Potential associations between alterations in gut microbiome and obesity-related traits after the bariatric surgery.

BACKGROUND: This study aimed to examine the effects of both obesity and bariatric surgery on gut microbiome, dietary intake, as well as metabolic and inflammatory parameters. METHODS: All participants (15 with morbid obesity who had bariatric surgery, 8 with morbid obesity and 11 non-obese) were followed up for a 6-month period with interviews at baseline (M0), at the end of 3 (M3) and 6 months (M6). Dietary assessment was done, and blood and faecal samples were collected. RESULTS: Dietary energy and nutrient intakes as well as serum glucose levels, total cholesterol, low-density lipoprotein (LDL)-cholesterol and high sensitivity C-reactive protein (hs-CRP) levels decreased after surgery (p < 0.05, for each). Participants with morbid obesity had higher levels of Firmicutes and lower levels of Bacteroidetes at M0 compared to non-obese participants. The abundances of Bacteroidetes increased (p = 0.02), whereas that of Firmicutes decreased (p > 0.05) after the surgery, leading to a significant decrease in Firmicutes/Bacteroidetes ratio (p = 0.01). At sub-phylum level, the abundances of Lactobacillus and Bifidobacterium decreased, whereas those of Akkermansia increased after the surgery (p < 0.01, for each). Although participants who were morbidly obese had a distinct profile according to ß-diversity indices at M0, it became similar with the profile of non-obese participants (p > 0.05) at M3 and M6. Similarly, α-diversity indices were lower in subjects with morbid obesity at M0, but became similar to levels in non-obese controls at M6. CONCLUSION: This study confirmed that bariatric surgery has substantial impacts on gut microbiome's composition and diversity, as well as anthropometrical measurements and biochemical parameters, which were associated with the alterations in dietary intake patterns.

Effects of different intraabdominal pressures on internal jugular vein, liver and kidney functions in obese patients undergoing laparoscopic sleeve gastrectomy.

OBJECTIVE: The aim of this study was to investigate whether there was a difference in laparoscopic sleeve gastrectomy (LSG) performed with either 10 mmHg or 13 mmHg intraabdominal pressures. Effects of these pressures on the internal jugular vein (IJV) diameter and flow along with the liver and kidney function tests were evaluated. MATERIALS AND METHODS: The patients were divided into two groups with respect to the intraabdominal pressure performed during LSG (either 10 or 13 mmHg). The patients' age, comorbidities, surgical history, height, weight, body mass index, family history, duration of surgery, length of hospital stay, serum liver and kidney function tests (Urea, creatinine, Aspartate transaminase, Alanine transaminase, Gamma-glutamyltransferase, Alkaline phosphatase, bilirubin) and the right IJV diameter and flow measured by Duplex ultrasound before intubation (t1), 10 min after insufflation (t2), and at the end of insufflation (t3) were recorded. RESULTS: Preoperative and postoperative kidney and liver function values of the patients in both groups were within the reference range. In both groups, there was a significant decrease in the IJV diameter and flow measurement values at t2 compared to t1, and a significant increase was observed at t3 compared to t2 (p < 0.05). The mean IJV diameter and flow were significantly higher in the 10 mmHg pressure group compared to the 13 mmHg group (p < 0.05). CONCLUSION: Neither of the peak pressures performed intraabdominal during LSG caused an adverse effect on liver or kidney functions. Our study emphasizes that low insufflation pressure does not have an advantage in terms of liver and kidney functions. But laparoscopic sleeve gastrectomy with low intra-abdominal pressure may be beneficial especially in patients who require central vein catheterization during the operation. We consider that LSG performed with CO2 pneumoperitoneum at 10 mmHg is a safe, effective and feasible method that can facilitate the insertion of the intraoperative central venous catheter due to lesser charges in the IJV diameter and flow compared to the standard technique.

Long-term impact of sleeve gastrectomy on serum uric acid levels.

