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1.
Obes Surg ; 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32152837

RESUMO

AIMS: To explore the intestinal microbiota composition affected by the two most widely used procedures of bariatric surgery, laparoscopic sleeve gastrectomy (LSG) and laparoscopic roux-en-Y gastric bypass (LRYGB), in Chinese obesity patients. METHODS: Stool samples were collected from the obese patients before (n = 87) and with follow-up after the surgery (n = 53). After DNA extraction, 16S rDNA (V3 + V4 regions) sequencing was completed on Illumina HiSeq 2500 sequencing platform. The samples were analyzed base on four groups, pre-LSG (n = 54), pre-LRYGB (n = 33), post-LSG (n = 33), and post-LRYGB (n = 20). The linear mixed models were used to analyze the alteration of intestinal microbiota before and after the surgeries of LSG or LRYGB. Student's t test and χ2 test were used for analysis of independent groups; Metastats analysis was used to compare the relative abundance of bacteria, and Pearson correlation and Spearman correlation analysis were used to test the correlation between indicated groups. RESULTS: 87 patients were included and 53 (60.92%) of them completed the follow-up (9.60 ± 3.92 months). Body mass index (BMI) decreased from 37.84 ± 6.16 kg/m2 to 26.22 ± 4.33 kg/m2 after LSG and from 45.75 ± 14.26 kg/m2 to 33.15 ± 10.99 kg/m2 after LRYGB. The relative abundance of 5 phyla and 42 genera were altered after the surgery in the cohort. Although no alteration of Firmicutes was observed at phylum level, 54.76% of the altered genera belong to phylum Firmicutes. Both LSG and LRYGB procedures increased the richness and evenness of intestinal microbiota in obese patients after the surgery. Particularly, 33 genera altered after LSG and 19 genera altered after LRYGB, in which 11 genera were common alterations in both procedures. CONCLUSION: Both LSG and LRYGB altered the composition of intestinal microbiota in Chinese obesity patients, and particularly increased the richness and evenness of microbiota. Genera belonging to phylum Firmicutes were the most altered bacteria by bariatric surgery. The procedure of LSG resulted in much more pronounced alteration of the intestinal microbiota abundance than that observed in LRYGB. While different genera were altered after LSG and LRYGB procedures, 10 genera were the common altered genera in both procedures. Bacteria altered after LSG and LRYGB were functionally associated with BMI, and with relieving of the metabolic syndromes.

2.
BMC Surg ; 20(1): 48, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32178649

RESUMO

BACKGROUND: Internal hernia (IH) is a serious complication following laparoscopic Roux-en-Y gastric bypass (LRYGB), and closure of mesenteric defect has been recommended to reduce this complication. But what kind of material about suture and how to close the mesenteric defects were still controversial. The main aim of this study was to compare the incidence rate of internal hernia after LRYGB between patients with different surgical techniques. METHOD: Three hundred and thirty-one patients underwent LRYGB between June 2004 and December 2017 in one single institute were retrospective analysed. The IH rate was evaluated according to different surgical methods and surgical materials before and 12 months after LRYGB. RESULTS: All the cases were subdivided into three groups based on the suturing method, Roux limb position, and Suture material. The mean follow up time was 36 ± 12 months, and the total incident rate of IH was 1.8% (n = 6). In the six IH cases, the duration of IH occurred time ranged from 1 month to 36 months postoperatively, and for the IH sites, one for intestinal defect, three for transverse mesocolon defect and two Peterson defect respectively. There was a significant difference about IH rate between interrupted suture and running suture groups (p = 0.011), and there were no significant differences between the other two groups. CONCLUSION: Compare with interrupted suture, running suture may prevent IH after LRYGB. Patient's gender, age, body mass index(BMI), glycometabolism condition, and Roux limb position and suture material had no effects on the IH prevalence after LRYGB.

