Histologic and microbiological findings of the defunctionalized loop in sleeve gastrectomy with jejunal bypass

BackgroundBariatric surgery produces anatomic changes in the digestive tract that can affect the intestinal microbiome and, in some cases, can cause small intestinal bacterial overgrowth. Since the inception of the sleeve gastrectomy with jejunal bypass (SGJB) in 2004, there has been discussion regarding the possible development of those complications associated with the now abandoned jejunoileal bypass (JIB) procedure.ObjectivesThe primary endpoint was to characterize the bacteriologic and histopathologic findings in the defunctionalized jejunal loop after the SGJB procedure and to analyze the liver profile. The secondary endpoint was to report SGJB conversions or reversions and to review the differences between SGJB and JIB.SettingAcademic medical center.MethodsWe conducted a prospective study of patients who underwent laparoscopy for any reason, having previously had an SGJB. A 5-cm segment at the proximal end of the excluded limb was resected. Luminal liquid and tissue samples were taken from this segment for aerobic and anaerobic cultures, and pathologic examination of the bowel wall was performed to evaluate trophism and signs of chronic inflammation. Other variables were liver function and pre- and postoperative status. Finally, we retrospectively reviewed the causes of revisional surgery in the prospective database.ResultsEleven patients underwent laparoscopy. The median time after SGJB was 14 months (range, 10–144 months). There were no complications from the procedure. Eight (72.7%) of the procedures were cholecystectomies. None of the patients showed histologic alterations or signs of chronic infection. The liquid and tissue cultures were negative. The liver tests and the laparoscopic morphology of the liver were normal in all patients, except in 1 with previously documented liver cirrhosis. The number of SGJB revisions was 19 of 1074 (1.8 %), and all of them were converted to Roux-en-Y gastric bypass for severe gastroesophageal reflux.ConclusionsIn this study, we were unable to demonstrate the presence of symptoms or histologic alterations that would suggest that patients undergoing SGJB develop small intestinal bacterial overgrowth in the short- and medium-term follow-up, unlike those who have undergone JIB. The study constitutes an initial step toward establishing what happens to the defunctionalized jejunal limb as a result of this surgical technique.     

Evidence for high-affinity binding sites for the adenosine A2A receptor agonist [3H] CGS 21680 in the rat hippocampus and cerebral cortex that are different from striatal A2A receptors

