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2.
J Clin Pathol ; 73(10): 618-623, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32591353

RESUMO

BACKGROUND: Bariatric surgical procedures are employed when there is a failure of lifestyle modification in arresting obesity. Laparoscopic sleeve gastrectomy (LSG) is quickly becoming the bariatric surgical procedure of choice. LSG results in a gastric remnant that is subject to pathological examination. The objective of this paper is to review the literature in regard to histological findings identified in gastric remnants post-LSG and identify the most pertinent histological findings. MATERIALS AND METHODS: A literature search was performed to identify relevant case series. Data gathered from relevant case series then underwent statistical analysis. RESULTS: The most common histological findings in an LSG specimen were clinically indolent findings such as no pathological abnormalities identified followed by non-specific gastritis. A minority of cases demonstrated clinically actionable findings for which Helicobacter pylori represented the majority of these findings. CONCLUSION: There is a broad spectrum of pathological findings in LSG specimens, ranging from clinically indolent to clinically actionable. The most common histological findings are clinically indolent and only a small portion are of clinical significance and, hence, actionable.


Assuntos
Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Estômago/patologia , Adulto , Cirurgia Bariátrica , Feminino , Gastrectomia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade
3.
Rev. bras. cir. plást ; 35(2): 249-253, apr.-jun. 2020. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1103841

RESUMO

Introdução: Atualmente com o aumento das gastroplastias redutoras (cirurgia bariátrica) e grande perda ponderal, há também um aumento na procura destes pacientes pela cirurgia plástica. Uma das características destes pacientes é o excesso de tecido dermogorduroso que causa deformidades, principalmente nos membros inferiores, acometendo a região trocantérica. Objetivo: Relatar um caso de dermolipectomia trocantérica em paciente pós-cirurgia bariátrica, onde a lipoaspiração por si só não resolveria a correção da deformidade. Relato de caso: IPMS, sexo feminino, 55 anos, histórico de gastroplastia redutora (cirurgia bariátrica) com grande perda ponderal. Relata desconforto importante com a lipodistrofia e extensa flacidez em região trocantérica bilateral. Após avaliação pela equipe, foi optado por realizar dermolipectomia trocantérica bilateral, em janeiro de 2019, no Serviço de Cirurgia Plástica Osvaldo Saldanha. Discussão: Nos casos de lipodistrofia trocantérica com deformidades graves, a cicatriz da dermolipectomia em relação à deformidade é favorável quanto a escolha desta técnica, pois a lipoaspiração poderá agravar ainda mais a deformidade, sendo mandatório utilizar a técnica de dermolipectomia trocantérica para corrigila. Quanto à lipodistrofia com deformidade moderada há dúvida entre a relação do benefício e a deformidade resultante, sendo aplicada a técnica de acordo com a necessidade do paciente e, por fim, nos casos de lipodistrofia com deformidade leve, opta-se pela lipoaspiração devido à correção ser realizada sem grandes cicatrizes aparentes. Conclusão: Portanto, a lipoaspiração tem benefício nos casos de adiposidade localizada, limitando as indicações da técnica de dermolipectomia, em especial na região trocantérica, sem invalidá-la para casos selecionados, como o descrito neste relato de caso.


Introduction: Currently, with the increase in reducing gastroplasty (bariatric surgery) and the great weight loss, there is also an increase in the demand of these patients for plastic surgery. One of the characteristics of these patients is the excess of dermal adipose tissue that causes deformities, especially in the lower limbs, affecting the trochanteric region. Objective: To report a case of trochanteric dermolipectomy in a patient after bariatric surgery, where liposuction alone would not solve the correction of the deformity. Case report: IPMS, female, 55 years old, history of reducing gastroplasty (bariatric surgery) with great weight loss. She reports significant discomfort with lipodystrophy and extensive flacidity in the bilateral trochanteric region. After the team's evaluation, it was decided to perform bilateral trochanteric dermolipectomy, in January 2019, at the Plastic Surgery Service Osvaldo Saldanha Discussion: In cases of trochanteric lipodystrophy with severe deformities, the scar of dermolipectomy in relation to the deformity is favorable in terms of the choice of this technique, since liposuction may further aggravate the deformity, and it is mandatory to use the trochanteric dermolipectomy technique to correct it. Conclusion: Therefore, liposuction is beneficial in cases of localized adiposity, limiting the indications for the dermolipectomy technique, especially in the trochanteric region, without invalidating it for selected cases, as described in this case report.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , História do Século XXI , Complicações Pós-Operatórias , Cirurgia Plástica , Obesidade Mórbida , Relatos de Casos , Cicatriz , Estudo de Avaliação , Extremidade Inferior , Cirurgia Bariátrica , Lipodistrofia/patologia , Complicações Pós-Operatórias/cirurgia , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/métodos , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Obesidade Mórbida/patologia , Cicatriz/cirurgia , Extremidade Inferior/cirurgia , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Lipodistrofia , Lipodistrofia/cirurgia , Lipodistrofia/complicações
4.
Sci Rep ; 10(1): 7393, 2020 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-32355175