3.
Obes Surg ; 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32180113

RESUMO

BACKGROUND: Scarce data exists about serum enzyme in bariatric patients. We attempted to evaluate serum enzyme status in patients receiving Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) and to identify related predictors. METHODS: We retrospectively reviewed the patients receiving RYGB and SG in our center from January 2013 to January 2018. Anthropometric data and serum enzyme data were collected preoperatively and 6 and 12 months postoperatively. RESULTS: Five hundred patients (201 RYGB, 299 SG) were included. Serum enzyme abnormalities were common preoperatively, with 50.8% for elevated alanine aminotransferase (ALT), 33.0% for elevated aspartate aminotransferase (AST), 36.6% for elevated γ-glutamyltranspeptidase (γ-GT), 17.6% for elevated creatine kinase (CK), 15.2% for elevated lactic dehydrogenase (LDH), 9.0% for elevated adenosine deaminase (ADA), 6.2% for elevated hydroxybutyrate dehydrogenase (HBDH), and 8.4% for decreased superoxide dismutase (SOD). After RYGB and SG, the prevalence of serum ALT, AST, γ-GT, LDH, and HBDH abnormalities reduced. The levels of ALT, AST, γ-GT, ADA, cholinesterase (CHE), LDH, CK, and HBDH reduced significantly, while amylase and SOD levels increased. Age and preoperative γ-GT level were independent predictors of ALT, AST, γ-GT, and LDH change 1 year postoperatively. Preoperative ALT, AST, ALP, LDH, and HBDH levels could predict postoperative change, respectively. Gender and surgical procedure could predict postoperative ALP change. CONCLUSION: Serum enzyme abnormalities are common in bariatric surgery candidates, with reduced prevalence of abnormalities postoperatively. RYGB and SG are related with reduced ALT, AST, γ-GT, ADA, CHE, LDH, CK, and HBDH levels, as well as increased amylase and SOD levels.

5.
Dalton Trans ; 48(46): 17258-17265, 2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31710322

RESUMO

The development of effective bifunctional catalysts for both oxygen reduction reactions (ORRs) and oxygen evolution reactions (OERs) is crucial for improving the performance of charge and discharge processes in rechargeable metal-air batteries. Here, we report a sulfonated cobalt phthalocyanine/carbon nanotube hybrid (CoPc-SO3H/CNT) prepared by a facile anchoring method along with sonication and magnetic stirring. The resulting CoPc-SO3H/CNT hybrid exhibits better catalytic activity for ORRs and OERs than the cobalt phthalocyanine/carbon nanotube hybrid (CoPc/CNT), sulfonated cobalt phthalocyanine (CoPc-SO3H), cobalt phthalocyanine (CoPc) and the carbon nanotube (CNT). The onset potential of CoPc-SO3H/CNT for the ORR in 0.1 M KOH is 0.88 V (vs. RHE), which is higher than that of CoPc/CNT (0.85 V), the CNT (0.80 V), CoPc-SO3H (0.77 V) and CoPc (0.66 V). Meanwhile, the CoPc-SO3H/CNT hybrid shows a much lower OER potential (1.62 V) at a current density of 10 mA cm-2 compared to CoPc-SO3H (1.64 V), CoPc/CNT (1.74 V), the CNT (1.96 V) and CoPc (>2.00 V) in 1 M KOH. Similar patterns are also found in 0.1 M KOH solution. Both the conductive CNT and the electron-withdrawing sulfonic groups are confirmed to benefit the electrochemical oxygen reactions (ORRs/OERs).

6.
Artigo em Inglês | MEDLINE | ID: mdl-31746665

RESUMO

Background: The purpose of this research was to investigate the feasibility and strategies of right central lymph node dissection (CLND) in endoscopic thyroidectomy through chest-breast approach. Materials and Methods: Retrospective analysis on the conduction of 68 cases of endoscopic thyroidectomy through chest-breast approach with right side CLND (endoscopic group) and 31 cases of thyroidectomy through low-neck collar cervical approach with right side CLND (open group) from July 2014 to February 2019. The intraoperative and postoperative data were compared between the two groups. Results: All the surgeries in open group were successfully completed as well as the endoscopic group without any intraoperative conversion into open surgery. There were no difference in sizes of tumor, incidence of lymph node metastasis, number of dissected and metastatic lymph nodes, and postoperative hospitalization days between the two groups. Temporal hypoparathyroidism occurred in both groups with endoscopic group to be 24 cases and open group to be 15 cases but no case in both groups suffering from permanent hypoparathyroidism, recurrent laryngeal nerve injury, lymphatic leakage, or death. One case in endoscopic group was treated with secondary surgery for lateral cervical lymph node metastasis and no evidence of recurrence or metastasis was found in other cases during postoperative follow-up. Conclusions: With strict control in surgical indications and contraindications, endoscopic surgery is safe and feasible for selected cases with the same effect as open surgery on dissection of lymph nodes in the right central region, which is in line with the principle of radical treatment of tumors.

