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Background: This study aimed to evaluate the 3-year outcomes of sleeve gastrectomy in non-diabetic individuals with class I obesity. Methods: A total of 78 participants with class I obesity and 78 participants with class II obesity, matched in terms of age, sex (93.6% female), and the rates of dyslipidemia and hypertension, were included in this prospective cohort study. Follow-up data, including metabolic features, body composition, nutritional characteristics, and surgery complications, were gathered at the baseline and 6, 12, 24, and 36 months post-bariatric surgery. Micronutrient deficiencies and comorbidities (hypertension and dyslipidemia) were evaluated in both groups using conditional logistic regression analysis, and Clavien–Dindo classification was used to compare surgical complications. Results: Baseline characteristics of the participants in both groups were similar (n = 78, mean age: 36.4 ± 8.5). The two groups were also comparable in terms of weight loss, cardiovascular risk factors, and remission of obesity-related comorbidities 3 years following sleeve gastrectomy. Overall values of Δ total weight loss (TWL)%, Δ excess weight loss (EWL)%, and β (95% CI) were − 1.86 (1.19), and − 2.56 (4.5) with a P value of 0.118 and 0.568, respectively. The occurrence of surgical complications and undesirable outcomes were also similar between the two study groups. Conclusion: Bariatric surgery is an effective and safe method to achieve weight loss and alleviate cardiovascular risk factors and obesity-related comorbidities in non-diabetic individuals with class I and class II obesity. [ABSTRACT FROM AUTHOR]

Surgical resection with curative intent is still a central therapeutic option for resectable esophageal cancer. Thoracoscopicesophagectomy in a prone position would give each benefit of the lateral position. The present research aimed to analyze the short-term outcomes of thoracoscopicesophagectomy in the prone position. This was a retrospective cross-sectional study. Patients who underwent thoracoscopicesophagectomy in the prone position at Tehran University Cancer institute from January 2017 to December 2018 entered the study. The esophagus was mobilized through the thoracoscopic approach in a prone position. The stomach was released using a laparoscopic approach for the gastric pull-up. Finally, an end-to-end hand-sewn cervical anastomosis was performed. Three, four, seven, one, and one patient suffered from pneumonia, leakage, tracheal tearing, chylothorax, and pneumothorax, respectively, after the operation. In 91.5% of patients, more than ten lymph nodes were resected. Sixty percent of patients were discharged from the hospital earlier than one week. Laparoscopicesophagectomy in the prone position is a feasible alternative. Better exposure and fewer complications were reported. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed at assessing nutrient adequacy after 1 year in patients who had undergone gastric bypass (GB) surgery or sleeve gastrectomy (SG) and to investigate the association of nutrient adequacy with anthropometric indices. Methods: A total of 180 severely obese patients (BMI ≥ 35 kg/m2) were selected among the participants of Tehran Obesity Treatment Study. Nutritional assessments were performed over 3 days of 24-h dietary recall. To evaluate the nutrient adequacy ratio (NAR), the subject's nutrient intake was divided by the dietary reference intakes. The mean adequacy ratio (MAR) was also determined as the sum of NARs divided by the number of involved nutrients (n = 11). Results: The mean age of SG (67%) and GB (32%) patients was 39.2 ± 12 and 41.4 ± 10 years, respectively. SG patients had more postoperative fat-free mass (52.0 ± 12 kg) than GB patients (49.7 ± 8 kg) (P < 0.05). The most common postoperative serum nutrient deficiencies were related to vitamin B12 (30%), ferritin (19%), and 25-hydroxyvitamin D (16.2%). Moreover, high inadequacy of protein (> 80%) and total fat (> 70%) intake was reported. The MAR score showed that almost 45% of the patients had possibly adequate intakes of some nutrients. The adequacy of nutrients was positively associated with fat-free mass (β = 8.67, P < 0.05). Conclusion: These findings revealed that patients had inadequate nutrient intakes 1 year after bariatric surgery, which was accompanied by serum nutritional deficiencies. Compared to GB patients, SG patients had a better body composition. Overall, compliance of patients with dietary guidelines and supplementations needs to be carefully monitored in the postoperative period. [ABSTRACT FROM AUTHOR]