RESUMO

Although bariatric surgery is proven to sustain weight loss in morbidly obese patients, long-term adverse effects have yet to be fully characterized. This study compared the long-term consequences of two common forms of bariatric surgery: one-anastomosis gastric bypass (OAGB) and Roux-en-Y Gastric Bypass (RYGB) in a preclinical rat model. We evaluated the influence of biliopancreatic limb (BPL) length, malabsorption, and bile acid (BA) reflux on esogastric mucosa. After 30 weeks of follow-up, Wistar rats operated on RYGB, OAGB with a short BPL (15 cm, OAGB-15), or a long BPL (35 cm, OAGB-35), and unoperated rats exhibit no cases of esogastric cancer, metaplasia, dysplasia, or Barrett's esophagus. Compared to RYGB, OAGB-35 rats presented higher rate of esophagitis, fundic gastritis and perianastomotic foveolar hyperplasia. OAGB-35 rats also revealed the greatest weight loss and malabsorption. On the contrary, BA concentrations were the highest in the residual gastric pouch of OAGB-15 rats. Yet, no association could be established between the esogastric lesions and malabsorption, weight loss, or gastric bile acid concentrations. In conclusion, RYGB results in a better long-term outcome than OAGB, as chronic signs of biliary reflux or reactional gastritis were reported post-OAGB even after reducing the BPL length in a preclinical rat model.


Assuntos
Refluxo Biliar , Mucosa Esofágica , Esofagite , Derivação Gástrica/efeitos adversos , Mucosa Gástrica , Modelos Biológicos , Obesidade Mórbida , Complicações Pós-Operatórias , Animais , Refluxo Biliar/etiologia , Refluxo Biliar/metabolismo , Refluxo Biliar/patologia , Refluxo Biliar/fisiopatologia , Doença Crônica , Mucosa Esofágica/metabolismo , Mucosa Esofágica/patologia , Mucosa Esofágica/fisiopatologia , Esofagite/etiologia , Esofagite/metabolismo , Esofagite/patologia , Esofagite/fisiopatologia , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patologia , Mucosa Gástrica/fisiopatologia , Hiperplasia/etiologia , Hiperplasia/metabolismo , Hiperplasia/patologia , Hiperplasia/fisiopatologia , Obesidade Mórbida/metabolismo , Obesidade Mórbida/patologia , Obesidade Mórbida/fisiopatologia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/metabolismo , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/fisiopatologia , Ratos , Ratos Wistar
5.
Sci Rep ; 10(1): 8496, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32444690

RESUMO

Non-alcoholic fatty liver disease (NAFLD) is a chronic disease with several degrees of histological features which may progress to cirrhosis. Obesity is an important risk factor and although NAFLD has no specific pharmacological treatment, bariatric surgery has been associated with NAFLD regression in severely obese patients. However, few longitudinal histological studies support this finding. Therefore, firstly, a retrospective study was performed including clinical and histological data of 895 obese patients who underwent bariatric surgery. In addition, histological analyses of 30 patient's liver biopsies were evaluated at two timepoints (T1 and T2). The retrospective analysis of the total number of patients revealed that the average body mass index (BMI) was 35.91 ± 2.81 kg/m2. The liver biopsies during bariatric surgery showed that 53.52% did not present NAFLD, 30.16% had NASH, 15.98% isolated steatosis and 0.34% liver cirrhosis. The median BMI of the longitudinal cohort decreased from 37.9 ± 2.21 kg/m2 at the time of bariatric surgery (T1) to 25.69 ± 3.79 kg/m2 after 21 ± 22 months after the procedure (T2). The prevalence of NAFLD in T1 was 50%, and 16.67% in T2. The histological area of collagen fiber was lower in T2 compared to T1 (p = 0.0152) in the majority of patients, which was also illustrated by immunohistochemistry for Kupffer cell and myofibroblast formation markers. These findings confirmed the NAFLD regression after bariatric surgery and, for the first time, showed the amelioration of these features using more accurate histopathological techniques.


Assuntos
Cirurgia Bariátrica/métodos , Fígado/metabolismo , Fígado/patologia , Hepatopatia Gordurosa não Alcoólica/cirurgia , Obesidade Mórbida/cirurgia , Adulto , Idoso , Biomarcadores , Brasil/epidemiologia , Colágeno/metabolismo , Estudos Transversais , Feminino , Seguimentos , Humanos , Testes de Função Hepática , Estudos Longitudinais , Macrófagos/metabolismo , Macrófagos/patologia , Masculino , Pessoa de Meia-Idade , Miofibroblastos/metabolismo , Miofibroblastos/patologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/patologia , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/patologia , Prevalência , Prognóstico , Estudos Retrospectivos
6.
Int J Mol Sci ; 21(3)2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32019174

