Morbid obesity treated by gastroplasty: radionuclide gastric emptying studies

Mechanisms by which gastroplasty for morbid obesity causes weight loss are poorly understood. We studied the role of altered gastric emptying in 50 patients before surgery, 1-4 weeks after surgery, and 2-24 months after surgery using technetium-99m pentetate in water for liquid meals and a Tc-99m styrene divinylbenzene copolymer resin in oatmeal for semisolid meals. We determined the emptying half-times of the stomach before and after surgery in the proximal and distal compartments. The proximal compartment emptied promptly in the early and late postoperative periods. The distal compartment emptied liquids at rates similar to those before surgery, while the late postoperative emptying of semisolids was significantly faster. The stoma connecting the two compartments thus permits rapid transit of liquids and semisolids without delay of distal compartment emptying. No correlation was seen between the emptying half-times or changes thereof and eventual weight loss. Delayed gastric emptying is therefore not the mechanism for satiety and weight loss after gastroplasty has been performed.     

miR-26a regulates mouse hepatocyte prolifera-tion via directly targeting the 3’ untranslated region of CCND2 and CCNE2

BACKGROUND: The deficiency of liver regeneration needs to be addressed in the fields of liver surgery, split liver transplantation and living donor liver transplantation. Researches of micro RNAs would broaden our understandings on the mechanisms of various diseases. Our previous research confirmed that mi R-26 a regulated liver regeneration in mice; however, the relationship between mi R-26 a and its target, directly or indirectly, remains unclear. Therefore, the present study further investigated the mechanism of mi R-26 a in regulating mouse hepatocyte proliferation.METHODS: An established mouse liver cell line, Nctc-1469, was transfected with Ad5-mi R-26a-EGFP, Ad5-anti-mi R-26 aEGFP or Ad5-EGFP vector. Cell proliferation was assessed by MTS, cell apoptosis and cell cycle by flow cytometry, and gene expression by Western blotting and quantitative real-time PCR. Dual-luciferase reporter assays were used to test targets of mi R-26 a.RESULTS: Compared with the Ad5-EGFP group, Ad5-antimi R-26a-EGFP down-regulated mi R-26 a and increased proliferation of hepatocytes, with more cells entering the G1 phase of cell cycle(82.70%±1.45% vs 75.80%±3.92%), and decreased apoptosis(5.50%±0.35% vs 6.73%±0.42%). CCND2 and CCNE2 were the direct targeted genes of mi R-26 a. mi R-26 a downregulation up-regulated CCND2 and CCNE2 expressions and down-regulated p53 expression in Nctc-1469 cells. On the contrary, mi R-26 a over-expression showed the opposite results.CONCLUSIONS: mi R-26 a regulated mouse hepatocyte proliferation by directly targeting the 3' untranslated regions of cyclin D2/cyclin E2; mi R-26 a also regulated p53-mediated apoptosis. Our data suggested that mi R-26 a may be a promising regulator in liver regeneration.     

The clinical results of the Turnbull–Cutait delayed coloanal anastomosis: a systematic review

Turnbull and Cutait described abdominoperineal pull-through followed by delayed coloanal anastomosis (DCA) in 1961. DCA could reduce anastomotic leaks, pelvic morbidity and use of stomas. Strong evidence about its clinical benefits is still lacking. This systematic review examined the clinical outcomes of DCA for the treatment of malignant or benign colorectal conditions. A systematic search of electronic medical databases was conducted. Two independent reviewers selected studies, extracted data and assessed risk of bias. The primary outcome was pelvic morbidity (anastomotic leak, pelvic abscess or sepsis, use of stoma). Fecal continence and survival data were also analyzed. From 1,251 citations, we included seven observational studies including 1,124 patients. All included studies were considered at high risk of bias. Two studies comparing DCA with immediate anastomosis reported a significant decrease in anastomotic leak, and pelvic abscess or sepsis. Low rates of pelvic morbidity were reported in the other five studies: anastomotic leak 0–7 %, pelvic abscess 0–11.8 % and pelvic sepsis 6.8–10 %. Rates of permanent stoma after DCA were low in six studies (1–6 %), with one study reporting an incidence of 25 %. Fecal continence was reported as satisfying in all studies. No differences were observed in a comparative setting. Survival data were reported in four studies. Clinical heterogeneity and methodological issues precluded meta-analysis. Based on retrospective evidence, DCA offers a low rate of anastomotic leak, pelvic morbidity and use of stoma, with reasonable fecal continence. Results are encouraging, but prospective studies are needed for comparison with standard of care.