The influence of patient's age on metabolic and bariatric results of laparoscopic sleeve gastrectomy in 2-year observation.

BACKGROUND: The incidence of obesity has been constantly growing and bariatric procedures are considered to be the most effective treatment solution for morbidly obese patients. The results of laparoscopic sleeve gastrectomy (LSG) may differ depending on patient's age, gender, preoperative body mass index (BMI) and physical activity. METHODS: The aim of this study was to evaluate age-related differences in the outcome of LSG in terms of weight loss parameters, lipid and carbohydrate profile. The retrospective analysis of 555 patients who had undergone LSG was performed to compare the metabolic outcomes of surgery in individuals < 45 and ≥ 45 years old. Evaluation of weight loss parameters along with selected laboratory data was performed to demonstrate the results of LSG in 2 years follow-up. RESULTS: Overall, 238 males and 317 females (43%/57%) with median age of 43 years and median preoperative BMI of 46.41 (42.06-51.02) kg/m2 were analyzed. Patients in both groups presented significant weight loss at 24 months after the surgery with comparable percentage of total weight loss (40.95% in < 45 years old group and 40.44% in ≥ 45 years old group). The percentage of excess weight loss (78.52% vs. 74.53%) and percentage of excess BMI loss (91.95% vs. 88.01%) were higher in patients < 45 years old. However, the differences were not statistically significant (p = 0.662, p = 0.788 respectively). Patients under 45 years old experienced faster decrease in fasting glucose level that was observed after only 3 months (109 mg/dl to 95 mg/dl in < 45 years old group vs. 103.5 mg/dl to 99.5 mg/dl in ≥ 45 years old group, p < 0.001). Both groups presented improvement of lipid parameters during the observation. However, patients < 45 years old achieved lower values of LDL at 3 and 12 months follow-up (115 mg/dl vs. 126 mg/dl, p = 0.010; 114.8 mg/dl vs. 122 mg/dl, p = 0.002). Younger group of patients also showed superior improvement of triglycerides level. CONCLUSIONS: LSG results in significant weight loss in all patients regardless age. In turn, superior and faster improvement in lipid and carbohydrate profile is achieved in patients under 45 years old.

The effect of high-fat diet and inhibition of ceramide production on insulin action in liver.

Liver, as one of the most important organs involved in lipids and glucose metabolism, is perceived as a key tissue for pharmacotherapy of insulin resistance (IRes) and type 2 diabetes. Ceramides (Cer) are biologically active lipids, which accumulation is associated with the induction of muscle IRes. We sought to determine the role of intrahepatic bioactive lipids production on insulin action in liver of insulin-resistant rats and after myriocin administration. The experiments were conducted on male Wistar rats divided into three groups: Control, fed high-fat diet (HFD), and fed HFD and treated with myriocin (HFD/Myr). Before sacrifice, the animals were infused with a [U-13 C]palmitate to calculate lipid synthesis rate by means of tracer incorporation technique in particular lipid groups. Liver Cer, diacylglycerols (DAG), acyl-carnitine concentration, and isotopic enrichment were analyzed by LC/MS/MS. Proteins involved in lipid metabolism and insulin pathway were analyzed by western blot analysis. An OGTT and ITT was also performed. HFD-induced IRes and increased both the synthesis rate and the content of DAG and Cer, which was accompanied by inhibition of an insulin pathway. Interestingly, myriocin treatment reduced synthesis rate not only of Cer but also DAG and improved insulin sensitivity. We conclude that the insulin-sensitizing action of myriocin in the liver is a result of the lack of inhibitory effect of lipids on the insulin pathway, due to the reduction of their synthesis rate. This is the first study showing how the synthesis rate of individual lipid groups in liver changes after myriocin administration.

In-and-Out Molecular Changes Linked to the Type 2 Diabetes Remission after Bariatric Surgery: An Influence of Gut Microbes on Mitochondria Metabolism.

