Trend of Changes in Serum Albumin and Its Relation with Sex,Age, and BMI Following Laparoscopic Mini-gastric Bypass Surgery in Morbid Obese Cases

Background

The aim of this study is to investigate the pattern of changes in serum albumin level after mini-gastric bypass (MGB) and its association with gender, age, and body mass index (BMI) of the patients.

Methods

This cohort study was conducted on 196 morbidly obese patients undergoing MGB followed for 1 year. The data on BMI, serum albumin level, demographic, anthropometric, biochemical variables and comorbidities were gathered before and after (3, 6, and 12 months) surgery. The trend of changes in BMI and serum albumin of the patients was investigated by repeated measures tests using general linear model (GLM) and generalized estimating equations (GEE) approaches.

Results

The mean age, baseline median BMI, and albumin of the patients were 41.34 ± 11.03 years, 44.54 kg/m², and 4.00 g/dl, respectively. There was a chronologically significant trend of decline in BMI (P < 0.001). GEE demonstrated no chronologically significant trend in serum albumin (P = 0.278). The trend of changes in albumin was significantly associated only with age grouping and baseline serum albumin level (P = 0.017 and 0.001, respectively). This trend had fluctuations in patients older than 40 years with baseline serum albumin level of 3.50–3.90 g/dl. For patients with any age and baseline serum albumin level of 4.00–4.90 g/dl, this trend was stable in all periods of follow-up.

Conclusion

MGB is an effective technique to lose weight. The trend of changes in serum albumin level was affected by its baseline levels and age.

     

Cholestasis induces apoptosis in mice cardiac cells: the possible role of nitric oxide and oxidative stress

Background/Aims: Acute cholestasis is associated with cardiovascular complications. The purpose of the present study was to investigate the effect of cholestasis on heart apoptosis and the involvement of nitric oxide (NO) and oxidative stress in the possible altered apoptosis of cholestatic hearts. Methods: Cholestasis was induced by bile duct–ligation, and sham‐operated mice served as controls. Three days after the surgery, heart tissues were evaluated for apoptosis and the level of malondialdehyde (MDA), and the activities of catalase (CAT), glutathione peroxidase (GSHPx) and superoxide dismutase (SOD) have been studied in cardiac tissues. The role of treatment with l ‐NAME, a non‐selective inhibitor of NO synthase, or with d ‐NAME, an inactive isomer of l ‐NAME, on cholestatic and sham cardiac apoptosis, level of MDA and CAT, SOD and GSHPx activities was also investigated. The content of NO in cardiac tissue was also determined. Results: Cholestatic hearts showed structural abnormalities and increased apoptosis compared with sham hearts. Treatment with l ‐NAME, but not d ‐NAME, improved both structural abnormalities and enhanced apoptosis of cholestatic hearts. Cholestatic hearts also had an increased level of MDA and decreased activities of CAT and GSHPx, which were not modified by d ‐NAME treatment. By l ‐NAME treatment, the level of MDA decreased and activities of CAT, GSHPx and SOD increased in BDL mice. The content of NO was higher in cholestatic cardiac tissue, which was decreased by l ‐NAME treatment. Conclusion: In conclusion, apoptosis in cholestatic heart might have occurred because of NO overproduction, which could induce oxidative stress in the heart of cholestatic mice.     

Vascular mechanisms of cyanidin-3-glucoside response in streptozotocin-diabetic rats

Background and objective: Considering the high incidence of cardiovascular disorders in diabetes mellitus and some evidence on the antioxidant and antidiabetic potential of cyanidin-3-glucoside (C3G), this study was conducted to evaluate the possible beneficial effect of C3G administration on vascular reactivity of isolated thoracic aorta in diabetic rats and some of its underlying mechanisms. Materials and methods: Male diabetic rats received C3G (10 mg/kg; i.p.) on alternate days for 8 weeks one week after streptozotocin (STZ) diabetes induction. Results: It was found out that treatment of diabetic rats with C3G exerted a hypoglycaemic effect and attenuated the increased malondialdehyde (MDA) content and reduced the activity of superoxide dismutase (SOD) in aortic tissue. Maximum contractile response of endothelium-intact aortic rings to phenylephrine (PE) was significantly lower in C3G-treated diabetic rats relative to untreated diabetics and endothelium removal abolished this difference. Meanwhile, endothelium-dependent relaxation to acetylcholine (ACh) was significantly higher in C3G-treated diabetic rats as compared to diabetic group. Conclusion: Chronic treatment with C3G may prevent some diabetes-related changes in vascular reactivity observed in diabetic rats directly and/or indirectly due to its hypoglycaemic effect and attenuation of lipid peroxidation and through endothelial-derived factors.     

