Mid-Term Diabetes Remission Outcome in Patients with BMI ≤ 30 kg/m2 Following Sleeve Gastrectomy.

BACKGROUND: Bariatric and metabolic surgery is recommended for Asian patients with type 2 diabetes mellitus (T2DM) and BMI ≥ 27.5 kg/m2. However, mid to long-term ·evidence is still lacking. METHODS: Patients' data that underwent laparoscopic sleeve gastrectomy (SG) as the primary surgery at the Affiliated Hospital of Xuzhou Medical University were analyzed. Patients with T2DM diagnosed with either fasting blood glucose (FBG) ≥ 7.0 mmol/L or glycosylated hemoglobin (HbA1c) level ≥ 7.0% and 27.5 ≤ BMI ≤ 30 kg/m2 were included. RESULTS: 24 patients (7 male and 17 female) were included in this study. With a mean follow-up duration of 4.5 ± 1.1 years, the mean percentage of total weight loss (%TWL) was 14.4 ± 6.7%. Postoperatively, nine patients (37%) still required oral anti-diabetic medications, while no patients used insulin. FBG and HbA1c levels declined to 6.3 ± 1.5 mmol/L and 6.0 ± 1.0%, respectively. Fifteen patients (63%) were with HbA1c levels < 7% and without medication requirements, five patients (21%) were with HbA1c levels < 7% with the help of oral anti-diabetic medication, and four patients (16%) were with HbA1c levels > 7% with the help of oral anti-diabetic medication. CONCLUSIONS: Our study provides further evidence that SG could result in both T2DM improvement and remission in patients with BMI ≤ 30 kg/m2. Longer follow-up duration and larger sample will be needed in the future.

Comparison of three different anastomotic methods of sleeve gastrectomy with transit bipartition using an obese rodent model.

The long-term effects and safety of single-anastomosis sleeve ileal (SASI) bypass have not been confirmed. The one anastomosis procedure carries the risk of bile reflux, and Braun anastomosis has the capacity to reduce bile reflux. This study was designed to compare the influences of bile reflux and histological changes in the esogastric sections of rats. Obese Sprague-Dawley rats underwent sleeve gastrectomy with transit bipartition (RYTB) (n = 12), SASI (n = 12), SASI bypass with Braun anastomosis (BTB) (n = 12), esojejunostomy (EJ) (n = 12), and SHAM (n = 8) surgery. During the 12-week follow-up period, weight changes, glucose improvement, and changes in serum nutrition were evaluated. Histological expression and bile acid concentration in the rats in all groups were also evaluated. No significant differences in weight loss and glucose improvements were observed in the RYTB, SASI, and BTB groups. The RYTB and BTB groups had significantly lower bile acid concentration and albumin levels than the SASI group. In addition, mucosal height in the RYTB and BTB groups was significantly lower than in the SASI group. Braun anastomosis had a significant effect on anti-reflux. BTB may be a superior primary procedure due to its potential for parallel bariatric and metabolic improvements, effective anti-reflux effects, simplified operations, and avoidance of severe malnutrition. Further clinical studies are needed to confirm these findings.

High-energy-density flexible graphene-based supercapacitors enabled by atypical hydroquinone dimethyl ether.

Supercapacitor is an electrochemical energy-storage technology that can meet the green and sustainable energy needs of the future. However, a low energy density was a bottleneck that limited its practical application. To overcome this, we developed a heterojunction system composed of two-dimensional (2D) graphene and hydroquinone dimethyl ether- an atypical redox-active aromatic ether. This heterojunction displayed a large specific capacitance (Cs) of 523 F g-1 at 1.0 A g-1, as well as good rate capability and cycling stability. When assembled in symmetric and asymmetric two-electrode configuration, respectively, supercapacitors can work in voltage windows of 0 âˆ¼ 1.0 V and 0 âˆ¼ 1.6 V, accordingly, and exhibited attractive capacitive characteristics. The best device can deliver an energy density of 32.4 Wh Kg-1 and a power density of 8000 W Kg-1, and suffered a small capacitance degradation. Additionally, the device showed low self-discharge and leakage current behaviors during long time. This strategy may inspire exploration of aromatic ether electrochemistry and pave a way to develop electrical double-layer capacitance (EDLC)/pseudocapacitance heterojunctions to boost the critical energy density.

High-performance reduced graphene oxide supercapacitors enabled by simple amino hydroquinone dimethylether.

Reduced graphene oxide (rGO) supercapacitors usually feature poor capacitive characteristics. In the current work, coupling of the simple, nonclassical redox molecule amino hydroquinone dimethylether with rGO was found to boost the rGO capacitance to 523 F g-1. The assembled device exhibited an energy density of 143 Wh kg-1 and excellent rate capability and cyclability.

Engineering electronic structure of graphene to boost Lithium-Storage performances.