Different kinds of gastrointestinal tract modulations known as "bariatric surgery" are actually the most effective treatment for obesity and associated co-morbidities, such as type 2 diabetes (T2DM). The potential causes of those effects have yet to be explained. In our study, we focused on molecular changes evoked by laparoscopic sleeve gastrectomy leading to T2DM remission. Two complementary metabolomics techniques, namely, liquid chromatography coupled with mass spectrometry (LC-MS) and gas chromatography mass spectrometry (GC-MS), were used to study those effects in a group of 20 obese patients with T2DM selected from a cohort of 372 obese individuals who underwent bariatric surgery and did not receive anti-diabetic treatment afterward. Modified levels of carnitines, lipids, amino acids (including BCAA) and α- and ß-hydroxybutyric acids were detected. Presented alterations suggest a major role of mitochondria activity in T2DM remission process. Moreover, some of the observed metabolites suggest that changes in gut microbiota composition may also correlate with the tempo of diabetes recovery. Additional analyses confirmed a relationship between biochemical and clinical parameters and the aforementioned metabolites, thereby, highlighting a role of mitochondria and microbes. Our data suggests that there is a previously undescribed relationship between mitochondria and gut microbiota, which changes after the bariatric surgery. More investigations are needed to confirm and explore the observed findings.

Inhibition of Ceramide De Novo Synthesis Affects Adipocytokine Secretion and Improves Systemic and Adipose Tissue Insulin Sensitivity.

Ceramide accumulation in muscle and in liver is implicated in the induction of insulin resistance. Much less in known about the role of ceramide in adipose tissue. The aim of the present study was to elucidate the role of ceramide in adipose tissue and to clarify whether lipids participate in the regulation of adipocytokine secretion. The experiments were performed on male Wistar rats divided into three groups: 1. Control, 2. fed high fat diet (HFD), and 3. fed HFD and treated with myriocin. Ceramide (Cer) and diacylglycerol (DAG) content were analyzed by LC/MS/MS. Hormone sensitive lipase (HSL) phosphorylation was analyzed by Western Blot. Plasma adiponectin and tumor necrosis factor alpha (TNF-α) concentration were measured by enzyme-linked immunosorbent assay. An oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) was also performed. In HFD group, total DAG and Cer content was elevated in both subcutaneous and visceral adipose tissue, which was accompanied by increased glucose, insulin, and HOMA-IR value. Myriocin treatment restored HOMA-IR as well as glucose and insulin concentration to control values. Moreover, myriocin decreased not only Cer, but also DAG levels in both fat depots. Furthermore, we observed a strong correlation between adiponectin (negative) and TNF-α (positive) and Cer in both fat tissues, which suggests that Cer is involved in the regulation of adipocytokine secretion.

Variation in blood levels of hormones in obese patients following weight reduction induced by endoscopic and surgical bariatric therapies.

BACKGROUND: Beneficial clinical effects of weight reduction following bariatric therapies is not fully understood and maybe related to the complex interactions between leptin, adiponectin, visfatin, omentin, and ghrelin. The aim of study was to investigate their timeline changes associated with weight reduction and their profile in relation to the type of treatment and its efficacy. METHODS: Circulating hormones levels were analyzed before and after endoscopic and surgical procedures in 67 obese patients and compared to non-obese healthy controls. RESULTS: Obese patients had higher leptin levels and lower levels of adiponectin, visfatin, omentin, and ghrelin than non-obese controls. During the consecutive follow-up visits after treatment, there was a gradual decrease in leptin levels and an increase in adiponectin levels to the levels observed in non-obese. At 50-54weeks, the ghrelin levels were lower and the levels of adiponectin and visfatin, but not omentin, were higher compared to their baseline values. BMI correlated with ghrelin and leptin levels. The percentage of total weight loss correlated positively with adiponectin levels and negatively with leptin levels. Patients with adequate weight loss had a significantly lower leptin concentration than those with treatment failure. There were timeline variations in hormone levels between endoscopic and bariatric therapies, however there were no significant differences in the median their concentration at 50-54weeks after therapy. CONCLUSION: Our study supports observations that weight loss itself, rather than the procedure type, is responsible for hormonal variation. The leptin levels reflect the best the body weight changes after bariatric therapies.