RESUMO

The gut microbiota remains relatively stable during adulthood; however, certain intrinsic and environmental factors can lead to microbiota dysbiosis. Its restoration towards a healthy condition using best-suited prebiotics requires previous development of in vitro models for evaluating their functionality. Herein, we carried out fecal cultures with microbiota from healthy normal-weight and morbid obese adults. Cultures were supplemented with different inulin-type fructans (1-kestose, Actilight, P95, Synergy1 and Inulin) and a galactooligosaccharide. Their impact on the gut microbiota was assessed by monitoring gas production and evaluating changes in the microbiota composition (qPCR and 16S rRNA gene profiling) and metabolic activity (gas chromatography). Additionally, the effect on the bifidobacterial species was assessed (ITS-sequencing). Moreover, the functionality of the microbiota before and after prebiotic-modulation was determined in an in vitro model of interaction with an intestinal cell line. In general, 1-kestose was the compound showing the largest effects. The modulation with prebiotics led to significant increases in the Bacteroides group and Faecalibacterium in obese subjects, whereas in normal-weight individuals, substantial rises in Bifidobacterium and Faecalibacterium were appreciated. Notably, the results obtained showed differences in the responses among the tested compounds but also among the studied human populations, indicating the need for developing population-specific products.


Assuntos
Bactérias/crescimento & desenvolvimento , Fezes/microbiologia , Microbioma Gastrointestinal/fisiologia , Obesidade Mórbida/tratamento farmacológico , Prebióticos/administração & dosagem , Magreza/tratamento farmacológico , Adulto , Bactérias/efeitos dos fármacos , Estudos de Casos e Controles , Feminino , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Técnicas In Vitro , Masculino , Obesidade Mórbida/metabolismo , Obesidade Mórbida/patologia , Magreza/metabolismo , Magreza/patologia
7.
Biochim Biophys Acta Mol Basis Dis ; 1866(5): 165705, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32001301

RESUMO

The proteolytic cleavage of Fibronectin type III domain-containing 5 (FNDC5) generates soluble irisin. Initially described as being mainly produced in muscle during physical exercise, irisin mediates adipose tissue thermogenesis and also regulates carbohydrate and lipid metabolism. The aim of this study was to evaluate the hepatic expression of FNDC5 and its role in hepatocytes in Non-Alcoholic Fatty Liver (NAFL). Here we report that hepatic expression of FNDC5 increased with hepatic steatosis and liver injury without impacting the systemic level of irisin in mouse models of NAFLD (HFD and MCDD) and in obese patients. The increased Fndc5 expression in fatty liver resulted from its upregulation in hepatocytes and non-parenchymal cells in mice. The local production of Fndc5 in hepatocytes was influenced by genotoxic stress and p53-dependent pathways. The down-regulation of FNDC5 in human HepG2 cells and in primary mouse hepatocytes increased the expression of PEPCK, a key enzyme involved in gluconeogenesis associated with a decrease in the expression of master genes involved in the VLDL synthesis (CIDEB and APOB). These alterations in FNDC5-silenced cells resulted to increased steatosis and insulin resistance in response to oleic acid and N-acetyl glucosamine, respectively. The downregulation of Fndc5 also sensitized primary hepatocytes to apoptosis in response to TNFα, which has been associated with decreased hepatoprotective autophagic flux. In conclusion, our human and experimental data strongly suggest that the hepatic expression of FNDC5 increased with hepatic steatosis and its upregulation in hepatocytes could dampen the development of NAFLD by negatively regulating steatogenesis and hepatocyte death.


Assuntos
Fibronectinas/metabolismo , Fígado/patologia , Hepatopatia Gordurosa não Alcoólica/patologia , Obesidade Mórbida/complicações , Adulto , Apoptose , Cirurgia Bariátrica , Biópsia , Dieta Hiperlipídica/efeitos adversos , Feminino , Fibronectinas/sangue , Fibronectinas/genética , Perfilação da Expressão Gênica , Células Hep G2 , Hepatócitos/metabolismo , Humanos , Resistência à Insulina , Lipogênese , Fígado/citologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/etiologia , Obesidade Mórbida/sangue , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Fosfoenolpiruvato Carboxiquinase (ATP)/metabolismo , Cultura Primária de Células , Fatores de Proteção , Regulação para Cima
8.
Acta Diabetol ; 57(7): 819-826, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32086613

RESUMO

AIMS: Not all people with obesity become glucose intolerant, suggesting differential activation of cellular pathways. The unfolded protein response (UPR) may contribute to the development of insulin resistance in several organs, but its role in skeletal muscle remains debated. Therefore, we explored the UPR activation in muscle from non-diabetic glucose tolerant or intolerant patients with obesity and the impact of bariatric procedures. METHODS: Muscle biopsies from 22 normoglycemic (NG, blood glucose measured 120 min after an oral glucose tolerance test, G120 < 7.8 mM) and 22 glucose intolerant (GI, G120 between 7.8 and 11.1 mM) patients with obesity were used to measure UPR activation by RTqPCR and western blot. Then, UPR was studied in biopsies from 7 NG and 7 GI patients before and 1 year after bariatric surgery. RESULTS: Binding immunoglobulin protein (BIP) protein was ~ 40% higher in the GI compared to NG subjects. Contrastingly, expression of the UPR-related genes BIP, activating transcription factor 6 (ATF6) and unspliced X-box binding protein 1 (XBP1u) were significantly lower and C/EBP homologous protein (CHOP) tended to decrease (p = 0.08) in GI individuals. While BIP protein positively correlated with fasting blood glucose (r = 0.38, p = 0.01), ATF6 and CHOP were associated with G120 (r = - 0.38 and r = - 0.41, p < 0.05) and the Matsuda index (r = 0.37 and r = 0.38, p < 0.05). Bariatric surgery improved metabolic parameters, associated with higher CHOP expression in GI patients, while ATF6 tended to increase (p = 0.08). CONCLUSIONS: CHOP and ATF6 expression decreased in non-diabetic GI patients with obesity and was modified by bariatric surgery. These genes may contribute to glucose homeostasis in human skeletal muscle.