BACKGROUND: Obesity is a risk factor for hyperuricemia. Bariatric surgery is an effective treatment method for metabolic control. The aim of our study was to evaluate the correlation between the preoperative and postoperative serum uric acid levels with body mass index, body weight, and excess weight loss in patients that underwent sleeve gastrectomy. METHODS: A total of 164 patients that underwent laparoscopic and open sleeve gastrectomy were evaluated in terms of the demographic characteristics, preoperative body weight, body mass index and serum uric acid levels, and postoperative body weight, body mass index, excess weight loss and serum uric acid levels at the first, third, sixth, 12th, 18th and 24th-36th months. RESULTS: There was a statistically significant increase in serum uric acid levels in the first postoperative month (p = 0.000). The patients with a high preoperative body mass index were found to have a lower excess weight loss in the first postoperative month, which was statistically significant (p = 0.000, R = -0.474). Serum uric acid levels were also positively correlated with body weight at the third and sixth postoperative months. DISCUSSION: The weight loss associated with sleeve gastrectomy is the main reason for the reduced postoperative serum uric acid levels.

Analysis of the Effect of Weight Loss on Eustachian Tube Function by Transnasal Videoendoscopy.

OBJECTIVE: To investigate the effect of weight loss after bariatric surgery on eustachian tube (ET) function with video endoscopy. MATERIALS AND METHODS: The present study was conducted as a prospective cohort and was completed with 19 patients. Three-step tympanometry (basal, Toynbee, Valsalva), dynamic slow-motion video endoscopy, and the Eustachian Tube Dysfunction Questionnaire-7 (ETDA-7) were applied to the patients preoperatively before bariatric surgery and in the postoperative 6th month. Dynamic slow-motion video endoscopy was graded between 0 and 3, or classified as patulous, as indicated in the literature. RESULTS: The mean body mass index of 6 male and 13 female patients decreased from 47.3 ±â€Š4.6 to 31.2 ±â€Š5.4. Grade decline (median 2 ±â€Š1) was experienced in all patients in DSVE, and 1 patient resulted as patulous ET. The ETDA-7 scores decreased in11 patients, remained stable in 7 patients, and increased in 1 patient with patulous ET. The statistical analysis of the preoperative and postoperative DSVE grading and ETDA-7 scores, excluding the patulous ET patient, was found to be significant (P  = 0.001 and P  = 0.003, respectively). There was no significant change in any of the tympanometry parameters (P > 0.05). CONCLUSIONS: Rapid weight loss with bariatric surgery results in an improvement in both the DSVE images and in the complaints of ET dysfunction in the majority of patients, but in some patients it may result in patulous ET. Therefore, preoperative evaluation of the ET with DSVE and questioning the patient's complaints are important in predicting patients who may develop patulous ET.

Whole mitochondrial genome of long-clawed mole vole (Prometheomys schaposchnikowi) from Turkey, with its phylogenetic relationships.

The mitogenome of Prometheomys schaposchnikowi was characterized for the first time as a circular DNA molecule (16.284 bp), containing 37 coding and 2 non-coding regions. In the mitogenome, ND6 and 8 tRNA genes were encoded on the light chain, while 12 PCGs, 14 tRNAs, 2 rRNAs, D-loop and OL were encoded on the heavy chain. The most common initiation codon in PCGs was ATG. As in many mammals, incomplete stop codons in P. schaposchnikowi were in the COX3, ND1 and ND4. Phylogenetic relationships were revealed using Bayesian method and the 13 PCGs. Seven genera (Arvicola, Dicrostonyx, Lasiopodomys, Myodes, Ondatra, Proedromys and Prometheomys) formed a monophyletic group, while Eothenomys, Microtus and Neodon were paraphyletic. P. schaposchnikowi constituted the most basal group within Arvicolinae. Divergence time estimation suggested that P. schaposchnikowi diversified during the Miocene (16.28 Mya). Further molecular studies are needed to test the distinctiveness and diversity of the genus Prometheomys.