Impact of morbid obesity and bariatric surgery on antioxidant/oxidant balance of the unstimulated and stimulated human saliva.

OBJECTIVE: There is no study evaluating the influence of morbid obesity and bariatric surgery on antioxidant/oxidant homeostasis of the unstimulated and stimulated human saliva. MATERIALS AND METHODS: Salivary flow rate, total antioxidant status (TAS), total oxidant status (TOS), oxidative status index (OSI), the total amount of uric acid (UA), polyphenols (pPh), catalase (CAT), superoxide dismutase 2 (SOD2), specific activity of peroxidase (Px), as well as malondialdehyde (MDA), and advanced glycation end products (AGE) concentrations were determined in the unstimulated (UWS) and stimulated (SWS) whole saliva of patients with morbid obesity before and after bariatric surgery. RESULTS: In both UWS and SWS, the total amount of TOS, OSI, SOD2, and MDA was statistically higher in patients with morbid obesity as compared to the healthy controls, as well as significantly lower in the patients treated surgically as compared to the obese patients. The median values of the total amount of TAS, CAT, UA, pPh, and specific activity of Px were significantly reduced in UWS and SWS in patients with morbid obesity as compared to the control group and also statistically elevated in patients after bariatric surgery as compared to the patients with morbid obesity. CONCLUSIONS: In morbid obesity, reduced unstimulated and stimulated salivary flow can be observed. Bariatric surgery restored only unstimulated salivary flow to normal values. Disturbances in oxidant/antioxidant homeostasis may be observed in UWS and SWS of obese patients before and after treatment.

Dietary habits of obese patients qualified for bariatric procedures.

BACKGROUND: Patients with obesity, including morbid obesity, commit numerous dietary mistakes. They prefer high-energy diets, but of poor nutritional value. Patients qualified for bariatric procedures show deficiencies in vitamins and minerals due to insufficient intake of vegetables, fruit and whole grain products. OBJECTIVE: Analysis of dietary habits in morbidly obese patients prepared for bariatric surgery, including assessment of eating style and frequency of consumption of certain products. MATERIAL AND METHODS: The study group contained 39 people aged 18 - 65 years, who were surveyed with a questionnaire elaborated in the Department of Clinical Dietetics and Nutrition, Medical University of Bialystok. The following factors were assessed: number of meals, snacking between meals and eating at night, types of snacks eaten, and frequency of consumption of certain foods. Results were analyzed using Statistica 9.0. RESULTS: The majority of surveyed men (41.7%) ate three meals a day, whereas most women (40.7%) had at least 4 meals a day. Nearly 85% of the respondents admitted snacking between meals, mainly eating fruit, sweets and sandwiches. Whole grain cereal, milk and dairy products, fish, fruit, vegetables and pulses appeared in diet of patients qualified for treatment of obesity very rarely. CONCLUSIONS: Dietary habits of obese patients qualified for bariatric procedures are not consistent with recommendations. Therefore, these patients should receive nutritional education in order to foster proper eating habits that will help in the postoperative nutrition.

Analysis of the risk factors for perioperative morbidity after laparoscopic revisional bariatric procedures: results from the multicenter Polish Revision Obesity Surgery Study.

