Adaptation of human gut microbiota to bariatric surgeries in morbidly obese patients: A systematic review.

BACKGROUND: Bariatric surgeries have turned to be a popular therapeutic option for morbid obesity nowadays. Gut microbiota is supposed to be responsible as a part of the bariatric surgeries success. In this systematic review, we detailed the human studies which investigated the effect of different bariatric surgeries on the composition of gut microbiota. METHODS: We did a comprehensive search in PubMed, Web of Science, and Scopus for all clinical trials and longitudinal observational studies documented up to December 2015. RESULTS: Our initial search yielded 1423 articles. After screening abstracts and full texts, 7 articles were included. In 6 studies, the type of surgical intervention was Roux-en-Y gastric bypass (RYGB) where one study assessed vertical banded gastroplasty (VBG), too. Only in one study the effect of laparoscopic sleeve gastrectomy (LSG) had been investigated. RYGB caused an increase in Proteobacteria and a decrease in Firmicutes. LSG led to less severe intestinal microbiota alteration compared to RYGB. Fecalibacterium prausnitzii species with anti-inflammatory properties increased after LSG. However, inconsistent alterations have been shown in abundance of Fecalibacterium species after RYGB. CONCLUSION: Weight loss after bariatric surgeries are associated with microbiota modifications caused by surgical procedures.

Diabetes Management by Probiotics: Current Knowledge and Future Pespective.

Diabetes mellitus, a multifactorial disorder, is related to the intestinal microbiota via numerous molecular mechanisms. The vast increase in the prevalence of diabetes and its associated complications requires a natural and safe solution. There is a growing evidence of gut microbiota effi ciency in improving insulin resistance, impaired insulin secretion, and metabolic complications in diabetic patients. Probiotics are defi ned as live microorganisms that, when ingested in adequate amounts, exert health benefi ts to the host. Probiotics can increase insulin sensitivity and reduce autoimmune responses by modulating intestinal microbiota and decreasing the infl ammatory reactions and oxidative stress. Recent evidences show that the intestinal microbiota infl uences the host through modulating intestinal permeability and mucosal immune response, manipulating eating behaviors by appetite-regulating hormones, including agouti related protein (AgRP), glucagon like peptide-1 (GLP-1) and neuropeptide Y, and controlling gut endocannabinoid (eCB) system which is now believed to be associated with infl ammation and diabetes. Moreover, intestinal microbiota control the host metabolism by affecting energy extraction from food and by biochemically converting molecules derived from the host or from gut microbes themselves. Experimental studies and clinical trials support the hypothesis that the modulation of the intestinal microbiota by probiotics, especially Lactobacillus and Bifidobacterium strains may be effective in prevention and management of diabetes. This review will highlight the current evidences in probiotic effectiveness and future prospects for exploring probiotic therapy in prevention and control of diabetes.

A comprehensive operating room information system using the Kinect sensors and RFID.

Occasionally, surgeons do need various types of information to be available rapidly, efficiently and safely during surgical procedures. Meanwhile, they need to free up hands throughout the surgery to necessarily access the mouse to control any application in the sterility mode. In addition, they are required to record audio as well as video files, and enter and save some data. This is an attempt to develop a comprehensive operating room information system called "Medinav" to tackle all mentioned issues. An integrated and comprehensive operating room information system is introduced to be compatible with Health Level 7 (HL7) and digital imaging and communications in medicine (DICOM). DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. Besides, a natural user interface (NUI) is designed specifically for operating rooms where touch-less interactions with finger and hand tracking are in use. Further, the system could both record procedural data automatically, and view acquired information from multiple perspectives graphically. A prototype system is tested in a live operating room environment at an Iranian teaching hospital. There are also contextual interviews and usability satisfaction questionnaires conducted with the "MediNav" system to investigate how useful the proposed system could be. The results reveal that integration of these systems into a complete solution is the key to not only stream up data and workflow but maximize surgical team usefulness as well. It is now possible to comprehensively collect and visualize medical information, and access a management tool with a touch-less NUI in a rather quick, practical, and harmless manner.

Predicting Factors of Complete Pathological Response in Locally Advanced Rectal Cancer.