7.
Am J Transl Res ; 11(4): 2455-2462, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31105852

RESUMO

Circular RNAs (circRNAs) play an important regulatory role in a variety of human cancers, including gastric cancer. The mechanisms for the circRNAs in gastric cancers are not fully understood. This study aims to uncover the mechanism by which circRNAs regulate gastric cancer tumorigenesis. Among the microarray data, we screened dysregulated circRNAs and identified an up-regulated circRNA, hsa_circ_0008035. Functionally, the hsa_circ_0008035 silencing by the siRNA transfection inhibited the proliferation and invasion of gastric cancer cells. Mechanically, hsa_circ_0008035 acted as a sponge for the miR-375 and absorbed its expression, and miR-375 was found to target YBX1 3'-UTR, constructing a hsa_circ_0008035/miR-375/YBX1 axis. Taken together, these findings are evidence that circRNA hsa_circ_0008035 promotes gastric cancer cell proliferation and invasion by regulating miR-375/YBX1.

8.
Langmuir ; 35(16): 5617-5625, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-30942585

RESUMO

Nanostructures and nanomaterials based on peptide self-assembly have attracted tremendous interests due to the functionalities of peptide molecules. Furthermore, the self-assembled peptide nanostructures are also adopted to fabricate nanomaterials and nanodevices. In this work, the intramolecular folding and self-assembly of a ß-hairpin peptide CBHH were first studied under the regulation of platinum ion. And then, platinum nanostructures were synthesized through the reduction of platinum ions templated with peptide self-assemblies. The results of circular dichroism spectroscopy, UV-vis spectroscopy, isothermal titration calorimetry, and atomic force microscopy observation showed that platinum ions could promote the conversion of peptide CBHH secondary structure from a random coil to a ß-sheet through coordination with histidine residues. Platinum nanostructures including nanorods and one dimensionally aligned nanorods were synthesized through in situ reduction with CBHH self-assembled nanofiber as the templates. And the synthesized platinum nanostructures showed excellent electrocatalytic activities.

9.
Obes Surg ; 29(6): 1965-1975, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30903425

RESUMO

This study aimed to make a meta-analysis regarding mid-long-term outcomes (≥ 3-year follow-up) after sleeve gastrectomy (SG), focusing on incidence, reasons, and results of revisional surgery. PubMed, EMBASE, and CENTRAL were searched and 32 studies were included. The overall revision rate was 10.4%, but for patients with ≥ 10-year follow-up, the rate was 22.6%. European studies had a higher revision rate (14.4%) than other studies. The most common reason for revision was failure in weight loss, and the most frequent revisional procedure was gastric bypass. Revisional surgery was favorable for weight reduction and comorbidity resolution. In conclusion, revision rate is not rare after SG, especially when looking at long-term follow-up. Bariatric surgeons and patients need to fully understand and deal with the need for revision after SG.

10.
Surg Obes Relat Dis ; 14(10): 1521-1529, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30449509

RESUMO

BACKGROUND: Changes in gastrointestinal and pancreatic hormones may play a role in promoting long-term weight reduction and improved glucose metabolism after sleeve gastrectomy and Roux-en-Y gastric bypass. However, few studies have examined the metabolic and endocrine effects of these procedures in Mainland China. OBJECTIVES: To compare the effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on gastrointestinal and pancreatic peptide hormones. SETTING: University hospital, China. METHODS: A nonrandomized prospective study was conducted in Chinese obese patients undergoing LSG or LRYGB. Of 20 patients in this study, 10 underwent LSG, and 10 underwent LRYGB. Fasting plasma levels of insulin, glucagon, ghrelin, gastric inhibitory peptide, peptide YY, glucagon-like peptide (GLP)-1, and GLP-2 were measured preoperatively and at 1, 3, 6, and 12 months after surgery. This trial was registered at www.clinicaltrials.gov (NCT02963662). RESULTS: During the first year after both operations, mean body mass index and fasting insulin levels steadily decreased at all intervals. Fasting plasma glucose levels significantly decreased at 1 month after surgery, then remained stable in both groups. Glucagon levels significantly decreased at 1, 3, and 6 months after surgery in both groups, but returned to baseline at 12 months. Fasting GLP-1 and peptide YY significantly increased in both groups, but more so after LRYGB. However, GLP-2 did not change in either group. Ghrelin levels significantly decreased after LSG, but not after LRYGB. Gastric inhibitory peptide levels decreased after LRYGB but not after LSG. CONCLUSIONS: LSG and LRYGB resulted in significant and distinct changes in multiple gastrointestinal and pancreatic peptide hormones that are important regulators of obesity and metabolic health.