BACKGROUND: The growing number of primary bariatric operations has led to an increase in demand for revision surgeries. Higher numbers of revisional operations are also observed in Poland, yet their safety and efficacy remain controversial because of a lack of current recommendations and guidelines. OBJECTIVE: To review risk factors influencing perioperative morbidity. METHODS: A retrospective study was conducted to analyze the results of surgical treatment among 12 Polish bariatric centers. Inclusion criteria were laparoscopic revisional bariatric surgeries and patients ≥18 years of age. The study included 795 patients, of whom 621 were female; the mean age was 47 years (range: 40-55 years). RESULTS: Perioperative morbidity occurred in 92 patients (11.6%) enrolled in the study, including 76 women (82.6%). The median age was 45 years (range: 39-54 years). Statistically significant risk factors in univariate logistic regression models for perioperative complications were the duration of obesity, revisional surgery after Roux-en-Y gastric bypass (RYGB) or adjustable gastric band (AGB), difference in body mass index before revisional surgery and the lowest achieved after primary surgery, and postoperative morbidity of the primary surgery as the cause for revisional bariatric surgery. These factors were included in the multivariate regression model. Revisional surgery after AGB (odds ratio [OR] = 2.18; 95% confidence interval [CI]: 1.28-3.69; P = .004), revisional surgery performed after RYGB (OR = 6.52; 95% CI: 1.98-21.49; P = .002), and revisions due to complication of the primary surgery (OR = 1.89; 95% CI: 1.06-3.34; P = .030) remained independent risk factors for perioperative morbidity. CONCLUSION: Revisional operations after RYGB or AGB and those performed because of postoperative morbidity after primary surgery as the main cause for revisional surgery were associated with a significantly increased risk of postoperative morbidity.

Exploring microRNAs as predictive biomarkers for type 2 diabetes mellitus remission after sleeve gastrectomy: A pilot study.

OBJECTIVE: This study aimed to evaluate microRNAs (miRNAs) as predictive biomarkers for type 2 diabetes (T2D) remission 12 months after sleeve gastrectomy (SG). METHODS: A total of 179 serum miRNAs were profiled, and 26 clinical variables were collected from 46 patients. Two patients were later excluded because of hemolysis, and six patients with unclear remission status were set aside to evaluate the prediction models. The remaining 38 patients were included for model building. Variable selection was done using different approaches, including Least Absolute Shrinkage and Selection Operator (LASSO). Prediction models were then developed using LASSO and assessed in the validation set. RESULTS: A total of 26 out of 38 patients achieved T2D remission 12 months after SG. The prediction model with only clinical variables misclassified two patients, which were correctly classified using miRNAs. Two miRNA-only models achieved an accuracy of one but performed poorly for the validation set. The best miRNA model was a mixed model (accuracy: 0.974) containing four miRNAs (hsa-miR-32-5p, hsa-miR-382-5p, hsa-miR-1-3p, and hsa-miR-21-5p) and four clinical variables (T2D medication, sex, age, and fasting blood glucose). These miRNAs are involved in pathways related to obesity and insulin resistance. CONCLUSIONS: This study suggests that four serum miRNAs might be predictive biomarkers for T2D remission 12 months after SG, but further validation studies are needed.

Resveratrol Relaxes Human Gastric Smooth Muscles Through High Conductance Calcium-Activated Potassium Channel in a Nitric Oxide-independent Manner.

Resveratrol, as a polyphenolic compound that can be isolated from plants, and also a component of red wine has broad beneficial pharmacological properties. The aim was to investigate the role of nitric oxide and potassium channels in resveratrol-induced relaxation of human gastric smooth muscle. Gastric tissues were obtained from patients who underwent sleeve gastrectomy for severe obesity (n = 10 aged 21-48; BMI 48.21 ± 1.14). The mechanical activity from the muscle strips was detected under isometric conditions as the response to increasing concentrations of resveratrol before and after different pharmacological treatments. Resveratrol caused an observable, dose-dependent gastric muscle relaxation. The maximal response caused by the highest concentration of resveratrol was 83.49 ± 2.85% (p < 0.0001) of the control. Preincubation with L-NNA, L-NAME, or ODQ did not prevent the resveratrol-induced relaxation. Apamin, glibenclamide, 4AP or tamoxifen, did not inhibit the relaxing effect of resveratrol, as well. In turn, blocking BKCa by TEA, iberiotoxin, or charybdotoxin resulted in inhibition of resveratrol-induced relaxation (91.08 ± 2.07, p < 0.05; 95.60 ± 1.52, p < 0.01 and 89.58 ± 1.98, p < 0.05, respectively). This study provides the first observation that the relaxant effects of resveratrol in human gastric muscle strips occur directly through BKCa channels and independently of nitric oxide signaling pathways. Furthermore, there is considerable potential for further extensive clinical studies with resveratrol as an effective new drug or health supplement to treat gastrointestinal dyspepsia and other gastric hypermotility disorders.

