Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy.

IMPORTANCE: The prevalence of laparoscopic sleeve gastrectomy (LSG) is increasing, but data on its long-term effect on obesity-related comorbidities are scarce. Because the population of bariatric patients is young, long-term results of those comorbidities are highly relevant. OBJECTIVE: To investigate the long-term effects of LSG on weight loss, diabetes mellitus, hypertension, dyslipidemia, and hyperuricemia. DESIGN, SETTING, AND PARTICIPANTS: Cohort study using a retrospective analysis of a prospective cohort at a university hospital. Data were collected from all patients undergoing LSGs performed by the same team between April 1, 2006, and February 28, 2013, including demographic details, weight follow-up, blood test results, and information on medications and comorbidities. MAIN OUTCOMES AND MEASURES: Excess weight loss, obesity-related comorbidities, and partial and complete remission at 1, 3, and 5 years of follow-up. RESULTS: A total of 443 LSGs were performed. Complete data were available for 241 of the 443 patients (54.4%) at the 1-year follow-up, for 128 of 259 patients (49.4%) at the 3-year follow-up, and for 39 of 56 patients (69.6%) at the 5-year follow-up. The percentage of excess weight loss was 76.8%, 69.7%, and 56.1%, respectively. Complete remission of diabetes was maintained in 50.7%, 38.2%, and 20.0%, respectively, and remission of hypertension was maintained in 46.3%, 48.0%, and 45.5%, respectively. Changes in high-density lipoprotein cholesterol level (mean [SD] level preoperatively and at 1, 3, and 5 years, 46.7 [15.8], 52.8 [13.6], 56.8 [16.0], and 52.4 [13.8] mg/dL, respectively) and triglyceride level (mean [SD] level preoperatively and at 1, 3, and 5 years, 155.2 [86.1], 106.3 [45.3], 107.2 [53.4], and 126.4 [59.7] mg/dL, respectively) were significant compared with preoperative and postoperative measurements (P < .001). The decrease of low-density lipoprotein cholesterol level was significant only at 1 year (P = .04) and 3 years (P = .04) (mean [SD] level preoperatively and at 1, 3, and 5 years, 115.8 [33.2], 110.8 [32.0], 105.7 [25.9], and 110.6 [28.3] mg/dL, respectively). The changes in total cholesterol level did not reach statistical significance (mean [SD] level preoperatively and at 1, 3, and 5 years, 189.5 [38.2], 184.0 [35.4], 183.4 [31.2], and 188.1 [35.7] mg/dL, respectively). No changes in comorbidity status correlated with preoperative excess weight. Hypertriglyceridemia was the only comorbidity whose remission rates at 1 year of follow-up (partial/complete, 80.6%; complete, 72.2%) correlated with percentage of excess weight loss (76.8%) (P = .005). CONCLUSIONS AND RELEVANCE: Undergoing LSG induced efficient weight loss and a major improvement in obesity-related comorbidities, with mostly no correlation to percentage of excess weight loss. There was a significant weight regain and a decrease in remission rates of diabetes and, to a lesser extent, other comorbidities over time.

Characterization of phloem-sap transcription profile in melon plants.

The phloem's role as a tissue responsible for the distribution of photoassimilates and nutrients among the various organs of higher plants has long been recognized. Recent studies have established that numerous proteins and mRNA molecules are also present in the phloem translocation stream; however, limited information is available on the identity of transcripts present within the phloem sap. In this study, a genomic approach was taken to produce a transcription profile of melon phloem sap. A cDNA library was constructed from mRNAs extracted from melon phloem sap and 1900 clones were randomly selected for sequencing. Selection of high-quality sequences resulted in 986 unique transcripts corresponding to 1830 ESTs. A comparison between the phloem-sap library and publicly available libraries from leaves and fruits indicated that the transcript profile of phloem sap is unique, with a substantially higher proportion of genes associated with biotic stimulus, response to stress, and metal-ion binding. Manual functional analyses revealed that over 40% of the transcripts are related to stress and defence responses, while over 15% of them are related to signal transduction. Out of the 1830 ESTs, only three were characterized as coding for chlorophyll-binding protein or ribulose bisphosphate carboxylase. Heterografting experiments established that six out of 43 examined transcripts are capable of long-distance trafficking from melon stocks to pumpkin scions. Annotation of these six transcripts revealed that three of them are associated with auxin-signal transduction while the other three were not identified. The potential role of the expressed transcripts in the phloem sap is discussed.