Organic functionalization of graphene framework was an effective means used to boost the storage performances of lithium, but it lacked a universal strategic guideline for introducing functional groups (electron-withdrawing and electron-donating modules are overall classified). It mainly entailed designing and synthesizing graphene derivatives, in which the interference functional groups were necessarily excluded. To this end, a unique synthetic methodology based on graphite reduction cascaded by electrophilic reaction was developed. The electron-withdrawing-type groups (Br; trifluoroacetyl: TFAc) and electron-donating-type counterparts (butyl: Bu; 4-methoxyphenyl: 4-MeOPh) were readily attached to graphene sheets at a comparable functionalization degree. As the electron density of carbon skeleton was enriched by electron-donating modules, particularly for Bu units, the lithium-storage capacity, rate capability and cyclability were appreciably boosted. For example, they had 512 and 286 mA h g-1 at 0.5C and 2C, respectively; and 88 % of capacity retention after 500 cycles at 1C.

Regulation of Pancreatic TXNIP-Insulin Expression Levels after Bariatric Surgery Using Diabetic Rodent Model.

Purpose: The purpose of this study was to investigate the effect of bariatric surgery on pancreatic thioredoxin-interacting protein (TXNIP) and insulin expression levels. The research question is does bariatric surgery induce changes in the pancreatic TXNIP level, given that TXNIP has been proposed as a key glucose control factor? Methods: Using nondiabetic and diabetic rats, we investigated whether our streptozotocin-induced diabetic rat models exhibited changes in pancreatic TXNIP regulation. Following this confirmation, we randomly divided the diabetic rats into the following three groups: the gastric bypass group (n = 16), pair-fed group (n = 10), and sham group (n = 10). Preoperatively and 3 weeks postoperatively, all the rats underwent an oral glucose tolerance test, insulin tolerance test, and blood sampling procedures for hormonal analysis. Results: The TXNIP messenger ribonucleic acid (mRNA) and protein expression levels were significantly lower in the gastric bypass group than in the other groups. Regarding the gastric bypass group, the pancreatic mRNA expression levels of microRNA-204 (miR-204) and MafA were significantly lower and higher, respectively, than in the other groups. Furthermore, the levels of pancreatic insulin expression at the mRNA and protein levels were also significantly higher in the gastric bypass group than in the other groups. Conclusion: Bariatric surgery significantly improved glucose control and regulated the pancreatic insulin production pathways of TXNIP, miR-204, and MafA. The regulation of TXNIP, miR-204, and MafA might play an important role in the mechanism of diabetes remission following bariatric surgery.

Can we abandon foregut exclusion for an ideal and safe metabolic surgery?

Foregut (foregut exclusions) and hindgut (rapid transit of nutrients to the distal intestine) theories are the most commonly used explanations for the metabolic improvements observed after metabolic surgeries. However, several procedures that do not comprise duodenal exclusions, such as sleeve with jejunojejunal bypass, ileal interposition, and transit bipartition and sleeve gastrectomy were found to have similar diabetes remission rates when compared with duodenal exclusion procedures, such as gastric bypass, biliopancreatic diversion with duodenal switch, and diverted sleeve with ileal interposition. Moreover, the complete exclusion of the proximal intestine could result in the malabsorption of several important micronutrients. This article reviews commonly performed procedures, with and without foregut exclusion, to better comprehend whether there is a critical need to include foregut exclusion in metabolic surgery.

Association Between the Parental Weight Status and the Weight Loss Outcome in Patients After Sleeve Gastrectomy.

PURPOSE: Obesity is a complex multifactorial disease. Parents with obesity could have an impact on the weight loss outcome of their children following bariatric-metabolic surgery. Therefore, we aimed to investigate the association between the weight status of the parents and the weight loss outcome in patients undergoing sleeve gastrectomy (SG). METHODS: Patients undergoing SG with ≥ 3 years of follow-up between January 2016 and June 2018 were included in this study. The patients were categorized into three groups: (1) both parents did not have obesity (non-obesity parents, NOP); (2) one parent had obesity (single-parent obesity, SPO); (3) both parents had obesity (both parents' obesity, BPO). The main parameters for this study were the patients' preoperative and postoperative weight and the weight of the parents. RESULTS: A total of 218 SG patients were included in this study (NOP, n = 116; SPO, n = 64; BPO, n = 38). There was no statistically significant difference in the preoperative assessments. The main results for the NOP vs. SPO vs. BPO were as follows; parents' body mass index (BMI) 23.6 ± 2.5 vs. 27.9 ± 5.0 vs. 30.2 ± 3.3 kg/m2, percentage of total weight loss (%TWL) 30.2 ± 9.0 vs. 30.8 ± 10.4 vs. 23.8 ± 10.9%. The %TWL for the BPO group was significantly lower than the NOP and SPO groups (p < 0.05). CONCLUSION: The patient's weight loss outcome was significantly lower when both parents had obesity. Further controlled or prospective studies are needed to determine the best means to improve weight loss outcomes in such patients.

Sleeve Gastrectomy with Braun Anastomosis Transit Bipartition (B-TB): a Potential Midway Between Single Anastomosis and Roux-en-Y Transit Bipartition.