The impact of severe postoperative complications on outcomes of bariatric surgery-multicenter case-matched study.

BACKGROUND: Bariatric surgery has relatively low complication rates, especially severe postoperative complications (defined by Clavien-Dindo classification as types 3 and 4), but these rates cannot be ignored. In other than bariatric surgical disciplines, complications affect not only short-term but also long-term results. In the field of bariatric surgery, this topic has not been extensively studied. OBJECTIVES: The aim of the study was to assess the outcomes of bariatric treatment in patients with obesity and severe postoperative complications in comparison to patients with a noneventful perioperative course. SETTING: Six surgical units at Polish public hospitals. METHODS: We performed a multicenter propensity score matched analysis of 206 patients from 6 Polish surgical units and assessed the outcomes of bariatric procedures. A total of 103 patients with severe postoperative complications (70 laparoscopic sleeve gastrectomy [SG] and 33 with laparoscopic Roux en Y gastric bypass [RYGB]) were compared to 103 patients with no severe complications in terms of peri- and postoperative outcomes. RESULTS: The outcomes of bariatric treatment did not differ between compared groups. Median percentage of total weight loss 12 months after the surgery was 28.8% in the group with complications and 27.9% in patients with no severe complications (P = 0.993). Remission rates of both type 2 diabetes mellitus and arterial hypertension showed no significant difference between SG and RYGB (36% versus 42%, P = 0.927, and 41% versus 46%, P = 0.575. respectively). CONCLUSIONS: The study suggests that severe postoperative complications had no significant influence either on weight loss effects or obesity-related diseases remission.

Revisional operations among patients after surgical treatment of obesity: a multicenter Polish Revision Obesity Surgery Study (PROSS).

Introduction: Revisional surgery is more technically challenging and associated with increased morbidity and mortality. Nevertheless, the frequency of revisional bariatric surgery (RBS) is increasing. Therefore, investigating this group of patients appears to be currently valid. Aim: The objective of this multicenter study was to collect, systematize and present the available data on RBS after surgical treatment of morbid obesity among Polish patients. Material and methods: This multicenter study included a retrospective analysis of a prospectively maintained database. Outcomes included an analysis of the indications for RBS, the type of surgery most frequently chosen as RBS and the course of the perioperative period of treatment among patients undergoing RBS. Results: The group consisted of 799 patients (624 (78.1%) women, 175 (21.9%) men). The mean age was 38.96 ±9.72 years. Recurrence of obesity was the most common indication for RBS. The most frequently performed RBS procedures were one anastomosis gastric bypass (OAGB) - 294 (36.8%) patients, Roux-en-Y gastric bypass (RYGB) - 289 (36.17%) patients and sleeve gastrectomy (SG) - 172 (21.52%) patients. After primary surgery 63.58% of patients achieved sufficient weight loss, but after RBS only 38.87%. Complications were noted in 222 (27.78%) cases after RBS with GERD being the most common - 117 (14.64%) patients. Conclusions: RBS most often concerns patients after SG. The main indication for RBS is weight regain. OAGB and RYGB were the two most frequently chosen types of RBS. Secondary operations lead to further weight reduction. However, RBS are associated with a significant risk of complications.