Purpose: Knowledge is limited about the efficacy, safety, and long-term outcomes of bariatric surgery in older adult patients with obesity. Methods: Fifty-six patients aged ≥ 60 years who underwent bariatric surgery, as either sleeve gastrectomy or gastric bypass, were matched for sex, baseline body mass index (BMI) and surgery type, with 112 younger controls, aged 18–60 years. We compared complications, weight loss, resolution of co-morbidities, and changes in body composition status (fat mass [FM], fat-free mass [FFM], lean mass [LM] and percentage of fat mass [FM%]) 12 months postoperatively between the groups. Results: Complications were similar in the two groups. Diabetes mellitus (DM) and dyslipidemia showed similar remission and improvement rates postoperatively in the two groups. Remission from hypertension (HTN) was higher in the control group, but improvement rates were similar. Changes from baseline to 12 months postoperatively in weight, BMI, excess weight loss (EWL%), total weight loss (TWL%), FFM, and LM were greater in the control group than in the older-age group. Changes in FM and FM% were similar in the two groups. Conclusion: Bariatric surgery is a safe intervention for the management of obesity and obesity-related co-morbidities in older adults, with similar surgery-risk and complication rates to those of younger adults. Reduction in FM and FM% was equal in two groups and the concern about greater LM loss in older adults seems unfounded. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the rates and predictors of remission and relapse of type 2 diabetes mellitus (T2DM) in individuals with T2DM undergoing sleeve gastrectomy (SG) or one‐anastomosis gastric bypass (OAGB). Methods: An observational prospective study with 5 years of follow‐up was conducted in a total of 891 patients (82.5% female) with concomitant T2DM and obesity (body mass index ≥ 30.0 kg/m2) undergoing SG or OAGB between March 2013 and March 2021. T2DM remission was defined as achieving a glycated haemoglobin (HbA1c) level < 48 mmol/mol and a fasting plasma glucose (FPG) level <7 mmol/L, and being off glucose‐lowering agents/insulin. T2DM relapse was defined as when FPG or HbA1c reverted to the diabetic range (≥7 mmol/L and ≥48 mmol/mol, respectively), or there was a need for pharmacotherapy. Results: After bariatric surgery, the overall T2DM remission and relapse rates were 61.4 per 1000 person‐months (95% confidence interval [CI] 56.8–66.4) and 5.7 per 1000 person‐months (95% CI 4.1–7.9), respectively. These rates were similar in the SG and OAGB groups. Multivariate hazard ratio analysis identified history of insulin therapy and T2DM duration prior to surgery as predictors of remission, while treatment with ≥2 glucose‐lowering agents was the only relapse predictor. Additionally, patients undergoing SG experienced either remission or relapse within a significantly shorter time frame compared to those undergoing OAGB. Conclusion: After 5 years of follow‐up, there were no significant differences between the SG and OAGB groups with regard to T2DM remission and relapse. Bariatric surgery was less likely to result in remission in patients with a history of insulin therapy and longer durations of T2DM prior to surgery. Furthermore, patients who received ≥2 glucose‐lowering agents, despite possible remission, were at a higher risk of experiencing late relapse. [ABSTRACT FROM AUTHOR]

Background: Preventing unintended pregnancy is an important issue for women undergoing bariatric surgery, not only to avoid an adverse fetal outcome but to also ensure maximum weight loss for mother. Current guidelines strongly advise to use a reliable method of contraception following surgery and to delay pregnancy for 12-18 months after surgery.Case Presentation: We present the case of a woman who underwent laparoscopic sleeve gastrectomy while she was unknowingly pregnant. She was monitored closely throughout her pregnancy for maternal-fetal wellbeing and delivered a healthy full-term girl. At her last follow-up visit 6 months post-delivery, both mother and infant were in good general condition and the mother achieved 94.4% excess weight loss.Conclusions: In all-female patients of childbearing age planning to undergo bariatric surgery, pregnancy should be avoided by using a reliable method of contraception well before surgery. Pregnancy should also be excluded on the day of surgery. [ABSTRACT FROM AUTHOR]

Aim: We aimed to compare the effectiveness and safety of sleeve gastrectomy versus gastric bypass at one-year. Background: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most commonly performed bariatric procedures worldwide. Methods: Patients from a prospectively collected database who presented to a specialized bariatric center and underwent a primary bariatric procedure between March 2013 and April 2015 were included and compared regarding major and minor complication rates and weight loss parameters at 6 and 12 months. Results: A total of 513 patients with a mean age of 37.5±12.5, 82.6 % female and mean body mass index (BMI) of 44.1 ±6.3 kg/m² were included in our analysis: 73.3% underwent SG and 26.7% underwent RYGB. Major and minor complication rates were 7.1 and 2.6% for SG vs. 9.5 and 2.2% for the RYGB, respectively (P=NS). The operative and anesthesia time in SG patients were significantly shorter than in RYGB patients (P<0.001 ). SG and RYBG patients achieved similar excess weight loss at one year (75.4±20.5% vs. 71.8±26.3%, respectively, P=NS). Baseline BMI was the only predictive factor for weight loss at one year (OR: 0.901, CI: 0.827-0.982, P<0.017). Conclusion: RYGB and SG both showed similar one-year safety and effectiveness. Long-term studies are needed to complement these findings. [ABSTRACT FROM AUTHOR]