Assuntos
Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Hormônios Gastrointestinais/metabolismo , Laparoscopia/métodos , Hormônios Pancreáticos/metabolismo , Adulto , Biomarcadores/metabolismo , Glicemia/metabolismo , Índice de Massa Corporal , Jejum/sangue , Feminino , Derivação Gástrica/métodos , Glucagon/metabolismo , Humanos , Insulina/metabolismo , Masculino , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Estudos Prospectivos , Perda de Peso/fisiologia
11.
Surg Laparosc Endosc Percutan Tech ; 28(6): 380-384, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30222694

RESUMO

BACKGROUND: For selected patients, endoscopic thyroidectomy via the oral-vestibular approach (ETOVA) can be used to achieve a very good esthetic effect. This study aimed to assess the learning curve for ETOVA and identify improvements. PATIENTS AND METHODS: This retrospective study evaluated the outcomes of 101 patients who underwent ETOVA by surgeons A and B. The patients were classified according to whether they had undergone surgery during the primary or advanced stage of the learning curve, respectively. Proficiency with the procedure in various types of cases and the operation time, operative blood loss, hospital stay length, and postoperative complications were analyzed. RESULTS: In total, 56 and 45 patients were treated by surgeons A and B, respectively. For both surgeons, the operation times decreased considerably after 20 cases. Statistically significant differences with respect to stage were observed in terms of operation time (P<0.05) and drainage tube reservation (P<0.05). By contrast, significant differences were not observed between stages in terms of operative blood loss (P>0.05) or postoperative hospital stay length (P>0.05). The total postoperative complication rate was low and comparable with that of open surgery. CONCLUSIONS: The specific learning curve identified for ETOVA suggests that surgeons with sufficient endoscopic surgery experience could achieve a stable proficiency after ∼20 cases. A standardized training program and exposure to more cases would reduce the learning curve.


Assuntos
Competência Clínica/normas , Curva de Aprendizado , Cirurgia Endoscópica por Orifício Natural/normas , Cirurgiões/normas , Tireoidectomia/normas , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Cirurgia Endoscópica por Orifício Natural/educação , Cirurgia Endoscópica por Orifício Natural/métodos , Duração da Cirurgia , Estudos Retrospectivos , Cirurgiões/educação , Tireoidectomia/educação , Tireoidectomia/métodos
12.
Biomed Pharmacother ; 106: 618-623, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29990851

RESUMO

This study aims to determine the pharmacodynamics (PD) effect (measured by cardiovascular depression) of propofol during anesthesia induction period on morbidly obese (MO) patients. Four hemodynamics indexes [i.e., three indexes about blood pressure and cardiac output (CO)] representing cardiovascular function were measured. Pharmacokinetic/pharmacodynamic (PK/PD) modeling was performed by population analysis to obtain PD parameters. Two propofol dosing scalars, namely, dosing based on total body weight (TBW) or lean body weight (LBW), were used for MO subjects. The PD data were well described by a PK/PD model. Blood pressure and CO were rapidly decreased within one minute after intravenous injection of propofol (2 mg/kg). TBW group showed significantly lower blood pressure and CO values at and 1 min after propofol administration compared with the control group, whereas the control and LBW groups had similar PD profiles. In addition, the propofol EC50 value was significantly decreased in MO patients, whereas all other PD parameters were similar between control and MO subjects. This change indicated that propofol potency and/or sensitivity was increased in MO subjects. For MO patients, dosing of propofol based on LBW rather than TBW would be a safer choice due to a less cardiovascular depression effect.