[The clinical significance of fatty acid binding proteins]. / Znaczenie kliniczne bialek wiazacych kwasy tluszczowe (FABPs).

Excessive levels of free fatty acids are toxic to cells. The human body has evolved a defense mechanism in the form of small cytoplasmic proteins called fatty acid binding proteins (FABPs) that bind long-chain fatty acids (LCFA), and then refer them to appropriate intracellular disposal sites (oxidation in mitochondria and peroxisomes or storage in the endoplasmic reticulum). So far, nine types of these proteins have been described, and their name refers to the place in which they were first identified or where they can be found in the greatest concentration. The most important FABPs were isolated from the liver (L-FABP), heart (H-FABP), intestine (I-FABP), brain (B-FABP), epidermis (E-FABP) and adipocytes (A-FABP). Determination of H-FABP is used in the diagnosis of myocardial infarction, and L-FABP in kidney lesions of different etiologies. It is postulated that FABPs play an important role in the pathogenesis of metabolic diseases. Elevated levels of A-FABP have been found in the pericardial fat tissue and were associated with cardiac dysfunction in obese people. A rise in A-FABP has been observed in patients with type II diabetes. I-FABP is known as a marker of cell damage in the small intestine. Increased concentration of B-FABP has been associated with human brain tumors such as glioblastoma and astrocytoma, as well as with neurodegenerative diseases (Alzheimer's, Parkinson's) and other disorders of cognitive function. The aim of this work was to present current data on the clinical significance of fatty acid binding proteins.

Complications associated with laparoscopic sleeve gastrectomy - a review.

Laparoscopic sleeve gastrectomy (LSG) is an essential bariatric procedure performed in obese patients, which provides significant weight loss and has a positive impact on obesity-related diseases. However, as with any surgical procedure, it carries the risk of complications. The complications that can arise in patients following LSG are divided into acute (diagnosed within 30 days after the surgery) and late. Early complications that require rapid management include haemorrhage (intraluminal or extraluminal), leak in the staple line, and abscess formation. Late complications include gastric stenosis, nutrient deficiencies, mediastinal pouch migration, and the development or exacerbation of gastroesophageal reflux diseases. In this review, we present the basic information about most common complications following LSG, and their symptoms, diagnostic tools, and management.

Impact of COVID-19 pandemic on bariatric patients in Podlaskie Voivodeship in Poland.

The research shows that despite the pandemic and higher risk of mortality and complications after SARS-CoV-2 infection, bariatric patients declare a high level of willingness to undergo the bariatric procedure, and the impact of COVID-19 pandemic does not play an important role in their decision-making process concerning the bariatric procedure. </br> </br> Due to the noticeable lifestyle changes during the pandemic such as greater food intake and decrease in physical activity among the bariatric patients, the process of qualification to the bariatric procedure should be conducted very meticulously and the recommended values for weight loss should be implemented to increase patients' motivation before and after the procedure. As the research shows, bariatric patients tend to neglect their strive for healthy lifestyle, even in the presence of the pandemic. Therefore, weight gain prior to the bariatric procedure can lead to more frequent complications during surgery and deterioration of the expected results of bariatric surgery. In conclusion, the group of bariatric patients is a high-risk group not only because of greater mortality due to COVID-19 infection, but also because they do not attach much importance to the external factors such as global pandemic.

Skin Substitute Preparation Method Induces Immunomodulatory Changes in Co-Incubated Cells through Collagen Modification.