Background: Current treatment of choice for locally advanced rectal cancer is neoadjuvant chemoradiotherapy (neo-CRT) followed by surgical resection and adjuvant chemotherapy. Some patients may experience complete pathological response (cPR) after the neoadjuvant treatment. However, the predicting factors are still debated. Methods: In this registry-based retrospective cohort study, 258 patients with locally advanced rectal cancer were included. Patients were categorized into two groups with or without cPR. Logistic regression analysis was recruited to investigate the odds ratio for all independent variables, and those with significant results were included in multivariate regression analysis. Results: Achievement of cPR was 21.3%. The odds ratio of cPR was significantly lower when the tumor distance from the anal verge was>10 centimeters (OR=0.24, P=0.040). Also, the odds of cPR with N1 involvement in comparison with N0 involvement decreased for 0.41 (P=0.043). It was also true for patients with N2 involvement in comparison with N0 involvement (OR=0.31, P=0.031). Higher odds ratio of cPR was observed in patients who underwent surgery in>12 weeks after neo-CRT (OR=2.9, P=0.022). Furthermore, the odds of cPR decreased for 0.9 with increasing in carcinoembryonic antigen (CEA) level (P=0.044). Conclusion: Patients with rectal cancer in clinical stage II or lower, without the involvement of the lymphatic system at diagnosis, and with tumors located in the lower parts of the rectum, with lower levels of CEA, and longer duration between neo-CRT and surgery were more likely to achieve cPR after neo-CRT. With the current knowledge, the "wait and watch policy" is still debated and needs to be defined more precisely by upcoming studies.

Effect of garlic extract on weight loss and gut microbiota composition in obese women: A double-blind randomized controlled trial.

Objective: From a nutritional perspective, garlic extract could be a prebiotic product, which is useful for obese subjects, and one of its health-promoting underlying mechanisms is modulating gut microbiota composition. In this randomized double-blind clinical trial, the goal was to determine the effect of Allium (garlic extract) on anthropometric indices and gut microbiota composition in obese women following a low-calorie diet. Materials and methods: Forty-three obese women were randomly divided into garlic extract (400 mg Allium sativum powder containing 1,100 mcg allicin/tablet) or placebo groups. During the 2 months of the study, each participant took two tablets per day. At the beginning and at the end of the clinical trial, anthropometric measurements were done and blood and fecal samples were collected. We evaluated the gut microbiota composition using quantitative real-time PCR. Results: In total, 16 subjects in each group completed the 2-month trial. Allium and placebo groups' participants had mean ages of 37.8 ± 7.4 and 34.2 ± 6.8 years, respectively (P > 0.05). Baseline body mass index (BMI) was significantly different between groups, subjects in the placebo group had lower BMI compared with the Allium group (P < 0.05). Allium and placebo caused a 1.7% and 2.7% decrease in BMI from the baseline values, respectively (P < 0.01). Fasting insulin level significantly decreased in the both groups (P < 0.01). Level of homeostasis model assessment of insulin resistance (HOMA-IR) has decreased significantly in the Allium group (P = 0.007). The frequency of Akkermansia had decreasing trend while the abundance of Faecalibacterium and Bifidobacterium showed increasing trend in the Allium group. Conclusion: In the both groups, a decrease in BMI and other anthropometric indices has been observed. Despite weight loss after following a low-calorie diet and taking Allium, slight changes have been shown in the composition of gut microbiota in obese women. Trial registration: This trial was registered in the Iranian Registry of Clinical Trials (IRCT) (code: IRCT090420001825N2).

The Comparison of Postoperative Pain, Nausea, and Vomiting between Veress Needle Entry and Direct Trocar Entry Methods in Patients Undergoing Laparoscopic Cholecystectomy.