External validation of anastomotic leakage risk analysis system in patients who underwent colorectal resection

Background/aim: One of the most feared complications after colon resection for carcinoma is anastomotic leakage. Prediction of anastomotic leakage can alter pre- and perioperative management of patients. This study validates an anastomotic leakage prediction system. Materials and methods: Ninety-five patients who underwent colonic resection between 1 January 2016 and 30 January 2017 were included in the study. Patient records and electronic charting system data were used to calculate anastomotic leakage risk on the http://www.anastomoticleak.com/ website. Results: Fifty-six (58.9%) patients were male and thirty-nine (41.1%) were female. The mean age was 61.7 (min: 33, max: 90). Six (6.3%) patients had anastomotic leakage. According to the ROC analysis, the area under curve for the prediction system was 0.767. Conclusion: The prediction system for anastomotic leakage produced significant results for our patient population. It can be effectively utilized in preoperative and perioperative measures to prevent anastomotic leakage.

Efficacy of laparoscopic sleeve gastrectomy for the treatment of obesity in a non-Western society.

PURPOSE: The objective of this study was to analyze the mid-term outcomes of sleeve gastrectomy in a cohort of obese patients. METHODS: We analyzed the outcomes of 159 adult patients who had laparoscopic sleeve gastrectomy between January 2011 and January 2015 in our center. Data collected included patient demographics, presence of comorbid diseases, preoperative body mass index, percent excess weight loss, resolution of comorbid diseases, morbidity and in-hospital mortality. RESULTS: We achieved a 24th month percent excess weight loss of 75.1 ± 10.5. Remission of diabetes mellitus, hypertension, hyperlipidemia and obstructive sleep apnea syndrome after sleeve gastrectomy was as high as 84, 63.9, 75.8 and 93 %, respectively, in different studies. Our results in diabetes mellitus, hypertension and hyperlipidemia are comparable with other data on the improvement of comorbidites after sleeve gastrectomy. We found less improvement in obstructive sleep apnea syndrome in our cohort when compared to other reports. CONCLUSIONS: Sleeve gastrectomy is an efficient, durable technique for the treatment of obesity and associated comorbidities in all body mass index subgroups of obese population. For better outcomes, strategies for proper education and certification are needed.

Randomized Controlled Trial Comparing the Effects of Vessel Sealing Device and Milligan Morgan Technique on Postoperative Pain Perception after Hemorrhoidectomy.

BACKGROUND: The aim of this study was to compare postoperative pain perception after Milligan Morgan and Ligasure™ techniques in hemorrhoidectomy. METHODS: Fifty-four patients diagnosed with Grade 3-4 hemorrhoids requiring surgery between May 2013 and September 2013 were enrolled in the study. Patients were randomized into either the Ligasure™ hemorrhoidectomy group (Group 1, n = 26) or the Milligan Morgan hemorrhoidectomy group (Group 2, n = 28). RESULTS: The difference between visual analogue scale scores on postoperative day 1 was not statistically significant but on the third postoperative day, the Ligasure™ group had higher visual analogue scale scores (4 ± 2.61) when compared to the Milligan Morgan hemorrhoidectomy group (2.43 ± 1.20). This difference on the third postoperative day visual analogue scale scores was statistically significant (p < 0.025). CONCLUSIONS: Ligasure™ does not seem to have an advantage in postoperative pain when compared to Milligan Morgan hemorrhoidectomy.

Blocking SIG1R Along with Low Cadmium Exposure Display Anti-cancer Qualities in Both MCF7 and MDA-MB-231 Cells.

Sigma-1 receptor (SIG1R) is a chaperone that modulates inositol 1,4,5-trisphosphate receptor type1 (IP3R1) calcium (Ca2+) channels on the endoplasmic reticulum. Therefore, SIG1R functions as an indirect regulator of Ca2+ and acts as an apoptosis modulator. Increased expression of SIG1R is associated with poor prognosis in breast cancers (BC), and SIG1R antagonists like BD1047 induce apoptosis. As a heavy metal, cadmium (Cd2+) is competitive with Ca2+ due to its physicochemical similarities and may trigger apoptosis at low concentrations. Our study investigated the SIG1R protein expression in 74 BC patients and found a significant increase in SIG1R expression in the triple-negative BC subtype. We also examined the apoptotic and anti-cancer effects of BD1047 in combination with CdCl2 in MCF7 and MDA-MB-213 cells. Cells were treated with CdCl2 at doses of 1 µM, 25 µM, and 50 µM, along with BD1047. Higher doses of CdCl2 were cytotoxic on both cancer cells and significantly increased DNA breaks. However, low-dose CdCl2 with BD1047 increased cell death and the apoptotic index in BC cells, although it did not exhibit cytotoxic effects on HUVEC cells. Co-administration of low-dose CdCl2 with BD1047 also reduced the migration and colony-forming ability of BC cells. Moreover, the expression of SIG1R protein in these groups decreased significantly compared to groups treated with BD1047 or low-dose CdCl2 alone. In conclusion, low-dose CdCl2 is thought to increase the apoptotic ability of BD1047 in BC cells by reducing SIG1R expression.