Chronic ulcerative and hard-healing wounds are a growing global concern. Skin substitutes, including acellular dermal matrices (ADMs), have shown beneficial effects in healing processes. Presently, the vast majority of currently available ADMs are processed from xenobiotic or cadaveric skin. Here we propose a novel strategy for ADM preparation from human abdominoplasty-derived skin. Skin was processed using three different methods of decellularization involving the use of ionic detergent (sodium dodecyl sulfate; SDS, in hADM 1), non-ionic detergent (Triton X-100 in hADM 2), and a combination of recombinant trypsin and Triton X-100 (in hADM 3). We next evaluated the immunogenicity and immunomodulatory properties of this novel hADM by using an in vitro model of peripheral blood mononuclear cell culture, flow cytometry, and cytokine assays. We found that similarly sourced but differentially processed hADMs possess distinct immunogenicity. hADM 1 showed no immunogenic effects as evidenced by low T cell proliferation and no significant change in cytokine profile. In contrast, hADMs 2 and 3 showed relatively higher immunogenicity. Moreover, our novel hADMs exerted no effect on T cell composition after three-day of coincubation. However, we observed significant changes in the composition of monocytes, indicating their maturation toward a phenotype possessing anti-inflammatory and pro-angiogenic properties. Taken together, we showed here that abdominoplasty skin is suitable for hADM manufacturing. More importantly, the use of SDS-based protocols for the purposes of dermal matrix decellularization allows for the preparation of non-immunogenic scaffolds with high therapeutic potential. Despite these encouraging results, further studies are needed to evaluate the beneficial effects of our hADM 1 on deep and hard-healing wounds.

Type 2 Diabetes Remission 5 Years After Laparoscopic Sleeve Gastrectomy: Multicenter Cohort Study.

PURPOSE: Bariatric surgery is no longer considered only as a weight loss surgery but also a way of treating obesity-related comorbidities such as type 2 diabetes mellitus (T2DM). Short-term T2DM remissions in patients undergoing laparoscopic sleeve gastrectomy (LSG) have been shown, but there are very few reports on the mid-term results. We aimed to assess the remission rate of T2DM in obese patients after LSG throughout 5-year follow-up. MATERIALS AND METHODOLOGY: We performed a retrospective multicenter cohort analysis of 240 patients who underwent LSG. We assessed the remission rate of T2DM 1 year and 5 years after surgery. RESULTS: Forty-six percent of patients achieved T2DM remission 5 years after LSG. The remission group had better weight loss results (median% of total weight loss 5 years after: 30.1% (22.9-37.0) vs 23.0% (13.7-30.2), p < 0.001) and were significantly younger than the no remission group (43 (38-52) vs 52 (44-58) years, p < 0.001). Duration of T2DM was significantly shorter (2 (1-5) vs 5 (3-10) years, p < 0.001) with less insulin requirement and less diabetes-related complications (7.2% vs 19.8%, p < 0.001) and significantly lower median DiaRem score (4.0 (IQR 2.0-6.0) vs 12.0 (IQR 5.0-16.0), p < 0.001). Preoperative body mass index (BMI) had no effect on remission. CONCLUSIONS: Our study suggests that diabetes remission after laparoscopic sleeve gastrectomy occurs frequently, and in the 5-year follow-up, it may remain at the level of 46%. We identified the age of patients, duration, and severity of T2DM as factors affecting mid-term diabetes remission. Nevertheless, further well-designed trials are needed to support our findings.

Abdominoplasty Skin-Based Dressing for Deep Wound Treatment-Evaluation of Different Methods of Preparation on Therapeutic Potential.