BACKGROUND Postoperative pain, nausea, and vomiting are the most common side effects of laparoscopic cholecystectomy (LC). In the present study, we investigated the differences in postoperative pain, nausea, and vomiting between Veress needle and direct trocar entry methods among patients undergoing LC. METHODS 96 patients with gallstones were studied. They were randomly divided into two groups: the patients in the first group (n = 48) were insufflated 8.1 liters per minute CO2 gas by direct trocar port, and the patients in another group (n = 48) were insufflated 2.1 liters per minute CO2 gas by Veress needle. Pain intensity, nausea, and vomiting were assessed at 20 minutes, 4 hours, and 12 hours after the operations. RESULTS The duration of CO2 gas insufflation in Veress needle was 88.7 ± 10.7 seconds and indirect trocar was 16.6 ± 1.6 seconds. Visual analog scale (VAS) score significantly reduced in Veress needle compared with direct trocar (0.39 ± 0.98 vs. 1.68 ± 1.48) at 20 min after the operation, while there was no difference at 4 hours and 12 hours after the operation. The requirement and dose of pethidine injection were significantly lower in Veress needle than direct trocar. In addition, nausea and vomiting occurred in Veress needle less than direct trocar at 20 min, 4 hours, and 12 hours after LC. CONCLUSION Pain intensity just in the short term after LC in the group with CO2 gas insufflation in Veress needle was significantly less than the other group, while nausea and vomiting were significantly less during the whole follow-up periods in the group with CO2 gas insufflation in Veress needle.

Probiotics as a Complementary Therapy for Management of Obesity: A Systematic Review.

BACKGROUND: Considering the observed role of probiotics in modulating gut microbiome, probiotics are discussed to be one potential complementary therapy for obesity management in recent years. The aim of the present study was to systematically review the meta-analyses of controlled trials and investigate the effects of probiotics on obesity. METHODS: A comprehensive search was conducted on PubMed, Web of Science, and Cochrane Library web databases up to May 2020. Inclusion criteria were meta-analyses of controlled trials which evaluated the impact of probiotics on obesity in English language. Meta-analyses done on pregnant women, children, animal studies, or the effect of prebiotics on anthropometric indices were excluded. RESULTS: Within 325 recorded studies, 20 studies met the inclusion criteria consisting of 16676 overweight/obese adults with different underlying disorders such as nonalcoholic fatty liver disease (NAFLD), or polycystic ovary syndrome (PCOS). The length of intervention varied from 2 to 26 weeks. Results of meta-analyses have shown a moderate effect of probiotics on body weight in overweight/obese adults: from -0.526 kg/m2 (95% CI: -0.810, -0.247) to -0.25 kg/m2 (95% CI: -0.33, -0.17). Body mass index (BMI) was changed from -1.46 kg/m2 (95% CI: -2.44, -0.48) to -1.08 kg/m2 (95% CI: -2.05, -0.11) in NAFLD. Probiotics could reduce BMI from -0.36 kg/m2 (95% CI: -0.74, 0.02) to -0.29 kg/m2 (95% CI: -0.54, -0.03) in patients with PCOS. CONCLUSION: It seems that the probiotic products could have beneficial effects as an adjunct therapy for care and management of obesity when used in high dose. However, due to heterogeneity of included studies, it is required to confirm our results by more meta-analyses of clinical trials.

Natural Derived Nasal Spray; A Proposed Approach for COVID-19 Disease Control.

Considering the importance of COVID-19 disease pandemic, emerged by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in line with other studies to find appropriate prevention or treatment methods for this virus infection, our study objective was proposing the use of natural derived ingredients as an approach for COVID-19 disease control. Here we reviewed previous studies on natural derived nasal sprays andfound that some known natural derived ingredients have antiviral properties, so their topical use as a nasalspray is effective in reducing the symptoms of respiratory infections. Moreover, such nasal sprays also have thepotential of decreasing viral load, including titer of coronaviruses, in the nasal cavity. It seems that the use ofcarrageenan or other herbal ingredients in the nasal spray may block the SARS-CoV-2 virus from entering thelung cells of an affected person and can also prevent virus transmission to other susceptible persons. Further,noticing what we know about the novel 2019 coronavirus so far, we suggested carrageenan that has an unspecific physical antiviral activity and some other natural derived ingredients, as a choice in coping with SARS-CoV-2 virus infection.

Probiotics as a New Regulator for Bone Health: A Systematic Review and Meta-Analysis.