Assuntos
Anestésicos Intravenosos/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Débito Cardíaco/efeitos dos fármacos , Cálculos da Dosagem de Medicamento , Modelos Biológicos , Obesidade Mórbida/fisiopatologia , Propofol/efeitos adversos , Adolescente , Adulto , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacocinética , Índice de Massa Corporal , Peso Corporal , Feminino , Gastrectomia/métodos , Humanos , Infusões Intravenosas , Laparoscopia , Masculino , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/cirurgia , Segurança do Paciente , Propofol/administração & dosagem , Propofol/farmacocinética , Medição de Risco , Fatores de Risco , Adulto Jovem
13.
Obes Surg ; 28(9): 2767-2773, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29707748

RESUMO

BACKGROUND: The prevalence of obesity and obesity-related disorders is rapidly increasing among the Chinese populations. Bariatric surgery is becoming more and more popular in China, yet little cases were performed compared with western countries. The acceptance of this new treatment modality in Chinese bariatric surgery candidates was seldom studied. OBJECTIVE: To investigate the factors affecting the choice of bariatric surgery in Chinese patients with obesity and metabolic disorders, so as to promote the popularization of bariatric surgery in developing countries like China METHODS: Patients with obesity and related metabolic disorders meet the indications for bariatric surgery in the Department of Metabolic and Bariatric Surgery in the First Affiliated Hospital of Jinan University between January 2016 and April 2017 were asked to answer a questionnaire about the demographics of the patients, social economic status, present and past history, family history, etc. The data collected and the relationship of the acceptance of bariatric surgery were analyzed. RESULTS: There were 157 patients (51 males, 32.5%; 106 females, 67.5%) with mean BMI 38.7 ± 8.1 kg/m2 answered the questionnaire. One hundred twenty-three of them (78%) accepted bariatric surgery. By univariate analysis, it was found that patients' weight, BMI, family support, medical insurance, past surgical history, family history of T2DM, and obesity-related comorbidities and symptoms are correlated with the acceptance of bariatric surgery. By multivariate analysis, it was found that patients' weight (P = 0.024), BMI (P = 0.007), family support (P < 0.001), medical insurance (P < 0.001), past surgical history (P = 0.011), family history of T2DM (P = 0.020), and obesity-related comorbidities and symptoms (P = 0.030) are statistically significant and were positively correlated with the acceptance of bariatric surgery. Age, height, gender, history of smoking and alcohol consumption, family history of obesity, history of hypertension and T2DM, education level, and marital status were not statistically significant (P < 0.05). CONCLUSIONS: Patients with heavier weight, higher BMI, family support, medical insurance reimbursement, past surgical history, family history of T2DM, and obesity-related comorbidities and symptoms are more likely to consider bariatric surgery in Chinese bariatric surgery candidates. It will be important to provide appropriate healthcare education and support to patients focusing on both obesity-related health risks and options of surgical treatment so to improve their acceptance of bariatric surgery.


Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Obesidade Mórbida , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , China/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Obesidade , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Prevalência , Fatores Socioeconômicos
14.
Obes Surg ; 28(9): 2727-2736, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29754386

RESUMO

BACKGROUND: Nutritional deficiencies have been reported in bariatric surgery patients with inconsistent results. However, scarce data exist for Chinese patients. We aimed to assess nutritional deficiencies in Chinese patients undergoing Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), and to identify predictors of postoperative nutritional status. METHODS: A retrospective review of a prospectively collected database was conducted in the patients undergoing RYGB and SG in our hospital between June 2013 and January 2017. Anthropometric data and nutritional data were collected before surgery, at 6 and 12 months postoperatively. RESULTS: This study enrolled 269 patients (120 RYGB, 149 SG). Nutritional deficiencies were common in Chinese bariatric candidates, with vitamin D deficiency the most serious (78.8%), followed by vitamin B1 (39.2%), vitamin B6 (28.0%), folate (26.8%), vitamin C (18.0%) albumin (13.4%), transferrin (11.6%), and phosphorus (11.5%). Despite postoperative routine multivitamin and calcium supplements, nutritional deficiencies were still obvious for RYGB and SG patients. The prevalence of hemoglobin and vitamin B12 deficiencies increased remarkably in the RYGB group; the levels of hemoglobin, globin, vitamin B12, and ferritin decreased significantly (P < 0.05). Preoperative hemoglobin, vitamin B12, and ferritin levels were independently associated with postoperative decrease, respectively. Deficiencies of vitamin D, vitamin B1, vitamin B6, vitamin C, and albumin before surgery were predictors for deficiencies 1 year after surgery, respectively. CONCLUSION: Nutritional deficiencies are common in Chinese bariatric surgery candidates. Similar deficiencies were also seen after RYGB and SG. Routine evaluation and related corrections of preoperative nutritional abnormity could contribute to postoperative nutrient balance.