Hydatid disease is a parasitic infection caused by Echinococcus granulosus (larval form) in humans with lesions most frequently encountered in the liver and lungs. It can rarely involve extra-hepatic organs. It is endemic in some regions of Iran. The omental hydatid cyst is a very rare manifestation of the disease. This report presents the interesting case of a very large omental hydatid cyst. [ABSTRACT FROM AUTHOR]

Background: Single incision laparoscopic surgery (SILS) is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS) with three portal (Conventional) laparoscopic splenectomy in dogs. Mongrel dogs (n = 18), weighting 15 ± 3 kg, were selected for this study (n = 12 SILS; n = 6 conventional). The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO2 using an automatic high flow pressure until achieving 12 mm Hg. Instrumentation used consisted of curved flexible-tip 5 mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments. Results: All dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1 ± 1.65 vs. 42.0 + 2.69 min) and the length of the surgical scar (51.6 ± 1.34 mm vs. 72.0 ± 1.63 mm; P < 0.001). There were no post-operative wound complication including inflammation, infection, hernia formation and dehiscence up to one month after surgery. Meanwhile, the conversion to open surgery or application of additional portals was not required in both approaches. Conclusion: This study demonstrated that SILS is a safe and feasible operation and could be used as an alternative approach to three portal (Conventional) for splenectomy in dog. [ABSTRACT FROM AUTHOR]

Acute paraplegia is a rare but catastrophic complication of surgeries performed on aorta and corrective operations of vertebral column. Trauma to spinal cord after spinal anesthesia and ischemia of spinal cord also may lead to acute paraplegia. Acute paraplegia as a complication of general anesthesia in surgeries performed on sites other than aorta and vertebral column is very rare. Here we present a 56 year old woman with acute paraplegia due to spinal cord infarction after laparoscopic cholecystectomy under general anesthesia probably caused by atherosclerosis of feeding spinal arteries and ischemia of spinal cord after reduction of blood flow possibly due to hypotension during general anesthesia. [ABSTRACT FROM AUTHOR]

Background: Obesity and hypothyroidism are common medical conditions that are associated with each other. Bariatric surgery (BS) is a common approach used to achieve substantial weight loss in obese patients. However, there is limited evidence regarding the need for postsurgery levothyroxine (LT4) dose adjustment in patients with hypothyroidism undergoing BS. Methods: This was a three-year prospective cohort study assessing postsurgery LT4 requirements with attention to body composition changes. The current study included 1030 patients with hypothyroidism, who underwent sleeve gastrectomy (SG) (n = 707, 88.3% women) or one anastomosis gastric bypass (OAGB) (n = 323, 92% women). Patients were followed for 36 months after surgery. A bioelectrical impedance analyzer was used for body composition assessment. LT4 requirements were assessed by generalized estimating equation (GEE) methods adjusted for weight as a time-varying covariate. Results: During the follow-up, TSH (mIU/L) and T4 (ng/dL) measurements did not significantly change in the OAGB group over time. However, in the SG group, TSH measurement decreased over time (ptrend = <0.001). In the third year of the follow-up, 56.1% and 33.3% of patients in the SG and OAGB groups experienced LT4 (μg/day) dose reduction, while 24.4% and 9.1% of the participants experienced LT4 dose increments, respectively. GEE analysis showed a significant increase in the LT4/fat mass (FM) (μg/kg) ratio after 36 months of follow-up compared with the baseline in both the SG [1.8 (1.5–2.2) to 2.7 (2.0–3.5), ptrend = 0.039)] and OAGB [1.7 (1.4–2.2) to 3.2 (2.7–4.8), ptrend = <0.001)] groups. Moreover, patients who underwent OAGB experienced greater LT4/FM (μg/kg) dose adjustments compared to those undergoing SG (pbetween = 0.060). In both groups, after the first year, the increase in LT4/FM (μg/kg) plateaued (pinteraction = 0.009). Conclusion: Most hypothyroid patients experienced either a reduction or no change in LT4 (μg/day) dosage after 36 months in both surgical groups. The LT4/FM (μg/kg) was significantly increased in patients undergoing either SG or OAGB with greater alterations in the latter. Further studies on larger populations and with longer duration of follow-up are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Purposes: There is no consensus regarding the optimal bariatric procedure in patients with super obesity [body mass index (BMI) ≥ 50 kg/m2]. This study compared the outcomes of one-anastomosis gastric bypass (OAGB) with those of sleeve gastrectomy (SG) in these patients. Methods: This retrospective study was conducted based on the prospectively maintained data in a cohort of 557 patients with super obesity, who underwent either SG (n = 348) or OAGB with a 200-cm BPL (n = 154) or a 160-cm BPL (n = 55) by the same surgical team from March 2013 to 2017. Results: Patients undergoing OAGB had greater weight loss in comparison to those managed by SG during the first, second, and third years of follow-up. Comparing the OAGB and SG groups within 3 years after surgery, the total weight loss was 36.5 vs. 33.2% (P < 0.001) and the ΔBMI was 20.1 vs. 18.1 kg/m2 (P < 0.001), respectively. The resolution of diabetes mellitus, hypertension and dyslipidemia were similar after the two procedures. The operative time and length of hospital stay were longer in the OAGB group, and incidence of complications, requiring either readmission or reoperation, was significantly higher after OAGB, in comparison to SG. There was no significant difference in the postoperative weight loss results, resolution of comorbidities, or the incidence of complications between the OAGB-160 and OAGB-200 groups, with the exception of protein–calorie malnutrition requiring revision surgery, which was exclusively observed in the OAGB-200 group. Conclusion: Although OAGB provides superior mid-term weight loss, SG remains the first option for patients with super obesity, due to the safer surgical profile and comparable metabolic improvement. [ABSTRACT FROM AUTHOR]