Assuntos
Cirurgia Bariátrica , Intolerância à Glucose/cirurgia , Músculo Esquelético/metabolismo , Obesidade Mórbida/cirurgia , Resposta a Proteínas não Dobradas , Fator 6 Ativador da Transcrição/genética , Fator 6 Ativador da Transcrição/metabolismo , Adulto , Biópsia , Glicemia/metabolismo , Estudos de Casos e Controles , Estudos de Coortes , Estresse do Retículo Endoplasmático/genética , Estresse do Retículo Endoplasmático/fisiologia , Feminino , Regulação da Expressão Gênica , Intolerância à Glucose/complicações , Intolerância à Glucose/metabolismo , Intolerância à Glucose/patologia , Teste de Tolerância a Glucose , Humanos , Resistência à Insulina/fisiologia , Masculino , Músculo Esquelético/patologia , Obesidade Mórbida/complicações , Obesidade Mórbida/metabolismo , Obesidade Mórbida/patologia , Fator de Transcrição CHOP/genética , Fator de Transcrição CHOP/metabolismo
9.
Obes Surg ; 30(1): 3-10, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31444776

RESUMO

BACKGROUND: Although the Roux-en-Y gastric bypass (RYGB) is considered a standard procedure, many variations exist in the basic design. In order to achieve more pronounced and sustainable results after RYGB, factors such as diameter of the gastroenterostomy, limb length, and pouch size are gripping points for improvement of design. Extending the pouch could improve results by altering food passage through the pouch. OBJECTIVE: The aim of this randomized controlled trial was to evaluate the effect of an extended pouch RYGB (EP-GB) and standard pouch RYGB (S-GB). METHODS: In total, 132 patients were randomized in two groups: 68 patients received an EP-GB (pouch length 10 cm) and 64 a S-GB (pouch length 5 cm). Subsequently, weight loss, remission of comorbidities, nutritional status, complications, quality of life, and GERD-symptoms were assessed during a follow-up of 3 years. RESULTS: During the first 2 years of follow-up, no significant differences in terms of weight loss were observed. In the third year of follow-up, the S-GB group regained 3 kg, while in the EP-GB group no weight regain was observed. The mean TBWL after 36 months in the EP-GB group was 31% versus 27% in the S-GB group (p = 0.023). Additionally, besides a better remission rate of hypertension in the EP-GB group, no differences in complications, quality of life, and GERD-symptoms were found. CONCLUSION: Creation of an extended gastric pouch is a safe and effective modification in RYGB design. An EP-GB improves mid-term weight loss, potentially driven by a lower occurrence of weight regain.


Assuntos
Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Parede Abdominal/cirurgia , Adulto , Feminino , Seguimentos , Derivação Gástrica/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Obesidade Mórbida/patologia , Qualidade de Vida , Estômago/cirurgia , Resultado do Tratamento , Ganho de Peso , Perda de Peso/fisiologia
10.
Obes Surg ; 30(1): 69-76, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31446562

RESUMO

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is prevalent in children with obesity and is definitively diagnosed with liver biopsy. However, the utility of routine biopsy during adolescent bariatric surgery remains unknown. We describe the usefulness of routine versus selective intraoperative liver biopsy in adolescents undergoing bariatric surgery. METHODS: A retrospective review of adolescents who received bariatric surgery at our institution between 2007 and 2018 was performed. Prior to 2014, all patients routinely received intraoperative liver biopsy. After 2014, biopsy was performed selectively on an individual basis for transaminitis or clinical concern. Demographic, biochemical, and histopathologic data were compared between patients who underwent routine, selective, or no biopsy. RESULTS: There were 77 patients who received bariatric surgery during the study period: 32 underwent routine biopsy, 13 selective biopsy, and 32 no biopsy. Selective liver biopsy was more likely to show pathologic evidence of fibrosis (84.6% versus 31.2%, p = 0.000) and steatosis (100.0% versus 59.4%, p = 0.003), and higher mean NAFLD activity score compared with routine biopsies (4.4 versus 2.1, p = 0.001). Patients with steatosis had significantly higher preoperative fasting insulin (41.4 versus 21.1 mIU/L, p = 0.000), and patients with fibrosis had significantly higher glycated hemoglobin (6.1% versus 5.5%, p = 0.033) and alanine aminotransferase (81.5 versus 52.7 mg/dL, p = 0.043). There were no biopsy complications or changes in management due to biopsy results. CONCLUSIONS: Routine intraoperative liver biopsy during adolescent bariatric surgery possesses questionable benefit, as it does not appear to impact short-term postoperative management. Prospective, longitudinal studies are needed to better understand the meaningfulness of liver histopathology in this population.