Acoustic parameter changes after bariatric surgery.

OBJECTIVE: To investigate the acoustic parameter changes after weight loss in bariatric surgery patients. MATERIALS AND METHODS: This prospective, longitudinal study was conducted with 15 patients with planned bariatric surgery, who were evaluated pre-operatively and at 6 months post-operatively. Fundamental frequency (F0), Formant frequency (F1, F2, F3, and F4), Frequency perturbation (Jitter), Amplitude perturbation (Shimmer) and Noise-to-Harmonics Ratio (NHR) parameters were evaluated for /a/, /e/, /i/, /o/, and /u/ vowels. Changes in the acoustic analysis parameters for each vowel were compared. The study group was separated into two groups according to whether the Mallampati score had not changed (Group 1) or had decreased (Group 2) and changes in the formant frequencies were compared between these groups. RESULTS: A total of 15 patients with a median age of 40 ± 11 years completed the study. The median weight of the patients was 122 ± 14 kg pre-operatively and 80 ± 15 kg, post-operatively. BMI declined from 46 ± 4 to 31 ± 5 kg/m2. The Mallampati score decreased by one point in six patients and remained stable in nine. Of the acoustic voice analysis parameters of vowels, in general, fundamental frequency tended to decrease, and shimmer and jitter values tended to increase. Some of the formant frequencies were specifically affected by the weight loss and this showed statistical significance between Group 1 and Group 2. CONCLUSION: The present study reveals that some specific voice characteristics might be affected by successful weight loss after bariatric surgery.HighlightsObesity reduces the size of the pharyngeal lumen at different levels.The supralaryngeal vocal tract size and configuration is a determinative factor in the features of the voice.Changes in the length and shape of the vocal tract, or height and position of the tongue can result in changes especially in formant frequencies in acoustic analysis.

Controversies in periampullary tumors.

Periampullary tumors are one of the most common tumors of the gastrointestinal tract. Despite the increase of 1-5% in five year life expectancy in periampullary tumors prognosis is still poor. The controversies in diagnosis, surgical and adjuvant treatment will be discussed in this article.

Determinants of postoperative infection after laparoscopic cholecystectomy.

BACKGROUND/AIMS: The aim of this study was to evaluate the effect of antibiotic prophylaxis on the development of infectious complications in laparoscopic cholecystectomy. METHODOLOGY: A total of 208 patients undergoing elective laparoscopic cholecystectomy were randomized, double-blinded into one of two treatment arms: 1) cefazolin 1 g intravenously after induction of anesthesia and 2) no prophylactic antibiotics. The patients were followed-up for infectious complications for 30 days at the out-patient clinic. The data collected included age, sex, body mass index, ultrasonography findings, accompanying diseases, perforation during surgery, stone spillage, operation time, port of gallbladder delivery, suture material used for skin closure, preoperative and length of postoperative hospitalization, bile culture, pathology of the gallbladder, serum biochemical findings including alanine aminotransferase, aspartate aminotransferase, gammaglutamyl transpeptidase, bilirubin, alkaline phosphatase and glucose. RESULTS: Overall rate of infection was 3.36%. Four out of 105 patients who received antibiotics and 3 out of 103 patients who did not receive antibiotics developed infection. The difference was not statistically significant. Obesity and closing the skin with nylon sutures were found to be associated with increased rate of infectious complications. CONCLUSIONS: Cefazolin prophylaxis in low risk patients has no effect on postoperative infection rate in laparoscopic cholecystectomy.