Purposes: The increasing use of bariatric surgery in adolescents has raised some concerns regarding the postoperative outcomes and the optimal time of surgery at young ages. However, no study has yet compared the weight loss and comorbidity resolution following bariatric surgery between adolescents and young adults. Methods: This study was conducted on a case group of adolescents (aged 11–18) and a control group of young adults (aged 19–29) undergoing bariatric surgery (sleeve gastrectomy or gastric bypass). The two groups were matched in terms of gender, body mass index (BMI), and surgery type and were assessed regarding the surgical outcomes at 1 year after surgery. Results: The baseline characteristics of the adolescents (n = 118, mean age: 17.0 ± 1.6 years) and young adults (n = 236, mean age: 25.2 ± 3.2 years) were similar, as well as surgery-associated complications. The mean loss of BMI (− 15.4 ± 3.6 vs. −15.8 ± 4.6 kg/m2) and 12-month percentage of excess weight loss (80.4 ± 20.1 vs. 80.2 ± 20.1%) were similar in the two groups. Both groups showed parallel reductions in the cardiovascular risk factors. The remission of hypertension, diabetes mellitus, and dyslipidemia was similar between the groups. The increase in the hemoglobin level and copper deficiency was greater in young adults, whereas the increase in ferritin deficiency was greater in adolescents. Conclusion: Similar to young adults, bariatric surgery is an effective and safe method to achieve weight loss, resolve obesity-related comorbidities, and improve cardiovascular risk factors in the adolescents. [ABSTRACT FROM AUTHOR]

Men have been historically considered to be higher-risk patients for bariatric surgery compared to women, the perception of which is suggested to be a barrier to bariatric surgery in men. The purpose of this study is to conduct a matched-pair analysis to evaluate sex disparities in laparoscopic bariatric surgery outcomes. Data on patients who underwent laparoscopic bariatric surgery from March 2013 to 2017 was collected prospectively. Then, 707 men and 707 women pair-matched for age, preoperative body mass index (BMI) and the procedure type (i.e., sleeve gastrectomy, Roux-en-Y, or one-anastomosis gastric bypass) were compared in terms of weight loss, remission of obesity-related comorbidities, and postoperative complications classified according to the Clavien–Dindo classification. There was no difference between the two sexes regarding the operation time, bleeding during surgery and length of postoperative hospital stay. We observed similar total weight loss, BMI loss, and percentage of excess BMI loss at 12, 24, and 36 months postoperatively between men and women, with no difference in remission of diabetes mellitus, hypertension and dyslipidemia at 12 months. The rate of in-hospital, 30-day and late complications according to Clavien–Dindo classification grades was similar between men and women. Our matched-pair cohort analysis demonstrated that bariatric surgery results in comparable short- and mid-term efficacy in men and women, and is associated with similar rate and severity of postoperative complications between sexes. These findings suggest bariatric surgeons not to consider sex for patient selection in bariatric surgery. [ABSTRACT FROM AUTHOR]