Assuntos
Cirurgia Bariátrica , Fígado/patologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Obesidade Mórbida/cirurgia , Obesidade Pediátrica/cirurgia , Adolescente , Cirurgia Bariátrica/métodos , Biópsia , Estudos de Coortes , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Período Intraoperatório , Masculino , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/patologia , Obesidade Mórbida/complicações , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/patologia , Seleção de Pacientes , Obesidade Pediátrica/complicações , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/patologia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos
11.
Obes Surg ; 30(1): 313-318, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31482482

RESUMO

BACKGROUND: Asymptomatic liver disease is common in bariatric patients and can be diagnosed with intraoperative biopsy. This study aimed to establish the risk-benefit profile of routine liver biopsy, prevalence of clinically significant liver disease, relationship between liver pathology and body mass index, and compare outcomes between ethnic groups. METHODS: This retrospective cohort study included all patients who had index bariatric surgery at Auckland City Hospital between 2009 and 2016. Diagnosis of liver disease was based on intraoperative biopsy histology. Outcomes included safety (biopsy-related complication) and utility (liver pathology meeting criteria for referral). Liver pathology and referral rates were compared between ethnic groups. RESULTS: Of 335 bariatric surgery patients, 234 (70%) underwent intraoperative liver biopsy. There were no biopsy-related complications. Histological findings were as follows: normal 25/234 (11%), non-alcoholic fatty liver disease (NAFLD) 207/234 (88%), and other pathological findings in 35/234 (15%). Histological finding meeting referral criteria was present in 22/234 (9%). Of these, 12/22 (55%) were referred. Number needed to biopsy to identify histology meeting referral criteria: n = 11. Maori had a similar NAFLD rate to non-Maori [51/56 versus 156/178, p = 0.48]. Pasifika patients had a higher rate than non-Pasifika [39/40 versus 168/194, p = 0.049]. Maori and Pasifika patients had similar referral rates to non-Maori and non-Pasifika [2/3 versus 5/9, p = 0.73; 2/2 versus 5/10, p = 0.19]. CONCLUSIONS: Intraoperative liver biopsy during bariatric surgery is safe and identified liver disease in 89%, with 9% meeting referral criteria. Pasifika patients have a higher rate of NAFLD than non-Pasifika.


Assuntos
Cirurgia Bariátrica , Fígado/patologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Adulto , Idoso , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Biópsia/efeitos adversos , Biópsia/métodos , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade Mórbida/complicações , Obesidade Mórbida/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
12.
Obes Surg ; 30(1): 327-335, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31602628

RESUMO

OBJECTIVE: Roux-en-Y gastric bypass (RYGB) could affect immunological activity after surgery. We examined the role of RYGB on the NOD-like receptor pyrin domain containing-6 (NLRP6) in the intestine after surgery in rat models. METHODS: Expression of intestinal NLRP6 in the lean, obesity, RYGB, and sham-pair fed (PF) groups was analyzed by quantitative RT-PCR, Western blotting, and immunohistochemistry. Gut microbiota abundance was determined by 16S rRNA sequencing. Cohousing experiments were conducted to analyze the effects of gut microbiota. Inflammatory cell infiltration and gut permeability were further validated. RESULTS: Obese rats had decreased intestinal NLRP6 levels, which could be restored by RYGB but not by calorie restriction. This regulation was dependent on the gut microbiota-related metabolites, taurine, and histamine. After RYGB, there were increased levels of taurine, which could positively affect NLRP6 expression. The pair-fed groups showed increased histamine, which had the opposite effects on NLRP6. Obese rats had greater intestinal permeability along with increased CD8+ T cell infiltration. However, RYGB but not calorie restriction could restore these changes in a manner, dependent on gut NLRP6 expression. CONCLUSIONS: In rat models, RYGB could efficiently restore abnormal gut permeability and reduce inflammation in the intestine, depending on reactivation of NLRP6.


Assuntos
Derivação Gástrica , Inflamassomos/metabolismo , Mucosa Intestinal/metabolismo , Intestinos/imunologia , Obesidade Mórbida/cirurgia , Receptores de Angiotensina/metabolismo , Receptores de Vasopressinas/metabolismo , Animais , Derivação Gástrica/métodos , Microbioma Gastrointestinal/imunologia , Homeostase/fisiologia , Mucosa Intestinal/patologia , Intestinos/patologia , Intestinos/cirurgia , Masculino , Obesidade Mórbida/imunologia , Obesidade Mórbida/metabolismo , Obesidade Mórbida/patologia , Período Pós-Operatório , RNA Ribossômico 16S , Ratos , Ratos Sprague-Dawley , Regulação para Cima
13.
Sci Rep ; 9(1): 14678, 2019 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604985