Chronic subdural hematoma outcome prediction using logistic regression and an artificial neural network

Artificial neural networks (ANN) have not been used in chronic subdural hematoma (CSDH) outcome prediction following surgery. We used two methods, namely logistic regression and ANN, to predict using eight variables CSDH outcome as assessed by the Glasgow outcome score (GOS) at discharge. We had 300 patients (213 men and 87 women) and potential predictors were age, sex, midline shift, intracranial air, hematoma density, hematoma thickness, brain atrophy, and Glasgow coma score (GCS). The dataset was randomly divided to three subsets: (1) training set (150 cases), (2) validation set (75 cases), and (3) test set (75 cases). The training and validation sets were combined for regression analysis. Patients aged 56.5 ± 18.1 years and 228 (76.0%) of them had a favorable outcome. The prevalence of brain atrophy, intracranial air, midline shift, low GCS, thick hematoma, and hyperdense hematoma was 142 (47.3%), 156 (52.0%), 177 (59.0%), 82 (27.3%), 135 (45.0%), and 52 (17.3%), respectively. The regression model did not show an acceptable performance on the test set (area under the curve (AUC) = 0.594; 95% CI, 0.435–0.754; p = 0.250). It had a sensitivity of 69% and a specificity of 46%, and correctly classified 50.7% of cases. A four-layer 8–3–4–1 feedforward backpropagation ANN was then developed and trained. The ANN showed a remarkably superior performance compared to the regression model (AUC = 0.767; 95% CI, 0.652–0.882; p = 0.001). It had a sensitivity of 88% and a specificity of 68%, and correctly classified 218 (72.7%) cases. Considering that GOS strongly correlates with the risk of recurrence, the ANN model can also be used to predict the recurrence of CSDH.     

A Reduction in Delayed Gastric Emptying by Classic Pancreaticoduodenectomy with an Antecolic Gastrojejunal Anastomosis and a Retrogastric Omental Patch

Background  Delayed gastric emptying (DGE) continues to be a major cause of morbidity following pancreaticoduodenectomy (PD). A change in the method of reconstruction following PD was instituted in an attempt to reduce the incidence DGE. Methods  Patients undergoing PD from January 2002 to December 2008 were reviewed and outcomes determined. Pylorus-preserving pancreaticoduodenectomy (PPPD) with a retrocolic duodenojejunal anastomosis (n = 79) or a classic PD with a retrocolic gastrojejunostomy (n = 36) was performed prior to January 2008. Thereafter, a classic PD with an antecolic gastrojejunal anastomosis and placement of a retrogastric vascular omental patch was undertaken (n = 36). Results  A statistically significant decrease in DGE was noted in the antecolic group compared to the entire retrocolic group (14% vs 40%; p = 0.004) and compared to patients treated by classic PD with a retrocolic anastomosis alone (14% vs 39%; p = 0.016). On multivariate analysis, the only modifiable factor associated with reduced DGE was the antecolic technique with an omental patch, odds ratio (OR) 0.3 (confidence interval (CI) 0.1–0.8) p = 0.022. Male gender was associated with an increased risk of DGE with OR 2.3 (CI 1.1–4.8) p = 0.026. Conclusion  A classic PD combined with an antecolic anastomosis and retrogastric vascular omental patch results in a significant reduction in DGE.     

Fc gamma receptor IIa polymorphism in patients with brucellosis

Recent evidence suggests that certain Fc gamma receptor alleles are genetic risk factors for infectious diseases. In this study, we evaluated Fc gamma RIIa polymorphism in patients with brucellosis. In a case-control study, the frequency of two alleles and three genotypes for Fc gamma RIIa were measured by PCR in 150 patients with brucellosis and 125 healthy controls. The H131 and R131 alleles were found in 133 (44.3%) and 167 patients (47.6%), respectively. The frequencies for the three genotypes (a/a, a/r, r/r) were 10 (6.7%), 113 (75.3%) and 27 (18%), respectively. There was no significant difference in the distribution of Fc gamma RIIa genotypes and the two allelic forms between the patients and controls. Our study indicates that Fc gamma RIIa polymorphism is not decisive for the acquisition of brucellosis.     

Chronic epigallocatechin-gallate improves aortic reactivity of diabetic rats: Underlying mechanisms

Diabetes mellitus is associated with major cardiovascular risk factors which are responsible for excess morbidity and mortality. Green tea catechins including epigallocatechin-3-gallate (EGCG) could exert beneficial health effects to ameliorate cardiovascular and metabolic diseases. Thus, the effect of chronic administration of EGCG was studied on aortic reactivity of streptozotocin (STZ)-diabetic rats. Male diabetic rats received EGCG 25 mg/kg/day for 8 weeks 1 week after diabetes induction. Contractile responses to KCl and phenylephrine (PE) and relaxation responses to acetylcholine (ACh) and sodium nitroprusside (SNP) were obtained from aortic rings. Maximum contractile response of endothelium-intact rings to KCL and PE was significantly lower in EGCG-treated diabetic rats relative to untreated diabetic ones. Endothelium removal abolished the significant difference between EGCG-treated and untreated diabetic groups regarding contractile response to KCl and PE. Meanwhile, endothelium-dependent relaxation to ACh was significantly higher in EGCG-treated diabetic rats as compared to diabetic ones. Pretreatment of rings with N(omega)-L-arginine methyl ester (L-NAME) and indomethacin (INDO) significantly attenuated the observed responses. Meanwhile, two-month diabetes resulted in an elevation of malondialdehyde (MDA) and decreased superoxide dismutase (SOD) activity in aortic tissue and EGCG treatment attenuated the increased MDA content and reduced activity of SOD. Therefore, chronic treatment of diabetic rats with EGCG could prevent the abnormal functional changes in vascular reactivity in diabetic rats through nitric oxide- and prostaglandin-dependent pathways and via attenuation of aortic lipid peroxidation.