Assuntos
Deficiência de Vitaminas , Gastrectomia/estatística & dados numéricos , Derivação Gástrica/estatística & dados numéricos , Obesidade , Deficiência de Vitaminas/complicações , Deficiência de Vitaminas/epidemiologia , China/epidemiologia , Humanos , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/cirurgia , Prevalência , Estudos Retrospectivos
15.
Surg Endosc ; 32(12): 4749-4756, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29761277

RESUMO

BACKGROUND: An analysis of some special factors was performed to further evaluate and discuss whether endoscopic surgery and traditional open surgery have similar therapeutic outcomes for differentiated thyroid cancer (DTC). METHODS: A retrospective study was performed on 76 patients undergoing surgery to treat DTC. Forty patients were treated by endoscopic thyroidectomy via the chest-breast approach (endoscopic group) and thirty-six patients were treated by open surgery (open group). Serum thyroglobulin (sTg), radioactive iodine uptake (RAIU), radioactive technetium uptake (RATU), radionuclide imaging of the thyroid residual area (RITRA), radionuclide imaging of suspicious lymph nodes metastasis (RISLNM), and other general indexes were analyzed and compared between the two groups. RESULTS: All surgeries were successfully completed in both groups. There were no significant differences between the two groups regarding gender (P = 0.120), postoperative hospital stay (P = 0.766), operation time (P = 0.065), intra-operative blood loss (P = 0.064), tumor diameter (P = 0.059), and overall complications (P = 0.828). Among these complications, there was no significant difference between the two approaches in transient hypoparathryoidism (P = 0.771), transient recurrent laryngeal injury (P = 0.474) and serious neck skin traction sensation (2.5 vs. 0%, P = 1.000). Age and body mass index were lower in the endoscopic group than the open group (P < 0.05). No significant difference was found in special factors between two groups concerning surgical range (P = 0.872), RAIU-2 h/24 h (P = 0.660/P = 0.955), RATU (P = 0.116), number of dissected lymph nodes (P = 0.157), sTg before radioiodine therapy (P = 0.188), sTg after radioiodine therapy (P = 0.159), RITRA at different time points (99mTc 15 min: P = 0.144; 131I 24 h: P = 0.243; 131I 72 h: P = 0.624) and RISLNM (none: P = 0.805; central: P = 0.744; lateral: P = 1.000; central + lateral: P = 0.958). CONCLUSION: Endoscopic total thyroidectomy and central lymph nodes dissection via a chest-breast approach are safe and effective. Through the detection of the postoperative special factors, a well-trained surgeon can achieve similar therapeutic results for selected patients with DTC, compared with open surgery.


Assuntos
Endoscopia , Esvaziamento Cervical , Complicações Pós-Operatórias , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adulto , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/efeitos adversos , Esvaziamento Cervical/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Cintilografia , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos
16.
Obes Surg ; 27(12): 3292-3305, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29039052