RESUMO

Neutrophil extracellular traps (NETs) are DNAs products involved in immune process. Obesity through a low-grade chronic inflammation determines neutrophil activation, but it is still unclear its role in NETs formation. Here we analyzed the NETs levels in healthy and morbid obese, their association with anthropometric and glyco-metabolic parameters and their changes after bariatric surgery. For this study, we enrolled 73 patients with morbid obesity (BMI ≥40 kg/m2 or ≥35 kg/m2 + comorbidity) eligible to sleeve gastrectomy. In parallel, 55 healthy subjects and 21 patients with severe coronary artery disease were studied as controls. We evaluated anthropometric parameters, peripheral blood pressure, biochemical and serum analysis at the enrollment and at twelve months after surgery. Plasmatic levels of MPO-DNA complexes were assessed by ELISA. NETs levels were higher in obese than in control group (p < 0.001) and correlated with the main anthropometric variable (BMI, waist, hip), glyco-metabolic variables and systolic blood pressure. NETs trend after intervention was uneven. The reduction of NETs correlated with the entity of reduction of BMI (ρ = 0.416, p < 0.05), visceral fat area (ρ = 0.351, p < 0.05), and glycemia (ρ = 0.495, p < 0.001). In medical history of patients in whom NETs increased, we observed a higher number of thromboembolic events. Our observations indicate that severe obesity is associated with increased generation of NETs, which in turn could influence the patients' systemic inflammatory state. Weight loss and in particular, loss of adipose tissue after bariatric surgery does not in itself correct NET's dysregulated production. Finally, patients in whom NETs accumulation persists after surgery are probably those at the highest risk of cardiovascular events.


Assuntos
Armadilhas Extracelulares/metabolismo , Gordura Intra-Abdominal/metabolismo , Obesidade Mórbida/sangue , Perda de Peso , Adulto , Idoso , Antropometria , Cirurgia Bariátrica , Glicemia , Pressão Sanguínea/fisiologia , Feminino , Humanos , Gordura Intra-Abdominal/fisiopatologia , Gordura Intra-Abdominal/cirurgia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia
14.
Curr Psychiatry Rep ; 21(9): 86, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31410596

RESUMO

PURPOSE OF REVIEW: The goal of this paper was to extend the prior literature on eating pathology following bariatric surgery by highlighting themes in data published over the past 3 years and identifying limitations and future directions for research. RECENT FINDINGS: Changes in eating pathology after bariatric surgery remain consistent with previous research. Specifically, diagnostic prevalence rates and incidence of related behaviors generally decrease following surgery. However, some research supports that these factors increase and/or remit over time following surgery, and that they subsequently have a negative impact on weight loss outcomes. While recent findings have extended knowledge on eating pathology following bariatric surgery, the overall body of literature is still relatively limited. Additional research is needed, including work focusing on the standardization of eating pathology definitions, development/validation of standardized eating pathology instruments for bariatric surgery patients, and predictors of risk for continued or new onset eating pathology following surgery.


Assuntos
Cirurgia Bariátrica , Comportamento Alimentar , Obesidade Mórbida/fisiopatologia , Obesidade Mórbida/cirurgia , Humanos , Obesidade Mórbida/patologia , Resultado do Tratamento , Perda de Peso
15.
J Clin Endocrinol Metab ; 104(12): 6171-6181, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31408176

RESUMO

OBJECTIVE: Nonalcoholic fatty liver disease can lead to hepatic inflammation/damage. Understanding the physiological mechanisms that contribute to excess hepatic lipid accumulation may help identify effective treatments. DESIGN: We recruited 25 nondiabetic patients with severe obesity scheduled for bariatric surgery. To evaluate liver export of triglyceride fatty acids, we measured very-low-density lipoprotein (VLDL)-triglyceride secretion rates the day prior to surgery using an infusion of autologous [1-14C]triolein-labeled VLDL particles. Ketone body response to fasting and intrahepatic long-chain acylcarnitine concentrations were used as indices of hepatic fatty acid oxidation. We measured intraoperative hepatic uptake rates of plasma free fatty acids using a continuous infusion of [U-13C]palmitate, combined with a bolus dose of [9,10-3H]palmitate and carefully timed liver biopsies. Total intrahepatic lipids were measured in liver biopsy samples to determine fatty liver status. The hepatic concentrations and enrichment from [U-13C]palmitate in diacylglycerols, sphingolipids, and acyl-carnitines were measured using liquid chromatography/tandem mass spectrometry. RESULTS: Among study participants with fatty liver disease, intrahepatic lipid was negatively correlated with VLDL-triglyceride secretion rates (r = -0.92, P = 0.01) but unrelated to hepatic free fatty acid uptake or indices of hepatic fatty acid oxidation. VLDL-triglyceride secretion rates were positively correlated with hepatic concentrations of saturated diacylglycerol (r = 0.46, P = 0.02) and sphingosine-1-phosphate (r = 0.44, P = 0.03). CONCLUSION: We conclude that in nondiabetic humans with severe obesity, excess intrahepatic lipid is associated with limited export of triglyceride in VLDL particles rather than increased uptake of systemic free fatty acids.


