Role of PNPLA3 in the Assessment and Monitoring of Hepatic Steatosis and Fibrosis in Patients with Chronic Hepatitis C Infection Who Achieved a Sustained Virologic Response.

Background and Objectives: Hepatic diseases are an important public health problem. All patients with chronic hepatitis C virus (HCV) infection receive treatment, regardless of hepatic fibrosis severity. However, evaluation of hepatic fibrosis and steatosis is still useful in assessing evolution, prognosis and monitoring of hepatic disease, especially after treatment with direct-acting antivirals (DAAs). The aim of this study was to assess the link between patatin-like phospholipase domain-containing 3 (PNPLA3) polymorphism and the degree of hepatic steatosis and fibrosis in patients with chronic HCV infection, as well as changes in steatosis and fibrosis three monthsafter obtaining a sustained viral response (SVR). Materials and Methods:Ourstudy included 100 patients with chronic hepatitis C (CHC) infection and compensated cirrhosis who received DAA treatment and who were evaluated using Fibromax prior to and 3 months after SVR. The influence of PNPLA3 (CC, CG, GG) genotype among these patients on the degree of post-treatment regression of steatosis and fibrosis was assessed. Results: Regression was noticed in the degree of both hepatic steatosis and hepatic fibrosis post-DAA treatment (three months after SVR). Analysis of the correlation between PNPLA3 genotype and fibrosis indicated that the average level of fibrosis (F) before DAA treatment was higher in patients with the GG genotype than in patients with the CC or CG genotype. Three months after SVR, the average level of fibrosis decreased; however, it remained significantly increased in GG subjects compared to that in CC or CG patients. The degree of hepatic steatosis before treatment was not significantly different among patients with different PNPLA3 genotypes, and no significant correlations were observed three months after SVR. Conclusions: The genetic variants of PNPLA3 influence the evolution of hepatic fibrosis. The GG subtype plays an important role in the degree of hepatic fibrosis both before and after treatment (three months after SVR)and could be a prognostic marker for assessment of post-SVR evolution.

The influence of obstructive sleep apnea syndrome on anthropometric parameters at 12 months after laparoscopic sleeve gastrectomy.

The aim of this study was to assess the influence of obstructive sleep apnea syndrome (OSAS) on the change in anthropometric parameters and body composition, in patients undergoing laparoscopic sleeve gastrectomy (LSG). This prospective study included patients undergoing LSG who had pre-operative polysomnography data and were also evaluated at six and 12 months after surgery. All patients included also had whole body composition analysis data before surgery and at six and 12 months after surgery. The results are presented in comparison between patients with and without OSAS. We included 73 patients in the analysis with a mean ± SD age and body mass index (BMI) of 40.3 ± 10.9 years and 45.4 ± 6.3 kg/m2, respectively. As compared to the baseline levels, at 6 months there was a significant decrease in BMI, weight, waist circumference, serum glucose and HbA1c. At 12 months there was no further decrease as compared to the 6 months levels, irrespective of OSAS status. We observed a significant decrease at 6 months in percentage of fat, in both types of patients. However, as compared to the 6 months levels, at 12 months the percent fat had a significant decrease only in patients without OSAS (- 4.6%, 95% CI - 7.6 to - 1.7%) and not in those with OSAS (- 2.2%, 95% CI - 4.5 to 0.2%). In our study, patients with OSAS showed a similar decrease in different anthropometric parameters as those without OSAS after LSG. However, at 12 months of follow-up there was a significant decrease in the percent fat only in patients without OSAS.

Ghrelin-producing cells distribution in the stomach and the relation with Helicobacter pylori in obese patients.

OBJECTIVE: Ghrelin is believed to influence weight evolution after bariatric surgery. Helicobacter pylori (H. pylori) infection may influence ghrelin plasma levels by affecting the ghrelin-producing cells (GPC) in the stomach. The purpose of the study was to characterize the GPC distribution in the stomach in overweight patients and the influence of H. pylori infection on them. PATIENTS, MATERIALS AND METHODS: The study group included 21 obese patients undergoing bariatric surgery with ghrelin levels and anti-H. pylori antibodies previously measured, and upper gastrointestinal endoscopy with histological evaluation of H. pylori infection performed. Immunohistochemical expression of ghrelin was quantified in gastric resection specimens. RESULTS: The results showed a higher number of GPC in the obese women than in men (p>0.05). The highest number of GPC was detected in the gastric body, followed by the fundus and antral region (p<0.001). GPC number correlated inversely with anthropometric parameters: weight (p=0.011), body mass index (BMI) (p=0.017), waist circumference (WC) (p=0.066) was lower in patients with H. pylori infection (p>0.05) or gastritis (p>0.05), the number decreasing with the increase in depth of gastritis lesion (p>0.05). CONCLUSIONS: The present study fulfills the characterization of GPC in obese patients, showing a higher number in women than in men, their predominant location in the gastric body, and their relationship with the anthropometric parameters (weight, BMI, WC), H. pylori infection and gastritis lesions. These results open broad perspectives for a deeper understanding of the ghrelin involvement in the obesity pathogenic mechanism, associated or not with other gastric conditions.