Neurological complications secondary to weight loss surgery (WLS) are highly reported and include peripheral nerve injury, Wernicke's encephalopathy, polyradiculoneuropathy, neuropathy, myelopathy, peripheral neuropathy, and myopathy. Neurological complications may result from mechanical or inflammatory mechanisms, but they result mainly from deficiencies in B vitamins, vitamin D, vitamin E, zinc, and copper occurring in WLS. Herein is reported the case of a 25-year-old woman with complaints of paraplegia after a sleeve gastrectomy probably due to nutritional deficiencies. This case illustrates the necessity for medical nutrition therapy (MNT) before and after bariatric surgery. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has raised global health concerns and posed challenges for postoperative follow-up care for patients undergoing bariatric surgery due to social distancing rules. Methods: This was a cohort study on patients with morbid obesity who underwent bariatric surgery and had been enrolled in Tehran Obesity Treatment Study. Patients who had surgery between March 2020 and March 2021 were classified as those undergoing the procedure amid the COVID-19 pandemic, while those who had surgery between March 2017 and March 2018 were categorized as the pre-pandemic group. Results: The study included 982 patients in the pre-COVID-19 pandemic group and 602 patients in the COVID-19 pandemic group, with mean ages of 39.61 and 39.51 years, respectively. After adjusting for preoperative body mass index (BMI) and surgery type, the patients who underwent surgery during the COVID-19 pandemic demonstrated comparable results to the pre-COVID-19 group in terms of total weight loss %, excess weight loss %, BMI reduction, and fat mass reduction during the 12-month postoperative period. Additionally, the rate of complications with a grade≥III based on the Clavien–Dindo classification was significantly lower in patients who underwent surgery during the COVID-19 pandemic. Notably, there were no deaths reported in either group. Conclusion: Despite social isolation and unfavorable lifestyle modifications, bariatric surgery-induced weight loss after one year was the same in patients undergoing the procedure either before or after the implementation of social distancing measures. More research is needed to analyze the influence of the COVID-19 pandemic on the long-term outcomes of bariatric surgery. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) has become a leading cause of chronic liver disease worldwide. We aimed to study this condition and liver fibrosis in bariatric patients at baseline using ultrasound, NAFLD fibrosis score (NFS), and fibrosis index-4 (FIB-4). Methods: Adult patients with morbid obesity without other possible causes of liver pathology were evaluated. Liver biopsy was performed in a subset of patients. Diagnostic accuracy of tests was assessed using area under the receiver operating-characteristic curve (AUROC). Results: Overall, 1944 patients with mean age of 38.3 - 10.8 years and body mass index of 44.6 - 6.4 kg/m² comprised the study population. Liver Biopsyshowed features of NAFLDin 70%; 60.3% hadnonalcoholic fatty liver and9.6% steatohepatitis. Older age and higher transaminase levels were associated with higher NAFLD activity score. Fibrosis was present in 23.3% with the majority having F1. Ultrasound detected steatosis in 76.8%, with two-thirds having grade I to II fatty liver. Metabolic syndrome, hemoglobin A1c, age, and alanine transaminase were the strongest risk factors for fatty liver. Ultrasound showed an AUROC of 0.75 (95% confidence interval 0.63-0.86) for NAFLD with a sensitivity and specificity of 72.5% and 68.2%, respectively (cutoff of grade II). For diagnosis of fibrosis, FIB-4 had an AUROC of 0.72 (0.58-0.86) with 93.3% sensitivity and 43.1% specificity (cutoff of 0.50). NFS failed to show a significant AUROC curve for diagnosing fibrosis. Conclusions: Our findings confirmed a high prevalence of NAFLD in morbidly obese patients. Despite this high prevalence, fibrosis was uncommon and low-grade. This study questions the use of current cutoffs for NFS and FIB-4 in all patients. [ABSTRACT FROM AUTHOR]

Phosphatidylinositol-3-kinase (PI3K)/Akt signaling pathway regulates glucose and lipid metabolism. We examined the association of PI3K and Akt expression in visceral (VAT) and subcutaneous adipose tissue (SAT) with daily physical activity (PA) in non-diabetic obese and non-obese adults. In this cross-sectional study, we included 105 obese (BMI ≥ 30 kg/m2) and 71 non-obese (BMI < 30 kg/m2) subjects (aged/ ≥ 18 years). PA was measured using a valid and reliable International Physical Activity Questionnaire(IPAQ)-long-form, and the metabolic equivalent of task(MET) was calculated. Real-time PCR was performed to analyze the mRNA relative expression. VAT PI3K expression had a lower level in obese compared to non-obese (P = 0.015), while its expression was higher in active individuals than inactive ones (P = 0.029). SAT PI3K expression was increased in active individuals compared to inactive ones (P = 0.031). There was a rise in VAT Akt expression in the actives compared to the inactive participants (P = 0.037) and in non-obese/active compared to non-obese/inactive individuals (P = 0.026). Obese individuals had a decreased expression level of SAT Akt compared to non-obsesses (P = 0.005). VAT PI3K was directly and significantly associated with PA in obsesses (β = 1.457, P = 0.015). Positive association between PI3K and PA suggests beneficial effects of PA for obese individuals that can be partly described by PI3K/Akt pathway acceleration in adipose tissue. [ABSTRACT FROM AUTHOR]