Assuntos
Ácidos Graxos/metabolismo , Metabolismo dos Lipídeos , Fígado/metabolismo , Obesidade Mórbida/metabolismo , Adolescente , Adulto , Cirurgia Bariátrica , Ácidos Graxos não Esterificados/sangue , Feminino , Humanos , Lipoproteínas VLDL/sangue , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/etiologia , Hepatopatia Gordurosa não Alcoólica/metabolismo , Obesidade Mórbida/complicações , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Esfingolipídeos/metabolismo , Triglicerídeos/sangue , Adulto Jovem
16.
Indian J Med Res ; 149(4): 544-547, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31411179

RESUMO

Background & objectives: Ghrelin is an orexigenic gut hormone expressed by the gastric fundus. Laparoscopic sleeve gastrectomy (LSG) procedure involves resection of the gastric fundus leading to a decreased appetite and weight loss. This study was undertaken to determine the levels of plasma ghrelin after sleeve gastrectomy in obese patients. Methods: The study was conducted on 90 morbidly obese patients [body mass index (BMI) >40 kg/m[2]] and severely obese patients (BMI >35/kg/m[2]) who underwent sleeve gastrectomy. The patients were followed up for six months. Weight loss parameters and plasma ghrelin levels were assessed pre- and postoperatively. Results: A significant weight loss and decrease in BMI were observed at three and six months postoperatively. A significant decrease in plasma ghrelin levels over six months of follow up postoperatively was also seen. Interpretation & conclusions: These preliminary findings indicated inhibition of ghrelin production after LSG leading to a decrease in the plasma ghrelin levels within a few days of surgery and sustainable weight loss in obese patients.


Assuntos
Biomarcadores/sangue , Grelina/sangue , Obesidade Mórbida/sangue , Perda de Peso , Adulto , Idoso , Índice de Massa Corporal , Feminino , Gastrectomia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Período Pós-Operatório
17.
Gynecol Oncol ; 155(1): 27-33, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31349997

RESUMO

OBJECTIVE: To assess risk factors for lymph node involvement in patients with endometrial cancer and a body-mass index (BMI) ≥30 kg/m2. MATERIALS AND METHODS: A retrospective analysis was performed of obese patients diagnosed with endometrial carcinoma between 2007 and 2015, treated in a single center in Montreal. Preoperative variables evaluated were age, BMI, parity, and preoperative ASA score, grade, CA-125 and histology. Odds ratios (OR) and hazard ratios (HR) and their respective 95% confidence intervals (95%CI) were calculated using multivariable logistic regression and Cox proportional hazard models. RESULTS: The study included 230 women with BMI ≥30, 223 (97.0%) had complete staging. Pelvic lymph node involvement was detected in 26 patients (11.3%). Sentinel node detection and pelvic lymph node dissection decreased with increasing BMI (adjusted OR 0.86, 95%CI 0.76-0.97 and 0.76, 95%CI 0.59-0.96, respectively, per 1 kg/m2 increment). Pelvic lymph node involvement was inversely correlated with BMI (adjusted OR 0.88, 95%CI 0.79-0.99) and present in 16/85 (18.8%), 6/56 (10.7%), and 4/82 (4.9%) of patients with a BMI of 30.0-34.9, 35.0-39.9, and ≥40.0 kg/m2, respectively. Preoperative CA-125 was associated with lymph node involvement (adjusted OR 2.77, 95%CI 1.62-4.73, per quartile increment). CONCLUSION: Pelvic lymph node dissection might be omitted in selected cases of morbidly obese patients with failed sentinel nodes mapping and a low CA-125.


Assuntos
Neoplasias do Endométrio/patologia , Linfonodos/patologia , Obesidade Mórbida/patologia , Idoso , Índice de Massa Corporal , Antígeno Ca-125/metabolismo , Neoplasias do Endométrio/metabolismo , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/metabolismo , Linfonodos/cirurgia , Metástase Linfática , Proteínas de Membrana/metabolismo , Pessoa de Meia-Idade , Obesidade Mórbida/metabolismo , Estudos Retrospectivos , Fatores de Risco
18.
Obes Surg ; 29(12): 3786-3790, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31290111

RESUMO

INTRODUCTION: Indocyanine green (ICG) fluorescent angiography has been routinely applied for various laparoscopic procedures to evaluate the tissue blood supply. A promising branch for this technology is represented by bariatric surgery, especially to estimate the risk of gastric leak after laparoscopic sleeve gastrectomy (LSG), which seems mainly related to ischemia of the stomach. MATERIALS AND METHODS: 43 consecutive patients from January 2018 to March 2019 underwent in our institution LSG with intravenous injection of 5 ml ICG after the realization of gastric tube to evaluate the blood supply of the gastric tube. RESULTS: In all 43 cases, there have been no adverse events related to ICG. The vascular supply to stomach was estimated "satisfactory" along the stapled line in all cases. However, one patient showed signs and symptoms indicative of gastric leak in the fifth post-op day and diagnosis was confirmed by CT scan with Gastrografin. CONCLUSIONS: From our preliminary data, the intraoperative view of the blood supply of the stomach does not seem to represent a prognostic factor for the risk of gastric leak, suggesting a complex multifactorial etiology (intragastric hypertension? Abnormal inflammatory response?) which needs further data to be established.