Despite the proposed role of the gut microbiota-bone axis, findings on the association between probiotic consumption and bone health are conflicting. This systematic review aimed to assess the effect of probiotic consumption on bone health parameters. A systematic literature search of relevant reports published in PubMed/Medline, Web of Science, SCOPUS, EMBASE, and Google scholar before December 2020 was conducted. All clinical trials or experimental studies, which examined the relationship between probiotic consumption and bone health parameters, were included. No limitation was applied during the search. After screening articles based on inclusion criteria, 44 studies remained. In clinical trials, probiotic consumption affects bone health parameters such as serum calcium levels (3.82; 95% CI: 1.05, 6.59 mmol/l), urinary calcium levels (4.85; 95% CI: 1.16, 8.53 mmol/l), and parathyroid hormone (PTH) levels (-5.53; 95% CI: -9.83, -0.86 ng/l). In most studies, Lactobacillus species such as L. helveticus, L. reuteri, and L. casei were consumed and women aged 50 years or older were assessed. Spinal and total hip bone mineral density (BMD) was not affected significantly by probiotic consumption. In 37 animal experiments, probiotic or symbiotic feeding mostly had effects on bone health parameters. Some strains of Bifidobacterium and Lactobacillus including L. reuteri, L. casei, L. paracasei, L. bulgaricus, and L. acidophilus have indicated beneficial effects on bone health parameters. In conclusion, this systematic review and meta-analysis indicate that probiotic supplementation might improve bone health. Further studies are needed to decide on the best probiotic species and appropriate dosages.

Gut microbiota modulation as a possible mediating mechanism for fasting-induced alleviation of metabolic complications: a systematic review.

BACKGROUND: Intermittent fasting has been reported to have positive effects on obesity, diabetes, cardiovascular diseases, hypertension, and several neurodegenerative diseases through different mechanisms such as alteration in the gut microbiota. This systematic review was conducted with the aim of providing an overview of the existing animal and human literature regarding the gut microbiota alterations in various fasting regimens. METHOD: A systematic literature search was conducted on PubMed, Scopus and Web of Science databases up to May 2021 to find all relevant studies examining the gut microbiota alteration during the fasting. Original researches on animal models or human patients were included in this study. RESULTS: The search fulfilled 3072 documents from which 31 studies (20 animal and 11 human studies) were included. Upon fasting, abundance of several beneficial bacteria including Lactobacillus and Bifidobacterium shifted significantly. Moreover, some taxa, including Odoribacter which negatively associated with blood pressure bloomed during fasting. Ramadan fasting, as a kind of intermittent fasting, improves health parameters through positive changes in gut microbiota including upregulation of A. muciniphila, B. fragilis, Bacteroides and butyric acid-producing Lachnospiraceae. CONCLUSION: The findings suggest that different fasting regimens including alternate-day fasting, calorie- and time-restricted fasting programs and Ramadan fasting could promote health maybe through the modulation of gut microbiome. However, further studies are needed to explore properly the connection between gut microbiota and meal frequency and timing.

Remembering a critical triad in severe deceleration injuries to the chest: report of a traumatic aortic rupture case.

We aimed to present herein the case of a potentially preventable death involving traumatic aortic rupture and to develop a critical pathway for the management of isthmic aortic ruptures consistent with the available resources. A retrospective record review by a multidisciplinary panel of experts was done, and the probability of survival was estimated based on the Revised Trauma Score and Injury Severity Scale score. Literature review and expert consensus were used in a quality and safety analysis to develop a critical care pathway for future cases. A 32-year-old man, injured in a motorcycle accident, was referred to a trauma center in a state of shock. Thoracic aortic rupture was highly suspected. For educational purposes, the classic signs of a widened mediastinum, right tracheal deviation, and left-sided hemothorax (in a context of significant deceleration injury) are incorporated into an acute care triad for traumatic aortic rupture. In such cases, in the absence of poor access to aortography, we suggest (serial - if needed) contrast-enhanced chest computed tomography scanning for diagnosis confirmation and operative planning. Assumption of hemodynamic stability can be catastrophic, and transferring the patient to a second facility may endanger survival, when operative capacity exists at the initial trauma facility.

Gut microbiota-derived metabolites in obesity: a systematic review.