Phosphatidylinositol-3-kinase (PI3K)/Akt signaling pathway regulates glucose and lipid metabolism. We examined the association of PI3K and Akt expression in visceral (VAT) and subcutaneous adipose tissue (SAT) with daily physical activity (PA) in non-diabetic obese and non-obese adults. In this cross-sectional study, we included 105 obese (BMI ≥ 30 kg/m2) and 71 non-obese (BMI < 30 kg/m2) subjects (aged/ ≥ 18 years). PA was measured using a valid and reliable International Physical Activity Questionnaire(IPAQ)-long-form, and the metabolic equivalent of task(MET) was calculated. Real-time PCR was performed to analyze the mRNA relative expression. VAT PI3K expression had a lower level in obese compared to non-obese (P = 0.015), while its expression was higher in active individuals than inactive ones (P = 0.029). SAT PI3K expression was increased in active individuals compared to inactive ones (P = 0.031). There was a rise in VAT Akt expression in the actives compared to the inactive participants (P = 0.037) and in non-obese/active compared to non-obese/inactive individuals (P = 0.026). Obese individuals had a decreased expression level of SAT Akt compared to non-obsesses (P = 0.005). VAT PI3K was directly and significantly associated with PA in obsesses (β = 1.457, P = 0.015). Positive association between PI3K and PA suggests beneficial effects of PA for obese individuals that can be partly described by PI3K/Akt pathway acceleration in adipose tissue. [ABSTRACT FROM AUTHOR]

Introduction: Apelin could be one of the last protective defenses before developing obesity-related disorders, including insulin resistance, type 2 diabetes, and hypertension, which can be modified by dietary intake. The present study investigated the association of habitual intake of total fatty acids (TFAs), saturated-, monounsaturated-, polyunsaturated FAs, n-3, and n-6 FAs with Apelin expression in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Methods: We obtained VAT and SAT from 168 participants (64 nonobese and 104 obese) who had undergone open abdominal surgery. Dietary intake information was gathered with a valid and reliable food frequency questionnaire. The mRNA expression of the Apelin gene was analyzed by realtime PCR. Results: Apelin serum levels were increased in the obese subjects compared to the nonobese group (p = 0.016). The SAT and VAT Apelin mRNA levels were significantly elevated in the obese participants compared to the nonobese ones (p < 0.05). Based on BMI status, only obese subjects indicated a positive association between SAT and VAT Apelin expression and TFA intake (p < 0.001). However, this association was observed between SAT and VAT Apelin gene expression and polyunsaturated fatty acid (PUFA) and n-3 FA intakes in both obese and nonobese groups (p < 0.05). Conclusion: High Apelin gene expression was associated with TFA intake in obese subjects in both fat tissues. However, habitual intake of PUFA and n-3 FA was associated with Apelin gene expression in obese and nonobese individuals. Our results indicate a determinative role of the quality and quantity of FA intake on adipose tissue. [ABSTRACT FROM AUTHOR]

Background: Among two popular obesity phenotypes, metabolically healthy severely obese (MHSO) and metabolically unhealthy severely obese (MUSO), it is important to clarify whether or not those with MHSO phenotype would benefit from bariatric surgery in terms of an improvement in body composition parameters. Methods: A prospective cohort was conducted on a total of 4028 participants (1404 MHSO and 2624 MUSO) who underwent bariatric surgery; MHSO was defined as having abnormalities in none or one of these four parameters: systolic blood pressure and/or diastolic blood pressure, triglycerides, fasting plasma glucose, and high-density lipoprotein. Otherwise, the definition of MUSO was met. Body composition analysis was performed at the baseline and 6-, 12-, 24-, and 36-month post-surgery using bioelectrical impedance analyzer. Results: Both phenotypes showed a significant decrease in fat mass (FM) and fat-free mass (FFM) and a significant increase in EWL% and TWL% (Ptrend < 0.05). FFM, FM%, and excess weight loss (EWL%) were significantly different between the two phenotypes (Pbetween < 0.05) during the follow-up. Multivariate linear regression demonstrated that compared to MUSO patients, MHSO individuals experienced a greater increase in total weight loss (TWL%) and EWL% at 12- and 24-month and in EWL% at 36-month post-surgery and also a lower decrease in the FFML/WL% after 12 months. Conclusion: Despite a lower decrease of FFML/WL% and a greater increase in TWL and EWL in MHSO phenotype at some time points, there were no clinically significant differences between the study groups in terms of body composition changes throughout the follow-up period. [ABSTRACT FROM AUTHOR]

