Comparison of Sleeve Gastrectomy with Loop Duodenojejunal Bypass Versus One Anastomosis Gastric Bypass for Type 2 Diabetes: The Role of Pylorus Preservation.

BACKGROUND: One anastomosis gastric bypass (OAGB) is recognized as a standard procedure in metabolic surgery. However, concerns about postoperative bile reflux and nutritional risks are prevalent. Comparatively, sleeve gastrectomy with loop duodenojejunal bypass (SG + LoopDJB) bypasses an equivalent length of the foregut as OAGB while maintaining pyloric function. The role of pylorus function remains to be further elucidated regarding these metabolic procedures' therapeutic outcomes and side effects. METHOD: A retrospective study was conducted in our center to compare the surgical safety and 1-year outcomes of OAGB and SG + LoopDJB regarding type 2 diabetes mellitus (T2DM) remission, weight loss, gastrointestinal disorders, and nutritional status in T2DM patients matched by gender, age, and BMI. RESULTS: The baseline characteristics were comparable between groups. Compared with OAGB, SG + LoopDJB had longer operative time and length of stay (LOS) but similar major postoperative complications. At 1-year follow-up, OAGB has similar diabetes remission (both 91.9%), weight loss effect (28.1 ± 7.1% vs. 30.2 ± 7.0% for %TWL), and lipidemia improvement to SG + LoopDJB (P > 0.05). However, OAGB presented a higher incidence of hypoalbuminemia (11.9% vs. 2.4%, P = 0.026) but a low incidence of gastroesophageal reflux disease (GERD) symptoms (9.5% vs. 26.2%, P = 0.046) than SG + LoopDJB. There was no statistical difference regarding other gastrointestinal disorders and nutritional deficiencies between groups. CONCLUSION: Both OAGB and SG + LoopDJB show comparable, favorable outcomes in weight loss, T2DM remission, and lipidemia improvement at the 1-year follow-up. Pylorus preservation, while increasing surgical difficulty and the risk of de novo GERD, may reduce the risk of postoperative hypoalbuminemia.

Comparison of Single Versus Double Anastomosis Bariatric Metabolic Surgery in Obesity: a Systematic Review and Meta-analysis.

Major BMS are modified through loop rather than Roux-en-Y type reconstruction recently, and this study systematically reviews the BMS from the perspective of SA (single anastomosis) and DA (double anastomosis) procedures, aiming to research the differences among bariatric procedures. A total of 39 studies compared SA- and DA-BMS were finally eligible for analysis after searching in PubMed, Web of Science, and Cochrane Library. Compared with DA, SA shortens operative time and decreases complications especially obstruction, internal hernia, and reoperation. SA-GB (gastric bypass) has significantly higher %TWL and T2DM remission rate than DA-GB 1- and 5-year postoperatively. SA-DS (duodenal switch) has similar 1-year %TWL and lower 5-year %TWL, and comparable 1- and 5-year T2DM remission with DA-DS. SA provides significant advantages about simplicity and safety. This, together with the shorter learning curve, makes SA a promising choice.

Percentage of maximum weight lost as an optimal parameter of weight regain after bariatric surgery in Chinese patients with diabetes.

OBJECTIVE: The goal of this study was to compare measures of weight regain (WR) and their association with the glucose metabolism deterioration within 3 years following bariatric surgery among Chinese patients with obesity and type 2 diabetes mellitus (T2DM). METHODS: Among a retrospective cohort of 249 patients with obesity and T2DM who underwent bariatric surgery and were followed up to 3 years, WR was assessed by weight changes, BMI changes, percentage of presurgery weight, percentage of nadir weight, and percentage of maximum weight lost (%MWL). Glucose metabolism deterioration was defined as a change from an absence of antidiabetic medication use to use, or absence of insulin use to use, or an increase in glycated hemoglobin by at least 0.5% to 5.7% or greater. RESULTS: A comparison of C-index of glucose metabolism deterioration indicated %MWL had better discriminatory ability versus weight change, BMI change, percentage of presurgery weight, or percentage of nadir weight (all p < 0.01). The %MWL also had the highest prediction accuracy. The optimal %MWL cutoff point was 20%. CONCLUSIONS: Among Chinese patients with obesity and T2DM who underwent bariatric surgery, WR quantified as %MWL predicted 3-year postoperative glucose metabolism deterioration better than the alternatives; 20% MWL was the optimal cutoff point.