The management of hard-to-heal wounds is a significant clinical challenge. Acellular dermal matrices (ADMs) have been successfully introduced to enhance the healing process. Here, we aimed to develop protocol for the preparation of novel ADMs from abdominoplasty skin. We used three different decellularization protocols for skin processing, namely, 1M NaCl and sodium dodecyl sulfate (SDS, in ADM1); 2M NaCl and sodium dodecyl sulfate (SDS, in ADM1); and a combination of recombinant trypsin and Triton X-100 (in hADM 3). We assessed the effectiveness of decellularization and ADM's structure by using histochemical and immunochemical staining. In addition, we evaluated the therapeutic potential of novel ADMs in a murine model of wound healing. Furthermore, targeted transcriptomic profiling of genes associated with wound healing was performed. First, we found that all three proposed methods of decellularization effectively removed cellular components from abdominoplasty skin. We showed, however, significant differences in the presence of class I human leukocyte antigen (HLA class I ABC), Talin 1/2, and chondroitin sulfate proteoglycan (NG2). In addition, we found that protocols, when utilized differentially, influenced the preservation of types I, III, IV, and VII collagens. Finally, we showed that abdominoplasty skin-derived ADMs might serve as an effective and safe option for deep wound treatment. More importantly, our novel dressing (ADM1) improves the kinetics of wound closure and scar maturation in the proliferative and remodeling phases of wound healing. In conclusion, we developed a protocol for abdominoplasty skin decellularization suitable for the preparation of biological dressings. We showed that different decellularization methods affect the purity, structure, and therapeutic properties of ADMs.

Assessment of education effects on patient involvement and bariatric treatment outcome: an observational study.

INTRODUCTION: As a result of the growing number of people with obesity, the popularity of bariatric surgery has been systematically increasing. It has not yet been explored whether individual education of the patient can contribute to long-term success in weight reduction after bariatric treatment. AIM: To implement and compare the effects of different education methods, versus receiving one-time written information in the form of a guidebook, on patient involvement in abiding by lifestyle recommendations after laparoscopic sleeve gastrectomy (LSG) bariatric treatment. MATERIAL AND METHODS: The study included 160 patients with morbid obesity. The education session study participants were 100 patients after sleeve gastrectomy, with whom three education sessions were planned, and who were enrolled in the study. The control group consisted of 60 patients who underwent sleeve gastrectomy, and before discharge from the department, they received one-time written recommendations in the form of a guidebook. RESULTS: We confirmed that the three education sessions we conducted with the study group after LSG had a significant impact on weight loss. The control group, which received only written information, achieved weight loss and abided by the written recommendations, although to a lesser extent than the study group. The differences were evident particularly in motivation to adhere to recommendations and check-ups, which was significantly lower (p < 0.001) after a year of observation in the control group. CONCLUSIONS: This study results should encourage the establishment of education as a permanent element of the LSG procedure.

Utility of Inflammatory Markers in Detection of Perioperative Morbidity After Laparoscopic Sleeve Gastrectomy, Laparoscopic Roux-en-Y Gastric Bypass, and One-Anastomosis Gastric Bypass-Multicenter Study.

BACKGROUND: The most commonly performed bariatric operations are laparoscopic sleeve gastrectomy (LSG) and bypass surgeries (laparoscopic one-anastomosis gastric bypass (OAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB)), and predicting perioperative morbidity is crucial for early, safe patient discharge. We aimed to determine whether C-reactive protein (CRP) and white blood count (WBC) measured on the first postoperative day predicts perioperative morbidity in the first 30-days after LSG and bypass surgeries. METHODS: We retrospectively analyzed data for 1400 patients who underwent bariatric surgery in seven bariatric centers from 2014 to 2018. Patients were divided into a complicated group (patients with postoperative complications) and a non-complicated group. We also performed separate analyses for LSG and bypass surgeries. RESULTS: Patients were 929 women (66%) and 471 men (34%) with a median age of 42 years (range, 35-51 years); 1192 patients underwent LSG (85%), 120 underwent LRYGB (9%), and 80 underwent OAGB (6%). We performed ROC analyses to set cut-off points, followed by multivariate logistic regressions. CRP > 33.32 mg/L increased the odds ratio (OR) of perioperative complications after LSG 2.27 times, while WBC > 12.15 × 103/µL on postoperative day 1 was associated with a 3.34-times greater or of developing complications. WBC > 13.78 × 103/µL was associated with a 13.34-times higher or of perioperative morbidity in patients undergoing bypass surgeries. CONCLUSION: Even slightly elevated CRP and WBC on postoperative day 1 should alert surgeons to the potential risk of perioperative morbidity.