E. Hassinger J. Hunter Mehaffey Lily E. Johnston Robert B. Hawkins Bruce D. Schirmer Peter T. Hallowell 《Surgery for obesity and related diseases》2018,14(8):1133-1138
Background
Numerous studies have established the effectiveness of Roux-en-Y gastric bypass (RYGB) for weight loss and co-morbidity amelioration. However, its safety and efficacy in elderly patients remains controversial.Objectives
To evaluate outcomes in patients aged ≥60 years who underwent RYGB compared with nonsurgical controls with the hypothesis that RYGB provides weight loss benefits without differences in survival.Setting
University-affiliated tertiary center.Methods
All patients who underwent RYGB from 1985 to 2015 were identified and divided into elderly (age ≥60) and nonelderly (age <60) groups. A nonsurgical elderly control population was identified using a clinical data repository of outpatient visits to propensity match elderly patients 4:1 on demographic characteristics, co-morbidities, and relevant preoperative substance/medication use. Unpaired appropriate univariate analyses compared each stratified group. Kaplan-Meier survival curves were fitted based on social security death data.Results
A total of 2306 patients underwent RYGB. The 107 elderly patients had lower median body mass index (47.0 versus 49.9; P?=?.007) and higher rates of co-morbidities. Rates of complications did not differ between elderly and nonelderly patients. Elderly surgical patients were propensity matched 4:1 (10,044 controls) yielding 428 well-matched nonsurgical controls. The elderly group demonstrated significant percent reduction in excess body mass index compared with the control group (81.8% versus 10.3%; P < .001). Kaplan-Meier survival analysis with log-rank test demonstrated no difference in midterm survival (P?=?.63).Conclusions
A significant weight reduction benefit was identified after RYGB in elderly patients without a difference in midterm survival compared with propensity-matched controls, suggesting RYGB is a safe and efficacious weight loss strategy in the elderly. 相似文献14.
Katherine J.P. Schwenger Sandra E. Fischer Timothy Jackson Allan Okrainec Johane P. Allard 《Surgery for obesity and related diseases》2018,14(9):1233-1239
Background
In obese individuals undergoing Roux-en-Y gastric bypass (RYGB), nonalcoholic fatty liver disease (NAFLD) is seen in 75% to 100% of cases. This improves postsurgery, but some patients continue to have persistent NAFLD.Objective
The purpose of this study was to determine the factors associated with persistent NAFLD at 12 months post-RYGB.Setting
University Hospital, Canada, bariatric clinic.Methods
This is a prospective cohort study of 42 patients who underwent RYGB. Liver biopsy, biochemical and clinical parameters were collected pre- and 12 months post-RYGB. Based on histology at 12 months, patients were separated in 2 groups, normal liver (NL) and persistent NAFLD.Results
At baseline, NAFLD was diagnosed in 85.7% of patients and at 12 months post-RYGB, NAFLD was present in 19.1% of patients. Patients who had an NL at baseline remained with NL. RYGB resulted in significant decreases in body mass index, waist circumference, blood pressure, aspartate aminotransferase, alanine aminotransferase, fasting glucose and insulin, glycated hemoglobin, and triglycerides and significant increases in high-density lipoprotein cholesterol. Changes were similar in both groups except for waist circumference, which showed lower changes in those with persistent NAFLD. These patients also had significantly higher (P < .05) fasting glucose and insulin with a higher proportion of patients having insulin resistance compared with those with NL.Conclusions
RYGB resulted in significant improvements in liver histology, biochemical, and clinical parameters. However, despite similar weight loss, persistent NAFLD was associated with less improvement in waist circumference and worse glycemic control. 相似文献15.