Macrophage LAMTOR1 Deficiency Prevents Dietary Obesity and Insulin Resistance Through Inflammation-Induced Energy Expenditure.

Here, we studied the metabolic function of LAMTOR1 from macrophages using LAMTOR1 macrophage-specific knockout (MKO) mice. LAMTOR1 MKO mice showed resistance to high-fat diet (HFD)-induced obesity, lipid steatosis, and glucose metabolic disorders, with elevated levels of pro-inflammatory cytokines. The energy expenditure, oxygen consumption, and CO2 production increased significantly in HFD-fed MKO vs. wild-type (WT) mice. HE and immunohistochemistry staining showed a remarkable CD68+ Kupffer cell accumulation in the liver. Additionally, flow cytometry revealed that the proportion of macrophages and monocytes increased significantly in the liver of MKO mice. Of note, these macrophages were probably derived from the bone marrow since the proportion of CD11b+ cells as well as the proliferative activity was also increased in the context of femoral bone marrow cells. In addition, the Kupffer cells of both WT and KO mice were double-positive for the M1 (CD86) and M2 (CD206) markers. However, the expression of both M1 and M2 macrophage-related genes was increased in the liver of HFD-fed KO mice. Murine primary hepatocytes and Kupffer cells were further isolated and incubated with oleic acid for 24 h. The glucose output of primary hepatocytes from MKO mice was not affected. However, decreased lipid tolerance was observed in LAMTOR1-deficient Kupffer cells. Overall, our results suggest that LAMTOR1 deficiency in macrophages prevents obesity and metabolic disorders via the accumulation of Kupffer cells in the liver and the consequent hyper-inflammation and increased energy expenditure. Therefore, our results provide a new perspective for macrophage-derived LAMTOR1 in the context of systemic metabolism.

Insight into electrocatalytic activity and mechanism of bimetal niobium-based oxides in situ embedded into biomass-derived porous carbon skeleton nanohybrids for photovoltaics and alkaline hydrogen evolution.

Developing highly-efficient multifunctional electrocatalysts for energy conversion devices is of great importance. A sequence of nano-sized bimetal (Al, Cr, Fe) niobium oxide nanoparticles anchored on aloe peel-derived porous carbon skeleton hybrids (AN/APPC, CN/APPC, and FN/APPC) are successfully prepared via co-precipitation avenue and used as electrocatalysts for photovoltaics and alkaline hydrogen evolution reaction. Benefiting from the synergies between nano-sized metal niobium oxides and highly conductive porous carbon skeleton, these robust polycomponent hybrid electrocatalysts exhibit superior catalytic performances for accelerating the triiodide reduction and hydrogen evolution reaction. The solar cell with AN/APPC electrocatalyst achieves an outstanding device efficiency of 7.31%, superior to that with Pt (6.84%), and the AN/APPC electrocatalyst exhibit an overpotential (131.6 mV) when the current density is 10 mA cm-2 and Tafel slope (54 mV dec-1) in 1 M KOH for hydrogen evolution reaction. The AN/APPC electrocatalysts illustrate remarkable electrochemical durability in both I3-/I- electrolyte and alkaline media. Furthermore, the catalytic mechanism was clarified both from the electronic structure and work function through first-principle density functional theory (DFT) calculations. This work opens a new avenue for electrocatalysis field via using nano-sized porous bio-carbon skeleton loaded with niobium-based binary metal.

Association between 1,5-Anhydroglucitol and Acute C Peptide Response to Arginine among Patients with Type 2 Diabetes.