The role of histological evaluation of Helicobacter pylori infection in obese patients referred to laparoscopic sleeve gastrectomy.

Helicobacter pylori (H. pylori) is the etiological factor for gastritis in more than half of the worldwide population. H. pylori infection increases the risk for gastric pathology, but could also have consequences on cardio-metabolic status. Obesity has as epidemic growth, and the only efficient long-term treatment for morbidly obese patients is currently surgery. Although of vital importance, the preoperative assessment is not standardized, including the aspects related to H. pylori infection. The aim of this prospective study was to evaluate the prevalence of H. pylori (Hp) infection in a group of patients referred to bariatric surgery and the agreement of two commonly used methods for its diagnosis. We included 70 asymptomatic obese patients consecutively for 14 months, who were evaluated by serology (anti-Hp IgG antibodies) and by histology (gastroscopy with gastric mucosa biopsy). If diagnosed, H. pylori infection was standard treated and afterwards, all patients underwent laparoscopic sleeve gastrectomy; the resected stomach was morphologically evaluated. 58.6% of patients were H. pylori positive on serology and 51.4% were H. pylori positive on histology, agreement coefficient factor kappa between the two methods being 0.686, p<0.001. The serological diagnosis had a sensibility of 90.3% and a specificity of 77.8%. The prevalence of H. pylori infection in the resected stomach was 11.4%, and was associated with more severe degrees of chronic gastritis. In conclusion, as gastroscopy should anyhow be performed in all patients referred to surgery, our data favor the histological evaluation in all patients and the eradication treatment according to its results.

Pathological aspects underlying pancreatogenous hyperinsulinemic hypoglycemia--report of three cases.

Pancreatogenous hyperinsulinemic hypoglycemia (PHH) is a rare disorder determined by an abnormally high secretion of insulin in the pancreas, in the absence of other medical or pharmacological factors. Either ß-cell tumors (insulinomas) or ß-cell hyperplasia (nesidioblastosis) can determine this pathology. Most publications on insulinomas or nesidioblastosis approached these subjects from a clinical point of view. This paper aims to analyze pathological aspects underlying pancreatogenous hyperinsulinemic hypoglycemia. We present two cases of insulinomas with unusual pancreatic localization and size, one of them showing amyloid deposits in the stroma. In both cases, immunohistochemistry confirmed the clinical and imagistic supposition. The third reported case refers to a 57-year-old patient with nesidioblastosis with isolated disposition of endocrine cells and areas of focal organization, both morphological aspects being extremely rare in adults. Although clinical and laboratory data are usually identical in the two forms of PHH, histopathological and immunohistochemical diagnosis is essential in differentiating insulinomas from nesidioblastosis, as the surgical management is different: enucleation for insulinomas and total or subtotal pancreatectomy for nesidioblastosis.

The evaluation of preoperative nutritional status in patients undergoing thoracic surgery.

AIM: The aim of this study was to assess the preoperative nutritional status of patients undergoing thoracic surgery using different nutritional tools. MATERIAL AND METHOD: . We conducted a prospective study on a sample of 43 thoracic patients, including 23 with neoplasms and 20 with non-neoplastic pathology who underwent thoracic surgery procedures between July-September 2011, in the Thoracic Surgery Clinic in Iasi. Weight and height were measured and body mass index (BMI) was calculated. WHO classification for BMI categories was used. Preoperative serum level of transthyretin (TTR) and demographic data (gender, age) were also assessed. All patients were examined by the Subjective Global Assessment (SGA) and the Nutritional Risk Screening 2002 (NRS 2002). RESULTS: After performing SGA, 67.9% of the patients were well-nourished, 21.4% were moderately or suspected of being malnourished and 10.7% were severely malnourished. The level of TTR was significantly lower in the moderately or severely malnourished group, compared to those considered well-nourished. According to NRS-2002, 42.9% of the patients were considered at nutritional risk. The level of TTR of these patients was lower than the level of TTR of the patients without nutritional risk, but without statistical significance. CONCLUSIONS: Subjective Global Assessment (SGA) and the Nutritional Risk Screening 2002 (NRS 2002) are useful in identifying patients with nutritional risk, so that appropriate nutritional management could be initialised even before surgery.

The role and interactions of ghrelin concerning the nutritional and inflammatory status.

Ghrelin is an important neuroendocrine peptide having as main purpose the stimulation of growth hormone (GH) secretion. It is also an important regulator of the long-term energy balance and short-term nutritional intake. Ghrelin has several other biological actions, among which the capacity to regulate gastrointestinal motility, to modulate the reproductive and stress axes as well as the glucose metabolism, and other well-defined actions within the cardiovascular and renal physiology. Due to its numerous effects, ghrelin is considered on one hand a potential target in the treatment of obesity and on the other, a therapeutic option in other dysfunctions and illnesses.