Yen-Yi Juo Matthew J. Freeby Vanessa Arguello Linda Liu Emily Huang Erik Dutson Yijun Chen 《Surgery for obesity and related diseases》2018,14(9):1246-1253
Background
Metabolic surgery remains underutilized despite its efficacy and safety. Poor perception of surgery has been cited as one of the major reasons.Objectives
Evaluate current patient perceptions about metabolic surgery and measure the impact a video-based education program has on changing the perceptions of patients diagnosed with obesity and type 2 diabetes.Setting
A university hospital in the United States.Methods
A prospective interventional study was performed at an endocrinology clinic. Patients were asked to complete surveys evaluating their perception of metabolic surgery before and after watching a short educational video.Results
A total of 51 patients were recruited; almost all patients (98%) attempted weight loss in the past, and approximately 90.1% voiced dissatisfaction with their current weight. The video-based education program was effective in improving the patient's perception of the efficacy and safety with regard to surgery. In addition, the proportion of patients with overall positive impression toward metabolic surgery increased from 22.5% to 53.1% (P < .01) and those willing to undergo surgical consultation increased from 41.7% to 51.0% (P < .01). Among those that remained unwilling, fear of surgery in general was the most commonly voiced reason (31.4%), with safety (27.5%) and cost of metabolic surgery (27.5%) being equally concerning.Conclusions
Most patients with obesity and type 2 diabetes held negative impressions of metabolic surgery due to its perceived risk profile. A video-based educational intervention may improve patients’ perception and increase their willingness for surgical referral. Future trials with a broader sample and longer follow-up could provide answers to its efficacy in increasing metabolic surgery accessibility. 相似文献16.
Roux-en-Y gastric bypass surgery in youth with severe obesity: 1-year longitudinal changes in spexin
Seema Kumar MD Jobayer Hossain Thomas Inge P Babu Balagopal 《Surgery for obesity and related diseases》2018,14(10):1537-1543
Background
Spexin is a novel peptide predominantly produced in human white adipose tissue and has recently been implicated as a potential signal in the regulation of body weight, energy homeostasis, and satiety. The effect of bariatric surgery on spexin is unknown.Objectives
To study the effect of Roux-en-Y gastric bypass (RYGB) surgery on endogenous spexin concentration and various risk factors of type 2 diabetes and cardiovascular disease in youth with severe obesity.Setting
University hospital, United StatesMethods
Spexin, body mass index (BMI), insulin, glucose, total and high molecular weight adiponectin, leptin, and high sensitivity C- reactive protein were measured longitudinally (baseline, 6 mo, and 12 mo) after RYGB surgery in girls with severe obesity (n?=?12; age?=?16.7 ± 1.5 years; BMI?=?51.6 ± 2.9 kg/m2).Results
Serum spexin concentration increased (P?=?.01) at 6 months after surgery and stabilized afterward. Spexin level correlated negatively with homeostatic model assessment insulin resistance, HOMA-IR (Spearman correlation r?=??.796, P < .001) and positively with high molecular weight adiponectin (Spearman correlation r?=?.691, P?=?.011). The change in spexin concentration, from baseline to 6 months after surgery, was inversely correlated with the corresponding change in BMI (Spearman correlation r?=??.573, P?=?.051). Furthermore, the 6-month changes in spexin and HOMA-IR were inversely correlated (slope [standard error, SE]?=??.0084 (.0019), P?=?.001)], even after adjusting for the change in BMI.Conclusions
The enhancement of circulating spexin concentration in response to RYGB and correlations with beneficial postoperative changes in various adipokines in youth are novel findings that require further validation. 相似文献17.
Witigo von Schönfels Jan Henrik Beckmann Markus Ahrens Alexander Hendricks Christoph Röcken Silke Szymczak Jochen Hampe Clemens Schafmayer 《Surgery for obesity and related diseases》2018,14(10):1607-1616
Background
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in industrialized countries. Nonalcoholic steatohepatitis is the fastest growing cause for liver failure. Bariatric surgery represents a treatment option for NAFLD with an established effect on liver histology.Objectives
We aimed to assess the impact of bariatric surgery on standardized liver histology using the NAFLD activity score.Setting
Retrospective comparison of metabolic data before and after bariatric surgery and comparison of sleeve gastrectomy and Roux-en-Y gastric bypass. The study was performed in an academic center, the university hospital Schleswig-Holstein in Kiel, Germany.Methods
Between 2009 and 2012, bariatric surgery was performed in 257 patients according to the national guidelines, and a liver biopsy was obtained in 150 of these patients during surgery. A follow-up biopsy was available in 53 of these patients at a median of 192 days. Liver histology was analyzed using the NAFLD activity score. In this subgroup of 53 patients an analysis of the metabolic improvement after bariatric surgery and a comparative analysis between the 2 different operative procedures was performed.Results
The study cohort showed improvement of preoperative pathologic liver histology findings after operative procedures took place. Both surgery methods improved the NAFLD activity score significantly, all improvement ?2.0 (confidence interval ?2.5 to ?1.0; P < .001); Roux-en-Y gastric bypass, improvement ?1.0 (confidence interval ?2.0 to ?.0; P?=?.038); sleeve gastrectomy, improvement ?2.5 (confidence interval ?3.5 to ?1.5; P < .001). No differences were found with regard to histologic recovery between gastric bypass and sleeve gastrectomy (P = .22).Conclusions
Bariatric surgery significantly improves NAFLD. 相似文献18.
