Bariatric Surgery in Patients with Achondroplasia, a Feasibility Study of Two Case Studies.

BACKGROUND: Achondroplasia is a common skeletal dysplasia with a high prevalence of obesity in adulthood. Bariatric surgery has been shown to be effective in treating obesity and related comorbidities, but its feasibility and effectiveness in patients with achondroplasia have not been clearly established. OBJECTIVES: The objective of this study was to evaluate the feasibility and effectiveness of bariatric surgery in patients with achondroplasia. SETTING: This study was performed in France, and bariatric surgeons from the Société Française et Francophone de Chirurgie de l'Obésité et des Maladies Métaboliques (French Francophone Society of Surgery for Obesity or Metabolic Diseases) were asked to participate. METHODS: Two adult women with confirmed achondroplasia and a high BMI were selected for laparoscopic sleeve gastrectomy. Preoperative data were collected, including demographic information, comorbidities, and follow-up at 1, 3, and 6 months and 1 year after surgery. Complications were monitored and recorded. RESULTS: Both patients had good excess weight loss outcomes, with an average excess weight loss of 60.5% 1 year after surgery. One patient had a follow-up of 3 years and an excess weight loss of 44%. The surgery was well-tolerated, and no major complications were observed. CONCLUSIONS: Bariatric surgery is feasible and effective in patients with achondroplasia, with good outcomes for excess weight loss and related comorbidities. These findings suggest that bariatric surgery should be considered a treatment option for patients with achondroplasia and obesity.

Adjuvant Glucose-Like Peptide 1 Receptor Agonist Therapy for Suboptimal Weight Loss After Bariatric Surgery: a Systematic Review.

Addressing suboptimal weight loss post-bariatric surgery poses a challenge. While glucagon-like peptide 1 receptor agonists (GLP1-RA) show promise in managing obesity, their role as an adjuvant treatment after bariatric surgery remains uncertain. We conducted a systematic literature review focused on the efficacy and safety of GLP1-RA in bariatric surgery patients with insufficient weight loss or distant weight regain. Our literature search identified 1167 articles, with 10 (involving 594 patients) meeting inclusion/exclusion criteria for detailed review. GLP1-RA therapy resulted in 5 to 17% weight loss over 6 to 12 months, with 10-50% experiencing non-severe side effects like nausea. Overall, GLP1-RA emerges as an effective adjuvant therapy for patients experiencing inadequate weight loss or regain after bariatric surgery, offering a viable alternative to revision surgery.

Precision medicine in endocrinology: Unraveling metabolic health through time-restricted eating.

As a promising avenue in nutrition, intermittent fasting, particularly time-restricted eating like the 8/16 protocol, requires careful individualization. This approach involves voluntary food restriction interspersed with normal eating, aiming to align with inner circadian rhythms for potential benefits in metabolism and weight management. Endocrinologists, responding to patient interest and backed by evidence-based medicine, can now delve into the intricacies of time-restricted eating. They consider each patient's unique medical history and expectations, integrating this approach into tailored treatment plans in a personalized medicine approach. Ongoing research is essential to deepen our comprehension of how time-restricted eating influences metabolic health, enabling the development of precise recommendations suitable for diverse populations and various clinical conditions. While time-restricted eating is a relevant metabolic approach, endocrinologists should exercise caution to prevent the promotion of eating disorders due to its restrictive nature.

Structural Properties of Kerogens with Different Maturities.

The thermogenic transformation of kerogen into hydrocarbons accompanies the development of a pore network within the kerogen that serves as gas storage locations both in pore space and surface area for adsorbed gas within the source rock. Therefore, the successful recovery of gas from these rocks depends on the accessible surface area, surface properties, and interconnectivity of the pore system. These parameters can be difficult to determine because of the nanoscale of the structures within the rock. This study seeks to investigate the pore structure, surface heterogeneity, and composition of recovered kerogens isolated from source rocks with progressively increasing thermogenic maturities. Prompt gamma-ray activation analysis (PGAA), nitrogen and methane volumetric gas sorption, and small-angle neutron scattering (SANS) are combined to explore the relationship between the chemical composition, pore structure, surface roughness, surface heterogeneity, and maturity. PGAA results indicate that higher mature kerogens have lower hydrogen/carbon ratio. Nitrogen gas adsorption indicates that the pore volume and accessible specific surface area are higher for more mature kerogens. The methane isosteric heat at different methane uptake in the kerogens is determined by methane isotherms and shows that approximately two types of binding sites are present in low mature kerogens while the binding sites are relatively homogeneous in the most mature kerogen. The hysteresis effect of the structure during the adsorption and desorption process at different CD4 gas pressures are studied. An extended generalized Porod's scattering law method (GPSLM) is further developed here to analyze kerogens with fractal surfaces. This extended GPSLM quantifies the surface heterogeneity of the kerogens with a fractal surface and shows that kerogen with high maturity is chemically more homogeneous, consistent with the results from methane isosteric heat. SANS analysis also suggests a pronounced surface roughness in the more mature kerogens. A microporous region circling around the nanopores, which contributes to high surface roughness and methane storage, is shown to develop with maturity.