Recent evidence suggests that gut microbiota-derived metabolites affect many biological processes of the host, including appetite control and weight management. Dysbiosis of the gut microbiome in obesity influences the metabolism and excretion of gut microbiota byproducts and consequently affects the physiology of the host. Since identification of the gut microbiota-host co-metabolites is essential for clarifying the interactions between the intestinal flora and the host, we conducted this systematic review to summarize all human studies that characterized the gut microbiota-related metabolites in overweight and obese individuals. A comprehensive search of the PubMed, Web of Science, and Scopus databases yielded 2,137 articles documented up to July 2018. After screening abstracts and full texts, 12 articles that used different biosamples and methodologies of metabolic profiling and fecal microbiota analysis were included. Amino acids and byproducts of amino acids, lipids and lipid-like metabolites, bile acids derivatives, and other metabolites derived from degradation of carnitine, choline, polyphenols, and purines are among the gut microbiota-derived metabolites which showed alterations in obesity. These metabolites play an important role in metabolic complications of obesity, including insulin resistance, hyperglycemia, and dyslipidemia. The results of this study could be useful in development of therapeutic strategies with the aim of modulating gut microbiota and consequently the metabolic profile in obesity.

Our Little Friends with Big Roles: Alterations of the Gut Microbiota in Thyroid Disorders.

BACKGROUND: The thyroid gland influences the metabolic processes in our body by producing thyroid hormones, and thyroid disorders can range from a harmless goiter to life-threatening cancer. A growing number of evidence support the link between gut microbiota composition and thyroid homeostasis. Gut dysbiosis can disrupt the normal gut barrier function, leading to immunologic and metabolic disorders. OBJECTIVE: The aim of this review was to discuss the main features of gut dysbiosis associated with different thyroid disorders. RESULTS: Gut microbiota contributes to thyroid hormone synthesis and hydrolysis of thyroid hormones conjugates. It has been shown that microbial metabolites may play a role in autoimmune thyroid diseases via modulating the immune system. Intestinal microbiota can contribute to the thyroid malignancies via controlling DNA damage and apoptosis and influencing inflammatory reactions by the microbiota- derived metabolites. However, the pathogenic role of altered gut microbiota in different thyroid disorders has not yet fully elucidated. CONCLUSION: Further research is needed to assess the role of alterations of the gut microbiota in disease onset and development in order to achieve novel strategies for the prevention and treatment of these diseases.

Effect of probiotic foods and supplements on blood pressure: a systematic review of meta-analyses studies of controlled trials.

OBJECTIVE: Recent evidences suggested that hypertension was associated with changes in gut microbiota composition. As intervention with probiotics might be considered as one of the approaches for modulating gut microbiota, the objective of the present study was to systematically review the meta-analyses of controlled trials (CTs) to elucidate the effects of probiotics on blood pressure. METHODS: We searched PubMed, Web of Science, and Cochrane Library databases until November 2019 to explore all the meta-analyses conducted on the CTs assessing the efficacy of probiotics in the management of blood pressure (BP). Meta-analyses performed on in vitro, animal or observational studies were excluded from the study. References of the included studies were also screened to obtain further eligible publications. RESULTS: From the 111 records which were identified during the literature search, 5 meta-analyses met the selection criteria. Total sample size was 2703 subjects (1009 subjects with type 2 diabetes mellitus (T2DM)), aged 12-75 years from both sexes. Results of meta-analyses have been shown a moderate effect of probiotics on BP in hypertensive adults with/without T2DM; from 3.10 to 5.04 mmHg for systolic blood pressure (SBP) and from 0.39 to 3.84 mmHg for diastolic blood pressure (DBP) after 3-24 weeks consumption. These effects were greater in adults with BP ≥ 130/85, by dairy products, by Asian fermented products with multiple species and higher dose of probiotics (≥ 1011 colony forming units (CFU)). CONCLUSION: It seems probiotic foods and supplements which were contained high dose multiple species of probiotic bacteria could be more effective in BP control.

The landscape of microbiota research in Iran; a bibliometric and network analysis.