RESUMO

We aimed to make a meta-analysis regarding the effect of bariatric surgery on thyroid function in obese patients. PubMed, EMBASE, CENTRAL, and four Chinese databases were searched for clinical studies. Data were pooled using Review Manager 5.3, and subgroup and sensitivity analyses were performed if necessary and feasible. As a result, 24 articles were included into meta-analysis. Bariatric surgery was associated with significant decrease in TSH, FT3, and T3 levels. However, FT4, T4, and rT3 levels were not significantly changed postoperatively. In addition, bariatric surgery had a favorable effect on overt and subclinical hypothyroid, with reduction of thyroid hormone requirements postoperatively. In conclusion, TSH, FT3, and T3 decrease are expected following bariatric surgery, as well as non-significant change of T4, FT4, and rT3 levels.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Glândula Tireoide/fisiopatologia , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/estatística & dados numéricos , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/etiologia , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/fisiopatologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Testes de Função Tireóidea , Hormônios Tireóideos/sangue
17.
Surg Laparosc Endosc Percutan Tech ; 27(4): e66-e68, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28654507

RESUMO

BACKGROUND: Changes in thyroid function following bariatric surgery in euthyroid obese patients have yielded inconsistent results. Nevertheless, no data exist on changes in thyroid function after bariatric surgery in Chinese obese subjects. OBJECTIVES: The objective of this study is to evaluate the influence of weight reduction on thyroid function following laparoscopic sleeve gastrectomy (LSG) in patients with normal thyroid function. PATIENTS AND METHODS: Serum free thyroxine (FT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) levels were retrospectively analyzed before and 12 months after LSG in euthyroid patients with morbid obesity. Correlation between weight loss after LSG and changes in thyroid function were investigated. RESULTS: In total, 16 patients who underwent LSG were included in the study. Mean BMI change from 35.78 to 23.66 kg/m (P<0.000) after LSG was associated with a mean reduction in the TSH from 2.31 to 1.54 mU/L (P=0.022), whereas FT4 (15.19±0.33 pmol/L at baseline and 14.85±0.58 pmol/L at 12 mo after LSG; P=0.583) and FT3 (4.98±0.15 pmol/L at baseline and 4.77±0.60 pmol/L at 12 mo after surgery; P=0.406) levels remained steady. Decrease in TSH was significantly correlated with decrease in BMI at 12 months after surgery but did not correlate with excess weight loss and total weight loss. CONCLUSIONS: Weight loss after LSG is accompanied by significant decrease in serum TSH level but no change in serum FT4 and FT3 levels. However, further work is required to elucidate the mechanism.


Assuntos
Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Obesidade Mórbida/cirurgia , Glândula Tireoide/fisiologia , Adulto , Grupo com Ancestrais do Continente Asiático/etnologia , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/etnologia , Obesidade Mórbida/fisiopatologia , Estudos Retrospectivos , Tireotropina/metabolismo , Tiroxina/metabolismo , Tri-Iodotironina/metabolismo , Perda de Peso/fisiologia , Adulto Jovem
18.
Int J Surg ; 40: 52-59, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28235670

RESUMO

BACKGROUND: Despite experience with the use of endoscopic surgical technology, there is controversy over the role of endoscopic thyroidectomy (ET) for Graves' disease (GD). This study aimed to conduct a meta-analysis to evaluate the cosmetic and safety outcomes of ET versus conventional open thyroidectomy (OT) for GD with respect to short-term consequences. METHODS: We searched the following English language databases (Ovid MEDLINE, ISI Web of Science, and the Cochrane Library), and Chinese language databases (CNKI, CBMdisc, and SinoMed) between January 1996 and November 2015. The quality of the included studies was determined by the Newcastle-Ottawa Scale. A meta-analysis was conducted using RevMan 5.3 software. Pooled mean differences (MD) or odds ratios(OR) with I2 were calculated using either fixed or random-effect models. RESULTS: Six trials including 846 total cases were ultimately selected for meta-analysis. ET was associated with reduced blood loss (MD = -32.02; 95%CI: -36.92 to -27.12; P < 0.00001) and better cosmetic satisfaction (OR = 38.92; 95%CI: 17.40-87.06; P < 0.00001) than OT. However, OT was associated with reduced operation time (MD = 19.70; 95%CI: 2.04-37.35; P = 0.03) and lower hospital costs (MD = 303.21; 95%CI: 123.07, 483.36; P = 0.0010). Furthermore, ET and OT were not significantly different in terms of drainage volume, and they had an equivalent complication rate, including for transient recurrent laryngeal nerve palsy, transient hypocalcemia, postoperative hypothyroidism, and recurrent-hyperthyroidism. CONCLUSIONS: ET appeared to provide better cosmetic satisfaction and a reduction in blood loss, whereas OT had a shorter operation time and lower hospital costs. Randomized clinical trials with large samples that include long-term follow-up data are necessary to confirm our findings.