The binding of the adenosine A_2A receptor selective agonist 2-[4-(2-p-carboxyethyl) phenylamino]-5-N-ethylcarboxamidoadenosine (CGS 21680) to the rat hippocampal and cerebral cortical membranes was studied and compared with that to striatal membranes. [³H] CGS 21680, in the concentration range tested (0.2–200 nM), bound to a single site with a K _d of 58 nM and a B _max of 353 fmol/mg protein in the hippocampus, and with a K _d of 58 nM and a B _max of 264 fmol/mg protein in the cortex; in the striatum, the single high-affinity [³H] CGS 21680 binding site had a K _d of 17 nM and a B _max of 419 fmol/mg protein. Both guanylylimidodiphosphate (100 M) and Na⁺ (100 mM) reduced the affinity of [³H] CGS 21680 binding in the striatum by half and virtually abolished [³H] CGS 21680 binding in the hippocampus and cortex. The displacement curves of [³H] CGS 21680 binding with 1,3-dipropyl-8-cyclopentylxanthine (DPCPX), N ⁶-cyclohexyladenosine (CHA), 5-N-ethyl-carboxamidoadenosine (NECA) and 2-chloroadenosine (CADO) were biphasic in the hippocampus and cortex as well as in the striatum. The predominant [³H]CGS 21680 binding site in the striatum (80%) had a pharmacological profile compatible with A_2A receptors and was also present in the hippocampus and cortex, representing 10–25% of [³H]CGS 21680 binding. The predominant [³H]CGS 21680 binding site in the hippocampus and cortex had a pharmacological profile distinct from A_2A receptors: the relative potency order of adenosine antagonists DPCPX, 1,3-dipropyl8-{4-[(2-aminoethyl)amino]carbonylmethyloxyphenyl} xanthine (XAC), 8-(3-chlorostyryl) caffeine (CSC), and (E)-1,3-dipropyl-8-(3,4-dimethoxystyryl)-methylxanthine (KF 17,837) as displacers of [³H] CGS 21680 (5 nM) binding in the hippocampus and cerebral cortex was DPCPX > XAC CSC KF 17,837, and the relative potency order of adenosine agonists CHA, NECA, CADO, 2-[(2-aminoethylamino)carbonylethylphenylethylamino]-5-N-ethylcar-boxamidoadenosine (APEC), and 2-phenylaminoadenosine (CV 1808) was CHA NECA CADO > APEC CV1808 > CGS 21680. In the presence of DPCPX (20 nM), [³H] CGS 21680 (0.2-200 nM) bound to a site (A_2A-like) with a K _d of 20 nM and a B _max of 56 fmol/mg protein in the hippocampus and with a K _d of 22 nM and a B _max of 63 fmol/mg protein in the cortex. In the presence of CSC (200 nM), [³H]CGS 21680 (0.2–200 nM) bound to a second high-affinity site with a K _d of 97 nM and a B _max of 255 fmol/mg protein in the hippocampus and with a K _d of 112 nM and a B _max of 221 fmol/mg protein in the cortex. Two pharmacologically distinct [³H]CGS 21680 binding sites were found in synaptosomal membranes of the hippocampus and cortex and in the striatum, one corresponding to A_2A receptors and the other to the second high-affinity [³H]CGS 21680 binding site. In contrast, the pharmacology of [³H]CHA binding was similar in synaptosomal membranes of the three brain areas. The present results establish the existence of at least two high-affinity [³H]CGS 21680 binding sites in the CNS and demonstrate that the [³H]CGS 21680 binding site predominant in the hippocampus and cerebral cortex has different binding characteristics from the classic A_2A adenosine receptor, which predominates in the striatum.     

The Impact of Psychosis on Sexual Functioning: A Systematic Review

BackgroundSexual dysfunction among psychotic patients is highly prevalent. However, most research has focused on antipsychotic side effects on sexual functioning.AimTo provide evidence by means of a systematic review of the literature about the impact of psychosis on sexual functioning among unmedicated patients.MethodsSystematic search of MEDLINE (PubMed), Scopus, and Google Scholar for studies that reported sexual functioning among psychotic patients, who were drug-naïve or drug-free for at least 3 weeks before the study. Studies were published in English language between January 1994 and October 2019. We used the approach recommended by PRISMA, and the selection process was carried out by 2 reviewers.OutcomesThe outcome measures were sexual function and sexual dysfunctions.ResultsA total of 734 articles were obtained, 658 were obtained after duplicates were removed, 612 were excluded after reading the title and abstract, and 46 were included for a complete review of the articles. 5 papers were finally included. A total of 770 cases were included in the systematic review. The prevalence of sexual dysfunction in psychosis varied from 16.8% to 70% and in ultra-high state was 50%. It is noteworthy that those ultra–high-risk (prodromal) patients who develop psychosis had higher rates of sexual impairment. Therefore, we found higher rates of sexual dysfunction among untreated patients, both psychotic and ultra-high risk patients, than healthy controls.Clinical ImplicationsThe assessment of sexual behavior should be a part of routine psychiatric examination not only in psychotic but also in ultra–high-risk patients.Strengths & LimitationsThis is the first systematic review about the impact of psychosis on sexual functioning among unmedicated patients. However, scarce and heterogeneous studies were identified.ConclusionsImpaired sexual functioning is common in the onset of psychosis (or during ultra–high-risk state) and prior to the beginning of treatment. This suggests that psychotic symptoms and sexual dysfunction may have common etiological pathways at the psychosocial and neurobiological levels.Vargas-Cáceres S, Cera N, Nobre P, et al. The Impact of Psychosis on Sexual Functioning: A Systematic Review. J Sex Med 2021;18:457–466.