OBJECTIVES: To introduce bibliometric features of Iranian documents on microbiota and to provide descriptive information about retrieved documents related to the medical sciences and documents utilizing molecular techniques for microbiota detection. METHODS: This is a descriptive bibliometric study of all Iranian documents on microbiota in any language that were indexed in Scopus before 7 September 2019. We assessed the research performance through statistical analysis of the bibliometric indicators, including number of publications, citations, institutions and journals activities, co-citations and bibliographic couplings, and network analysis of co-authorships, countries' collaborations, terms and keywords. RESULTS: We extracted 425 relevant documents, 260 of which pertain to the medical sciences. The most focused microbiota modulating interventions and diseases in 33 clinical trials are 'synbiotics' (n = 8) and 'probiotics' (n = 8), and 'Obesity' (n = 3) and 'non-alcoholic fatty liver disease' (n = 3), respectively. During the last decade, Iranian microbiota publications have increasingly grown with a constant upward slope, particularly in the area of medical sciences after 2016. Citation counting reveals that originals and reviews have been cited 4221 times, with an average 10.76 citations and H-index of 34. The most significant performance in publishing Iranian microbiota documents belongs to 'Tehran University of Medical Sciences' as the active institution (n = 89 publications) and the supporting sponsor (n = 19), 'Microbial Pathogenesis' as the productive journal (n = 12), 'Seidavi A' as the most authorships (n = 19), and 'the United States' as the collaborative country (n = 46). CONCLUSIONS: The qualitative and quantitative information of this study will be a practical guidance for future study planning and policy-decision making.

Main gut bacterial composition differs between patients with type 1 and type 2 diabetes and non-diabetic adults.

BACKGROUND: Regarding the role of gut microbial dysbiosis in hyperglycemia, we aimed to compare the main gut bacterial composition among type 1 and type 2 diabetic patients and healthy non-diabetic adults. METHODS: A total of 110 adult subjects (49 patients diagnosed with type 2 diabetes, 21 patients diagnosed with type 1 diabetes and 40 healthy persons) were included in this case-control study. The intestinal microbiota composition was investigated by quantitative real-time polymerase chain reaction (qPCR) method targeting bacterial 16S rRNA gene. Comparison between three groups was done using one-way analysis of variance. RESULTS: The participants' mean age in the type 1 diabetes, type 2 diabetes and control groups was 35.4, 57.2 and 38.0 years, respectively. Higher level of Escherichia, Prevotella and Lactobacillus was observed in both type 1 and type 2 diabetic patients compared with the healthy group (P ˂0.001). In contrast, bacterial load of Bifidobacterium, Roseburia and Bacteroides was higher in healthy control group (P < 0.05). Faecalibacterium was significantly lower in type 1 diabetic patients compared with the other two groups (P ˂0.001). No significant difference was found in Akkermansia level among three groups. CONCLUSIONS: Gut microbial alterations have been observed among patients suffering from type 1 and type 2 diabetes mellitus and healthy control adults. Butyrate producing genera including Roseburia and Faecalibacterium decreased while Escherichia, Prevotella and Lactobacillus increased in diabetic patients compared to healthy subjects. Modulating approaches of gut microbiota composition could be helpful in diabetes management.

Patterns of Obesity and Overweight in the Iranian Population: Findings of STEPs 2016.

Background: Obesity has become a common health problem all over the world. Benefiting from a national representative sample, the present study aimed to estimate the prevalence of overweight/obesity and the distribution of Body Mass Index (BMI) levels in the Iranian adult population, by sex, age, and geographical distribution. Methods: This was a large-scale national cross-sectional study of Non-communicable Diseases risk factor surveillance in Iran. Through a systematic random sampling cluster, 31,050 Iranian adult participants aged 18 years and over were enrolled in the study. The main research tools were used to assess three different levels of data, namely: (1) demographic, epidemiologic, and risk-related behavioral data, (2) physical measurements, and (3) lab measurements. Anthropometric measurements were taken using standard protocols and calibrated instruments. Results: In 2016, the national prevalence rates of normal weight, obesity, and overweight/obesity among Iranian adults were, 36.7% (95% CI: 36.1-37.3), 22.7% (22.2-23.2), and 59.3% (58.7-59.9), respectively. There was a significant difference between the prevalence of obesity among males [15.3% (14.7-15.9)] and females [29.8% (29.0-30.5)] (p < 0.001). The 55-64 [31.5% (30.1-33.0)] and the 18-24 [8.3% (7.3-9.4)] year-old age groups had the highest and lowest prevalence of obesity, respectively. The results show a geographical pattern at provincial level, where the level of BMI increases among populations ranging from the southeastern to the northwestern regions of the country. The highest provincial prevalence of obesity was almost 2.5-fold higher than the lowest provincial prevalence. Conclusion: We found a significant difference between the prevalence of obesity in males and females. Moreover, there was a considerable difference in the geographical pattern of the prevalence of obesity and overweight. Further evidence is warranted to promote strategies and interventions related to prevention and control of factors that are associated with weight gain.