Assuntos
Fístula Anastomótica/diagnóstico , Angiofluoresceinografia/métodos , Gastrectomia/métodos , Verde de Indocianina/farmacologia , Obesidade Mórbida/cirurgia , Adulto , Fístula Anastomótica/etiologia , Fístula Anastomótica/terapia , Angiografia/métodos , Corantes/farmacologia , Feminino , Gastrectomia/efeitos adversos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Itália , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Dados Preliminares , Estômago/efeitos dos fármacos , Estômago/patologia , Estômago/cirurgia , Tomografia Computadorizada por Raios X
19.
Obes Surg ; 29(11): 3508-3513, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31175557

RESUMO

OBJECTIVE: Some patients fail to maintain weight loss after bariatric surgery. Weight regain (WR) disturbs the patients due to possible reappearance of obesity-related comorbidities. This study aimed to assess WR 5 years after laparoscopic sleeve gastrectomy (LSG). PATIENTS AND METHODS: This retrospective study included 100 adults who underwent LGS. The percentage of excess weight loss (%EWL) was recorded. WR was defined as an increase of at least 10% of the lowest postoperative weight. Patients with WR were subjected to CT gastric volumety. Eating behavior was assessed by the Three-Factor Eating Questionnaire-Revised 18-Items (TFEQ-R18). RESULTS: Preoperative comorbidities improved in 89.5% of the patients. Twenty-five females (32.5%) got pregnant within 3 years after surgery. Age, maximum weight loss, and uncontrolled and emotional eating scales of the TFEQ-R18 were independently affecting %EWL. Also, pregnancy negatively affected %EWL. Fourteen patients regain weight: 11 females and three males. CT volumetry of the 14 patients showed a median stomach volume of 515 mL (range 172-1066 mL). CT estimated gastric volume was negatively correlated with % EWL (r = - 0.674, p = 0.008). Patients who developed WR were significantly older (p = 0.006), with lower maximum weight loss, and having higher scores of uncontrolled and emotional eating scales of TFEQ-R18. CONCLUSION: Medium-term postsurgical weight regain and unsuccessful weight loss in patients who had undergone LSG is associated with older age, maladaptive eating behavior, larger residual stomach, and pregnancy.


Assuntos
Gastrectomia/efeitos adversos , Obesidade Mórbida/cirurgia , Ganho de Peso/fisiologia , Adulto , Índice de Massa Corporal , Comportamento Alimentar/fisiologia , Feminino , Seguimentos , Gastrectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Período Pós-Operatório , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Perda de Peso/fisiologia , Adulto Jovem
20.
Obes Surg ; 29(11): 3560-3568, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31187460

RESUMO

BACKGROUND: The staple line leakage is a dangerous complication of sleeve gastrectomy. Various strategies have been tried to reduce the leakage risk. The amniotic membrane (AmM) is the inner layer of the placental membranes and has anti-inflammatory, anti-fibrosis, and anti-scarring effects, and it also has lower immune characteristics which are another essential characteristic of AmM concerning its utility for grafting. In this study, we aimed to investigate the impact of AmM on the staple line healing process of sleeve gastrectomy model in rats. MATERIALS AND METHODS: We used twenty-eight Long-Evans rats in this study. Sleeve gastrectomy was performed with tristapler. Fourteen rats served as controls, AmM was applied staple line of the other fourteen. Fourteen animals were sacrificed (seven from the AmM applied group and the other seven from the control group) on the third postoperative day. And, the other fourteen animals were sacrificed (seven from the AmM applied group and seven from the control group) on the seventh postoperative day. The tissue around the staple line was evaluated microscopically and macroscopically, bursting pressures and hydroxyproline levels were also measured. RESULTS: The bursting pressure and hydroxyproline measurements of the AmM applied group was significantly higher on the seventh postoperative day (p = 0.015, p = 0.012) Fibroblast activity and neoangiogenesis of the AmM applied group was also significantly higher on the seventh postoperative day (p = 0.004, p = 0.002). CONCLUSION: This study showed that covering of staple line of sleeve gastrectomy model in rats significantly provided higher bursting pressures and increased hydroxyproline levels, fibroblast activity, and neoangiogenesis which may potentially lead a better staple line healing. We think further investigations are needed on this issue.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Âmnio/fisiologia , Anastomose Cirúrgica/métodos , Gastrectomia/métodos , Obesidade Mórbida/cirurgia , Grampeamento Cirúrgico , Cicatrização/fisiologia , Adulto , Âmnio/transplante , Fístula Anastomótica/prevenção & controle , Animais , Feminino , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Obesidade Mórbida/patologia , Período Pós-Operatório , Gravidez , Ratos , Ratos Long-Evans , Grampeamento Cirúrgico/efeitos adversos , Suturas
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