Morphological Changes in the Carotid Artery Intima after Gastric Bypass for Morbid Obesity.

BACKGROUND: Carotid intima-media thickness (C-IMT) can be considered as an early marker of atherosclerosis, thus representing a reliable cardiovascular risk predictor. Bariatric surgery decreases the burden of cardiovascular disease in obese patients through complex mechanisms, of which weight loss is merely the most evident epiphenomenon. The aim of this study is to evaluate C-IMT variations in patients undergoing Roux-en-Y gastric bypass (RYGB) and possible correlations with biometric parameters and cardiovascular risk factors. METHODS: Thirty patients undergoing RYGB for morbid obesity were enrolled for carotid artery B-mode ultrasound evaluation before surgery and at 1-, 3-, 6-, and 12-month follow-up; C-IMT was recorded at three levels (bulb, common, and internal carotid). At each one of the follow-ups, biometric and serohematic parameters were also collected. RESULTS: The 22 patients who completed the follow-up and were included in the study showed significant C-IMT reduction at all three levels at 12-month follow-up (p < 0.001). Along with a significant BMI reduction and diabetes/hypertension remission, we found a considerable decrease in total cholesterol (219 vs 164 mg/dl; p < 0.001) and uric acid (5.6 vs 4.5 mg/dl; p < 0.01) and a significant increase in HDL cholesterol (43.9vs59.2 mg/dl; p < 0.001). The data imply that the mean 10-year cardiovascular risk score drops by nearly 50 % (5.7 ± 5.6 vs. 2.9 ± 2.7 %, p < 0.001) according to Framingham cardiovascular risk stratification. CONCLUSIONS: RYGB is associated with significant decrease in C-IMT at 1 year. Pathophysiologic processes underlying such a variation, probably involving lipid and urate metabolism and their correlation with cardiovascular risk reduction should be confirmed by long-term prospective trials.

Road Running After Gastric Bypass for Morbid Obesity: Rationale and Results of a New Protocol.

BACKGROUND: In recent years, the pandemic explosion of obesity has led to the definition of a pre-eminent therapeutic role for bariatric surgery, confining physical activity to a success parameter of surgery rather than a primary prevention measure. The aim of this study is to evaluate the role for aerobic physical activity (road running) in strengthening the metabolic and psychosocial effects of bariatric surgery. METHODS: Ten patients who underwent gastric bypass for morbid obesity were submitted to an intensive program of road running training, aimed at completing a 10.5-km competition in September 2013. Inclusion criteria included age (<50), BMI (<35), suitability for sport activity, and good compliance. A cohort of 10 patients excluded for logistical issues were enrolled as a control group. During the training period, patients were submitted to biometrical, sport performance, cardiopulmonary, metabolic, and psychiatric evaluations. RESULTS: Protocol adherence was 70 %; no physical injury was registered among participants. More than weight loss (BMI 29.3 to 27.1), the runners experienced a redistribution of body mass with significant differences in fat percentage and waist/hip ratio. Participants had a significant running performance improvement and, differently from the controls, a significant amelioration of echocardiographic and cardiopulmonary parameters, predicting a reduction in cardiovascular risk. Psychiatric evaluation underlined a tendency to a reduction in anxiety, depression, and general psychopathology symptoms. CONCLUSIONS: Road running seems to have an important supporting role in boosting bariatric surgery results. The utilization of monitored and regulated training programs represents a fundamental prerequisite to achieving satisfactory results and patient compliance.

Lymph node ratio improves TNM and Astler-Coller's assessment of colorectal cancer prognosis: an analysis of 761 node positive cases.

BACKGROUND: Prognosis assessment of node-positive colorectal cancer patients by Astler-Coller (AC) and TNM classifications is suboptimal. Recently, several versions of lymph node ratio (LNR; ratio metastatic/examined nodes) have been proposed but are still mostly unused. METHODS: The prognostic value of several criteria, including LNR (two classes-LNR1 and LNR2-identified by a 15% cut-off) was studied in 761 consecutive patients, from 2000 through 2010. The relationships between total examined nodes, N, T and LNR were also analysed. LNR1 and LNR2 patients' survival was analysed within AC and TNM subgroups, and then coupled with them. RESULTS: Age, tumour location and LNR are independent factors predicting survival. The relationships between LNR, N stage and T stage with examined nodes suggest confusing factors. LNR allows for identification of subgroups with different survival within AC and TNM classifications (p < 0.0001). Patients with LNR class discordant from AC stage (LNR1-C2 and LNR2-C1) have a similar 5-year survival (54 and 57%, respectively). LNR2 and TNM stage IIIC define a poor 5-year prognosis (33%). CONCLUSIONS: LNR is a powerful prognosis predictor, easily integrated with TNM and AC classifications to improve prognosis assessment and facilitate clinical use. Possible confusing factors should be considered in future studies.