Summary : Vitamin D metabolism is altered in obese individuals. Our findings indicated that in patients with severe obesity, a relatively low 25(OH)D concentration was required to suppress PTH. The PTH inflection point increased following surgery-induced weight loss, highlighting 25(OH)D different regulation mechanisms in patients with obesity. Introduction: An optimal and sufficient concentration of 25-hydroxyvitamin D (25(OH)D) has been suggested as the level required to maximally suppress intact parathyroid hormone (iPTH). We evaluated the role of surgery-induced weight loss in determining the threshold(s) of 25(OH)D required to suppress iPTH. Methods: This study was conducted in the framework of the Tehran Obesity Treatment Study (TOTS). We prospectively analyzed 687 patients with severe obesity who participated in the TOTS and underwent bariatric surgery from March 2013 to March 2019. The patients were followed for 1 year after surgery. Anthropometric parameters and serum levels of iPTH, 25OHD, phosphorous, and calcium were measured. Nonlinear and piecewise linear regression was used to evaluate the relationship between 25(OH)D and iPTH and to determine the 25(OH)D-suppression point at which iPTH was maximally suppressed. Results: Body mass index was 44.6 kg/m2 at the baseline and decreased to 29.7 kg/m2 1 year after surgery (P < 0.05). Before the surgery, iPTH and 25(OH)D showed an exponential relationship; iPTH began to decrease rapidly at 25(OH)D concentration of 12 ng/mL, reaching maximal suppression at 30 ng/mL. However, the relationship between 25(OH)D and iPTH was non-exponential 1 year after surgery. The piecewise linear regression model revealed the 25(OH)D concentration of 21 ng/mL as the inflection point following surgery-induced weight loss. Conclusion: In patients with severe obesity, PTH was suppressed at a relatively lower concentration of 25(OH)D; this threshold increased following surgery-induced weight loss. These findings suggest a role for bariatric surgery in regulating 25(OH)D metabolism in patients with obesity. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery has been associated with iron, folate, and vitamin B12 deficiencies, which can lead to anemia. This study compares the incidence of anemia between sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB). Methods: Patients from a prospectively collected database of patients with morbid obesity undergoing a primary bariatric procedure from April 2013 to September 2018 were included. Statistical analysis was performed using the general estimation equation. Patients were followed for 6, 12, 24, and 36 months post-surgery. Results: The present study included 2618 patients, of whom 72.3% underwent SG and 27.6% underwent OAGB. The majority of the study population were women (75.7%), and the mean age of the participants was 39.5 ± 11.7 years. At the end of the follow-up, the excess weight loss percentage was 66.15 in the SG group and 75.41 in the OAGB group (P < 0.05). The incidence of anemia at 12-, 24-, and 36-month was 16.2, 19.7, and 24.3% in the SG group and 28.4, 37.6, and 56.5% in the OAGB group, showing significantly higher incidence in the OAGB than the SG group ( P between groups < 0.001). However, there was no significant difference between the SG and OAGB groups regarding the incidence of iron and vitamin B12 deficiency. Conclusions: The patients undergoing bariatric surgery, especially OAGB, should be closely monitored post-surgery regarding the incidence of anemia, and supplementation in developing countries could be continued even after the first year. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic gastrectomy is a new and technically challenging surgical procedure with potential benefit. The objective of this study was to investigate clinical and para-clinical consequences following Roux-en-Y and Jejunal Loop interposition reconstructive techniques for subtotal gastrectomy using laparoscopic assisted surgery. Results: Following resection of the stomach attachments through a laparoscopic approach, stomach was removed and reconstruction was performed with either standard Roux-en-Y (n = 5) or Jejunal Loop interposition (n = 5) methods. Weight changes were monitored on a daily basis and blood samples were collected on Days 0, 7 and 21 post surgery. A fecal sample was collected on Day 28 after surgery to evaluate fat content. One month post surgery, positive contrast radiography was conducted at 5, 10, 20, 40, 60 and 90 minutes after oral administration of barium sulfate, to evaluate the postoperative complications. There was a gradual decline in body weight in both experimental groups after surgery (P < 0.05). There was no difference in blood parameters at any time after surgery between the two methods (P > 0.05). Fecal fat content increased in the Roux-en-Y compared to the Jejunal loop interposition technique (P < 0.05). No major complications were found in radiographs and gastric emptying time was similar between the two groups (P > 0.05). Conclusion: Roux-en-Y and Jejunal loop interposition techniques might be considered as suitable approaches for reconstructing gastro-intestinal tract following gastrectomy in dogs. The results of this study warrant further investigation with a larger number of animals. [ABSTRACT FROM AUTHOR]

