Neurohormonal Changes in the Gut-Brain Axis and Underlying Neuroendocrine Mechanisms following Bariatric Surgery.

Obesity is a complex, multifactorial disease that is a major public health issue worldwide. Currently approved anti-obesity medications and lifestyle interventions lack the efficacy and durability needed to combat obesity, especially in individuals with more severe forms or coexisting metabolic disorders, such as poorly controlled type 2 diabetes. Bariatric surgery is considered an effective therapeutic modality with sustained weight loss and metabolic benefits. Numerous genetic and environmental factors have been associated with the pathogenesis of obesity, while cumulative evidence has highlighted the gut-brain axis as a complex bidirectional communication axis that plays a crucial role in energy homeostasis. This has led to increased research on the roles of neuroendocrine signaling pathways and various gastrointestinal peptides as key mediators of the beneficial effects following weight-loss surgery. The accumulate evidence suggests that the development of gut-peptide-based agents can mimic the effects of bariatric surgery and thus is a highly promising treatment strategy that could be explored in future research. This article aims to elucidate the potential underlying neuroendocrine mechanisms of the gut-brain axis and comprehensively review the observed changes of gut hormones associated with bariatric surgery. Moreover, the emerging role of post-bariatric gut microbiota modulation is briefly discussed.

Design of a Proficiency-Based Skills Training Curriculum for Our Newly Validated 3-Dimensional (3D) Laparoscopic Models, Using MISTELS.

Aim: There are presently no courses or training curricula for surgical simulation that include training with 3-Dimensional (3D) laparoscopic platforms. Our aim is to create an expert led design of a proficiency-based skills training curriculum for our newly validated 3D laparoscopic models, using MISTELS compensating speed for precision and accuracy. Method: In this study, 5 tasks were performed by 12 expert surgeons of different specializations on low-cost, portable models designed for 3D display. The competence level for each task was devised by using a target performance time (within the cutoff limit), maximum allowable error score and penalty error score, allowing real time instant scoring and feedback. The results were evaluated by MISTELS scoring system. Results: Out of the 12 experts, the top 3 with the shortest mean time with no errors would be chosen to design a proficiency curriculum. The final aim of developing such curriculum is to shorten learning curve and to improve technical skills of 3D laparoscopy. The curriculum provides a benchmark level for each task, indicating the cutoff and the target performance time, a list of the allowable errors and the number of repetitions. Conclusion: Our future plan is to investigate the cost and effectiveness of the curriculum and to reveal if practice and repetition will lead to mastering 3D skills among novices (medical students and junior doctors).

Gastrointestinal bleeding as initial presentation of extramedullary plasma cell neoplasms: A case report and review of the literature.

BACKGROUND: Plasma-cell neoplasms rarely involve the gastrointestinal tract and manifest as gastrointestinal bleeding. Plasmablastic myeloma is an aggressive plasma cell neoplasm associated with poor outcomes. A small number of cases with gastrointestinal involvement is reported in the literature and therefore high index of suspicion is essential for avoiding delays in diagnosis and treatment. CASE SUMMARY: Our aim is to present our experience of a 70-year-old patient with a secondary presentation of plasmablastic myeloma manifesting as unstable upper gastrointestinal bleeding and to review the literature with the view to consolidate and discuss information about diagnosis and management of this rare entity. In addition to our case, a literature search (PubMed database) of case reports of extramedullary plasma cell neoplasms manifesting as upper gastrointestinal bleeding was performed. Twenty-seven cases of extramedullary plasmacytoma (EMP) involving the stomach and small bowel presenting with upper gastrointestinal bleeding were retrieved. The majority of patients were males (67%). The average age on diagnosis was 62.7 years. The most common site of presentation was the stomach (41%), followed by the duodenum (15%). The most common presenting complaint was melena (44%). In the majority of cases, the EMPs were a secondary manifestation (63%) at the background of multiple myeloma (26%), plasmablastic myeloma (7%) or high-grade plasma cell myeloma (4%). Oesophagogastroscopy was the main diagnostic modality and chemotherapy the preferred treatment option for secondary EMPs. CONCLUSION: Despite their rare presentation, upper gastrointestinal EMPs should be considered in the differential diagnosis of patients with gastrointestinal bleeding especially in the presence of systemic haematological malignancy.