PURPOSE: The single anastomosis sleeve ileal bypass (SASI) procedure is a simple modification of the Roux-en-Y transit bipartition (RYTB) procedure; however, SASI risks patients with possible biliary reflux. Braun anastomosis has been proposed to fix the biliary reflux of single anastomosis procedures. This study presented our early "sleeve gastrectomy with Braun anastomosis Transit Bipartition" (B-TB) outcomes. MATERIALS AND METHODS: Patients who underwent B-TB or RYTB between June 2020 and April 2021 at our hospital and have completed three months follow-up were included in this study. RESULTS: Ten patients with B-TB and forty patients with RYTB were included. No significant differences were observed between the B-TB and RYTB patients regarding the preoperative conditions. The B-TB procedure had significantly shorter operation time and postoperative hospitalization time than the RYTB procedure. There was no significant difference between the two groups regarding the 3-month percentage of total weight loss (B-TB vs RYTB: 19.7 ± 2.7% vs 22.2 ± 5.4%) and the postoperative complications before discharge. Preoperatively, two patients and eight patients achieved GERD-Q score ≥8 for the B-TB and RYTB group, respectively. At postoperative 3 months, those with GERD-Q score ≥8 was reduced to one patient and two patients for the B-TB and RYTB group, respectively. No patients have reported symptoms of greenish-yellow vomiting in both groups postoperatively. CONCLUSION: B-TB is an exciting procedure with potential benefits. However, as it is an investigational procedure, extra care should be maintained. Larger samples and more extended follow-up data are needed in the future.

Effect of Sleeve Gastrectomy on Plasma Thioredoxin-Interacting Protein (TXNIP).

PURPOSE: The mechanism in which bariatric surgery induces diabetes remission is still poorly understood. This study proposes Thioredoxin-interacting protein (TXNIP) as a possible factor for the anti-diabetic mechanism after sleeve gastrectomy (SG). MATERIALS AND METHODS: Plasma TXNIP level in obesity patients with diabetes (T2D, N = 20), obesity patients without diabetes (NDO, N = 20), and patients without obesity and diabetes (lean, N = 10) were assessed before surgery and at 1 and 12 months after SG. RESULTS: Preoperative TXNIP level was significantly higher in T2D (196.4 ± 76.0 pg/ml) and NDO (149.7 ± 94.1 pg/ml) patients when compared with lean patients (98.7 ± 22.7 pg/ml) (p-value < 0.05). At 1 month and 12 months postoperatively, the TXNIP levels were reduced significantly from the preoperative levels in the T2D and NDO patients (p-value < 0.05). Before surgery, a correlation between TXNIP and fasting blood glucose (FBG) (r2 = 0.1585, p-value = 0.0109), HbA1C (r2 = 0.2120, p-value = 0.0028), and insulin (r2 = 0.1217, p-value = 0.0274) was observed. At 12 months after surgery, the reduction of TXNIP was also correlated with the degree of FBG (r2 = 0.1038, p-value = 0.0426), HbA1C (r2 = 0.2459, p-value = 0.0011), and insulin (r2 = 0.1365, p-value = 0.0190) reduction. CONCLUSION: Plasma TXNIP level is elevated in obesity patients with/without diabetes. SG resulted in a significant reduction of plasma TXNIP level which is correlated with the degree of FBG, HbA1C, and insulin reduction. Regulation of TXNIP could be part of the mechanism of diabetes remission after bariatric surgery.

[A national investigation on the application of Chinese guideline for the diagnosis and treatment of chronic rhinosinusitis].

OBJECTIVE: To investigate the application of Chinese guideline for the diagnosis and treatment of chronic rhinosinusitis (2008, Nanchang) on a national scale. METHODS: The contents of the guideline and its relevant applied indicators were designed into an initial questionnaire and, after a pre-survey, revised into a formal questionnaire. Then a stratified sampling was selected out of otolaryngology practitioners in the different level hospitals across the country. After a uniform training, the investigators were sent to these different hospitals to conduct questionnaire survey by face to face interview with otolaryngology respondents. Based on the summarized data, statistical analyses on the awareness and practice status of the guideline, together with their influencing factors, were made. SPSS 16.0 software was used to analyze the data. RESULTS: Issuing and withdrawing questionnaires were performed from December 2012 to June 2013 and 1 240 respondents in 350 hospitals from 30 different provinces, municipalities or autonomous regions were effectively investigated. An average awareness and practice rate of 48.7% and 40.8% upon the guideline was acquired, respectively. There was a significant correlation (r = 0.280, P = 0.000) between the two indicators. With linear regression, county-level hospitals, junior practitioners, non-rhino professionals were the risk factors of poor guideline adherence. In addition, respondents form western region showed lower awareness and practice rate than that of ones from central and eastern region. CONCLUSION: The adherence on Chinese guideline for the diagnosis and treatment of chronic rhinosinusitis is nationally low, so popularization of activities should be urgently strengthened, especially in focus areas, focus hospitals, and focus groups.