Assuntos
Endoscopia/métodos , Doença de Graves/cirurgia , Complicações Pós-Operatórias/etiologia , Tireoidectomia/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Glândula Tireoide/cirurgia , Resultado do Tratamento
19.
Surg Endosc ; 31(3): 1296-1304, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27422250

RESUMO

BACKGROUND: Reoperative thyroid surgery is associated with a higher morbidity and has traditionally been done in conventional open approach. This study aimed to evaluate the safety and effectiveness of endoscopic areola approach for reoperative thyroid surgery. METHODS: A retrospective study was conducted in 46 patients undergoing reoperative thyroid surgery with endoscopic areola approach (endoscopic group) and 70 patients with conventional open approach (open group). Perioperative and follow-up outcomes were compared between the two groups. RESULTS: Baseline characteristics were comparable between the two groups. Except for two cases of the endoscopic group intraoperatively converted to open surgery, all the other surgery was successfully completed. No significant difference was found between two groups concerning operation time, drainage volume, drainage time and postoperative hospital stay (all P > 0.05). Estimated blood loss was more in the open group than the endoscopic group (P = 0.000). Although not statistically significant, the overall complication rate was less in the endoscopic group than in the open group (21.7 vs. 37.1 %, P = 0.079). Of these complications, transient hypocalcemia was the most common (endoscopic group, 17.4 %; open group, 21.4 %; P = 0.594). One patient of the endoscopic group and 7 patients of the open group suffered from transient recurrent laryngeal nerve (RLN) paralysis (P = 0.210). Moreover, 2 patients of open group experienced permanent RLN paralysis. During the follow-up period (range 1-6 years), no recurrent case was encountered, but the endoscopic group had a higher cosmetic score (9.0 ± 0.9 vs. 5.9 ± 0.9, P = 0.000). CONCLUSION: In high-volume centers, with strict operation indication, sufficient preoperative evaluation and careful surgical maneuvers, endoscopic areola approach is a safe and effective method for reoperative thyroid surgery, allowing to provide a better cosmetic result and reduce intraoperative blood loss compared with open approach.


Assuntos
Endoscopia/métodos , Reoperação/métodos , Tireoidectomia/métodos , Adulto , Perda Sanguínea Cirúrgica , Estética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mamilos , Complicações Pós-Operatórias , Estudos Retrospectivos , Paralisia das Pregas Vocais/etiologia
20.
Tissue Eng Regen Med ; 14(3): 317-326, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30603488

RESUMO

Recurrent laryngeal nerve (RLN) injury can result in unilateral or bilateral vocal cords paralysis, thereby causing a series of complications, such as hoarseness and dyspnea. However, the repair of RLN remains a great challenge in current medicine. This study aimed to develop human umbilical mesenchymal stem cells (HuMSCs) and nerve growth factor (NGF)-loaded heparinized collagen scaffolds (HuMSCs/NGF HC-scaffolds) and evaluate their potential in the repair of RLN injury. HuMSCs/NGF HC-scaffolds were prepared through incorporating HuMSCs and NGF into heparinized collagen scaffolds that were prefabricated by freeze-drying in a template. The resulting scaffolds were characterized by FTIR, SEM, porosity, degradation in vitro, NGF release in vitro and bioactivity. A rabbit RLN injury model was constructed to appraise the performance of HuMSCs/NGF HC-scaffolds for nerve injury repair. Electrophysiology, histomorphology and diagnostic proteins expression for treated nerves were checked after application of various scaffolds. The results showed that the composite scaffolds with HuMSCs and NGF were rather helpful for the repair of broken RLN. The RLN treated with HuMSCs/NGF HC-scaffolds for 8 weeks produced a relatively normal electromyogram, and the levels of calcium-binding protein S100, neurofilament and AchE pertinent to nerve were found to be close to the normal ones but higher than those resulted from other scaffolds. Taken together, HuMSCs/NGF HC-scaffolds exhibited a high score on the nerve injury repair and may be valuable for the remedy of RLN injury.

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