OBJECTIVE: The aim of this study was to explore the association of 1,5-anhydroglucitol with acute C peptide response (ACPR) to arginine among patients with type 2 diabetes. METHODS: Patients with type 2 diabetes were enrolled from the Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital. ACPR was assessed using arginine stimulation test. Decreased ß-cell function was defined as ACPR < 2.1. Multivariable logistic regression models were used to demonstrate the association between 1,5-anhydroglucitol and decreased ß-cell function. RESULTS: Finally, 623 patients with type 2 diabetes were enrolled into the analysis. Multivariable-adjusted odds ratios for decreased ß-cell function across quartiles of 1,5-anhydroglucitol were 1.00, 0.47 (95% confidence interval (CI) 0.23-0.99), 0.41 (95% CI 0.20-0.84), and 0.27 (95% CI 0.13-0.57) (P trend = 0.042), respectively. When 1,5-anhydroglucitol was considered as a continuous variable after logarithm, the corresponding odds ratio was 0.40 (95% CI 0.23-0.71). CONCLUSIONS: We demonstrated a dose-response linear association between 1,5-anhydroglucitol and ACPR. 1,5-Anhydroglucitol was likely to be associated with ß-cell function. Further analysis with large sample size and prospective study design is warranted to validate our findings.

Biomass-derived carbon boosted catalytic properties of tungsten-based nanohybrids for accelerating the triiodide reduction in dye-sensitized solar cells.

Manganese tungstate (MnWO4), zinc tungstate (ZnWO4), and copper tungstate (CuWO4) embedded biomass-derived carbon (MWO-C, ZWO-C, CWO-C) was synthesized by hydrothermal treatment and investigated as counter electrode (CE) catalysts to test electrochemical activity. Biomass-derived carbon was used as the shape controlling agent, which changed the morphology of MWO from spherical to spindle-like. Owing to the synergistic effect between tungsten-based bimetal oxides and biomass-derived carbon, the MWO-C, ZWO-C, and CWO-C catalysts exhibited enhanced electrochemical performance in dye-sensitized solar cells (DSSCs) system. The MWO-C, ZWO-C and CWO-C catalysts in DSSCs showed outstanding power conversion efficiency (PCE) of 7.33%, 7.61%, and 6.52%, respectively, as compared with 7.04% for Pt based devices. Biomass-derived carbon improves the catalytic properties of tungsten-based nanohybrids. The results showed that biomass-derived carbon-enhanced inorganic compound as CE catalysts are promising alternatives to Pt-based CE catalysts for energy conversion devices.

Impact of acute-phase insulin secretion on glycemic variability in insulin-treated patients with type 2 diabetes.

AIMS: The association between ß-cell function and glycemic variability remains to be clarified in insulin-treated patients with type 2 diabetes. Therefore, the study sought to examine the association of various indices of ß-cell function with glycemic variability in Chinese insulin-treated patients with type 2 diabetes. METHODS: Glycemic variability was assessed by the coefficient of variation (CV) of glucose levels with the use of continuous glucose monitoring (CGM). Basal ß-cell function was evaluated by fasting C-peptide (FCP) and the homeostasis model assessment 2 for ß-cell function (HOMA2-%ß). Postload ß-cell function was measured by 2-hour C-peptide (2hCP) and the acute C-peptide response (ACPR) to arginine. RESULTS: When a cutoff value of CV ≥ 36% was used to define unstable glucose, the multivariable-adjusted odds ratios for labile glycemic control were 0.34 (95% CI 0.18-0.64) for each 1 ng/mL increase in ACPR, 0.47 (95% CI 0.27-0.81) for each 1 ng/mL increase in FCP, 0.77 (95% CI 0.61-0.97) for each 1 ng/mL increase in 2hCP, and 1.00 (95% CI 0.98-1.01) for each 1% increase in HOMA2-%ß. When we further adjusted for 2hCP and HOMA2-%ß in the ACPR and FCP analyses, and adjusted for ACPR or FCP in the 2hCP analyses, only ACPR but not FCP or 2hPC remained to be a significant and inverse predictor for labile glycemic control. CONCLUSIONS: ACPR evaluated by the arginine stimulation test may be superior to other commonly used ß-cell function parameters to reflect glycemic fluctuation in insulin-treated patients with type 2 diabetes.