Laparoscopic Heller Myotomy for Achalasia: Experience from a Single Referral Tertiary Center.

BACKGROUND Achalasia is the most well known esophageal motility disorder. Laparoscopic Heller myotomy (LHM) is the most effective treatment for achalasia. The aim of this study was to review our results on LHM for achalasia. METHODS In this cross-sectional study all patients undergoing LHM between 2015 and 2017 were studied. The myotomy was followed by an anterior or posterior partial fundoplication. All patients were followed up for at least six months. RESULTS We conducted this prospective study on 36 consecutive patients who underwent LHM over 3 years. The mean age of the patients was 36.64 ± 13.47 years. 30 patients (83.3%) underwent Toupet and 6 patients (16.7%) received Dor fundoplication. 11 patients (30.6%) developed reflux after the procedure. According to the Eckardt Symptom Scoring (ESS), the symptoms improved in 74.2% of the patients and remained unchanged in 25.8% of the patients. Analysis of the ESS, indicated a significant change in regurgitation and retrosternal pain, dysphagia, and weight loss after the surgery (p = 0.001, p = 0.002, p = 0.046, and p = 0.001, respectively). CONCLUSION LHM with anterior or posterior partial fundoplication is safe and achieves a good outcome in the treatment of achalasia, especially in patients who have not responded to other methods while no serious complication was reported despite several prior endoscopic interventions.

Targeting obesity management through gut microbiota modulation by herbal products: A systematic review.

OBJECTIVES: The gut dysbiosis has been implicated as a mediator to obesity and its manipulation could be an appropriate approach to sustainable weight loss. In this systematic review, our primary objective was to assess the potential manipulation of gut microbiota by herbal products in obesity. MATERIALS AND METHODS: We did a comprehensive search in PubMed, Web of Science, Scopus and Cochrane databases for all clinical trials and animal studies exploring the effects of various herbal products on gut microbiota composition in obesity documented up to May 2017. RESULTS: Our initial search yielded 2766 articles. After screening abstracts and full texts, 68 articles were included (55 animal studies and 13 clinical trials). The studies differed in their methodologies, type of interventions and intervention lengths. The weight loss was only reported in 23% of trials and in 64% of animal studies. An increasing tendency in Bifidobacterium species and butyrate-producing bacteria such as Faecalibacterium prausnitzii were observed after consuming non-digestible carbohydrates, although these changes did not always correlate with weight loss. Supplementation with high concentration of polyphenols reduced body weight gain in animal studies and inhibited growth of detrimental species such as Clostridia and Enterobacteria while the growth of Lactic acid bacteria and Akkermansia muciniphila is enriched. CONCLUSIONS: Alteration of gut microbiota after interventions has been affected by the baseline composition of gut microbiota. This systematic review shows that consumption of herbal products might have beneficial effects on restoring healthy gut microbiome besides body fat reduction.

Worldwide trends in scientific publications on association of gut microbiota with obesity.

OBJECTIVES: Recent evidence has shown underlying roles of gut dysbiosis and metabolic endotoxemia in obesity and its complications. Despite the large number of experimental and clinical researches performed on gut microbiota and obesity, no bibliometrics' study has been conducted so far. We aimed to assess the trend of global scientific publications in the field of gut microbiota and obesity. MATERIALS AND METHODS: The bibliometrics' data from January 2000 to April 2017 were retrieved based on Scopus database. The analysis of the publication year, main source, citation, subject area, co-authorship network, and geographical distribution were carried out, accordingly. The data were analyzed using the Scopus analysis tools, SPSS version 15 and Visualizing Scientific Landscapes (VOS) viewer version 1.6.5. RESULTS: Out of 4384 documents that were identified, the United States published the highest number (28.2%), followed by China and United Kingdom. The number of publications showed an increasing trend over the years of which the most productive year was 2016. The leading subject area was medicine. Most of published scientific documents were original articles and the top source was "PLoS One". The documents were cited totally 153576 times with average citations per article as 35.03, and h-index of 159. Top author in the co-authorship network assessment was "Wang J." from China. CONCLUSION: This study could provide practical sources to researchers to find highly cited studies. Moreover, the study could pave the way for researchers to be engaged in studies which potentially lead to more publication in the field.