Prapimporn Chattranukulchai Shantavasinkul Michael J. Muehlbauer James R. Bain Olga R. Ilkayeva Damian M. Craig Christopher B. Newgard Laura P. Svetkey Svati H. Shah Alfonso Torquati 《Surgery for obesity and related diseases》2018,14(8):1126-1132
Background
Gastric bypass surgery for weight reduction often corrects dysglycemia in diabetic patients, but a full understanding of the underlying biochemical pathways continues to be investigated.Objectives
To explore the effects of weight loss by surgical and dietary interventions on plasma metabolites using both targeted and discovery-oriented metabolomics platforms.Setting
An academic medical center in the United States.Methods
Improvement in homeostatic model assessment for insulin resistance (HOMA-IR), as an index of insulin resistance, was compared at 6 months in 11 patients that underwent Roux-en-Y gastric bypass against 11 patients that were matched for weight loss in the Weight Loss Maintenance (WLM) program. Metabolites in plasma were evaluated by nontargeted gas chromatography/mass spectrometry for the potential detection of >1100 biochemical markers.Results
Among multiple metabolites detected, 2-hydroxybutyric acid (2-HBA) declined most significantly after 6 months in comparing patients that underwent Roux-en-Y gastric bypass with those in WLM (P < .001), corresponding with declines in HOMA-IR (P?=?.025). Baseline levels of 2-HBA for all patients were correlated with preintervention levels of HOMA-IR (R2?=?.565, P < .001). Moreover, the changes in 2-HBA after 6 months were correlated with changes in HOMA-IR (R2?=?.399, P?=?.0016).Conclusions
Correlation between insulin resistance and 2-HBA suggests the utility of the latter as an excellent biomarker for tracking glycemic improvement, and offers further insight into the pathways that control diabetes. This is the first report of a decline in 2-HBA in response to bariatric surgery. 相似文献19.
Liat Deutsch Limor Ben Haim Yael Sofer Nathan Gluck Erwin Santo Sigal Fishman 《Surgery for obesity and related diseases》2018,14(10):1561-1569
Background
Exclusion of the proximal gut from nutrient absorption entails significant metabolic benefits. The duodenal-jejunal bypass liner (DJBL) is the first endoscopic device that excludes the first part of the gut by covering it.Objectives
To assess weight and glycemic control at the end of treatment and after 1 year of follow-up.Setting
Bariatric endoscopy service in a tertiary medical center.Methods
Diabetic patients were treated with DJBL and followed prospectively between 2013 and 2016. Data were collected during scheduled visits.Results
Out of 51 patients treated, 39 completed at least 9 months with the device. Complications were recorded for the entire cohort. Percent of total weight loss was 15.05% ± 6.0% after 12 months of treatment (P < .001 versus baseline). Twelve months postretrieval, percent of total weight loss decreased to 8.75% ± 5.07% (P < .001 versus baseline). Patients with baseline body mass index ≥35 kg/m2 experienced greater percent total weight loss changes over time (P < .001). There was a significant effect on hemoglobin A1C levels over time (P?=?.003), and the nadir was reached at 9 months of treatment (median 6.05% versus 7.20% at baseline, P < .001). Insulin users had consistently higher median hemoglobin A1C values compared with insulin nonusers (P < .001). Adverse events were experienced by 12 of 51 patients (23.5%), of which 4 cases (7.8%) were severe.Conclusions
Proximal bowel bypass by DJBL is an effective tool for weight reduction and glycemic control. Metabolic achievements are partially preserved at 1 year after device removal. Because DJBL entails a considerable rate of side effects, strategies to mitigate them are warranted. 相似文献20.
Isabelle Fontanille Adrien Boillot Hélène Rangé Maria Clotilde Carra Silvia Helena de Carvalho Sales-Peres Sebastien Czernichow Philippe Bouchard 《Surgery for obesity and related diseases》2018,14(10):1618-1631