Background. Apelin is an adipokine with an intermediatory role in obesity and insulin resistance, which can be modified by dietary intake. Aims. In this study, we aimed to determine the association of the plasma fatty acid composition with apelin plasma concentration and gene expression in visceral (VAT) and subcutaneous (SAT) adipose tissues. Methods. In this cross-sectional study, we recruited 179 patients aged 19-75 years who were candidates for elective surgery. Through the surgery, SAT and VAT were collected to measure apelin gene expression. Anthropometric measurements, fasting blood samples, and dietary intakes were collected before surgery. Free fatty acids (FFAs) in fasting whole plasma were measured using gas chromatography with flame ionization detection. Linear regression models were used to estimate standardized β (STZ β) showing the association of individual and total FFAs with apelin gene expression after adjustment for potential confounding variables. Results. In multivariable analysis, we observed a significant positive association of total plasma free fatty acids (FFAs) (STZ β = 0.241 , P = 0.006), saturated fatty acid (SFA) (STZ β = 0.336 , P < 0.001), and monounsaturated fatty acid (MUFA) (STZ β = 0.313 , P < 0.001) concentrations with apelin gene expression from VAT after controlling for age, sex, body mass index, homeostatic model assessment for insulin resistance (HOMA-IR), physical activity, and energy intake. In the SFA family, there was a direct association with plasma concentration of myristic acid (STZ β = 0.372 , P < 0.001), pentadecanoic acid (STZ β = 0.252 , P = 0.002), and heptadecanoic acid (STZ β = 0.407 , P < 0.001) with apelin mRNA expression in VAT. There was no significant association between FFAs and apelin plasma concentration and SAT mRNA levels. Conclusions. In conclusion, circulating plasma FFAs, SFA, and MUFA had a positive association with apelin gene expression in VAT. It seems that plasma fatty acid composition may regulate apelin gene expression in VAT. [ABSTRACT FROM AUTHOR]

Purpose: The human obesity susceptibility gene, FTO, associates with body mass and obesity in humans through regulation of energy expenditure and intake. We aimed to determine how fatty acids in plasma and in diet associate with FTO gene expression in subcutaneous and visceral adipose tissues. Methods: In this study, 97 participants aged ≥ 18 years were selected from patients admitted to the hospital for abdominal surgeries. Habitual dietary intake of participants was collected using a valid and reliable food frequency questionnaire (FFQ), from which the intake of fatty acids was quantified. Plasma fatty acids were assessed by gas–liquid chromatography. The mRNA expression of the FTO gene in visceral and subcutaneous adipose tissues obtained by biopsy was measured by Real-Time Quantitative Reverse Transcription PCR. Standardized β-coefficients were calculated by multivariable linear regression. Results: After adjusting for age, homeostasis model insulin resistance index (HOMA-IR), and body mass index, total fatty acid intake was significantly associated with FTO gene expression in visceral (STZβ = 0.208, P = 0.037) and subcutaneous (STZβ = 0.236, P = 0.020) adipose tissues. Dietary intake of monounsaturated fatty acid (MUFA) and polyunsaturated fatty acids (PUFA) had positive significant associations with the expression of FTO in visceral (STZβ = 0.227, P = 0.023; STZβ = 0.346, P < 0.001, respectively) and subcutaneous (STZβ = 0.227, P = 0.026; STZβ = 0.274, P = 0.006, respectively) adipose tissues. There were no associations between plasma fatty acids and FTO mRNA expression in either subcutaneous or visceral adipose tissues. Conclusion: The weak association of dietary total fatty acids, MUFA, and PUFA with FTO gene expression in both adipose tissues may highlight the importance of dietary fatty acids composition along with total fat intake in relation to FTO gene expression. [ABSTRACT FROM AUTHOR]

Tricuspid valve myxomas are very uncommon tumors that could be found after the occurrence of pulmonary thromboembolism, symptomatic tricuspid obstruction, and right-sided heart failure. Herein, we describe a 42-year-old woman evaluated for an abdominal mass. In preoperative consultation, a tricuspid valve mass was detected in echocardiography. She underwent the removal of a benign uterine myoma and a myxoma of the tricuspid valve. Tricuspid valve myxomas constitute a scarce diagnosis. They could be asymptomatic, occurring in unusual locations and in association with benign tumors in other organs. Our patient was asymptomatic, underscoring the significance of the early diagnosis of this type of tumor to prevent further catastrophic events. [ABSTRACT FROM AUTHOR]

Highlights • The determinative factors on VDR gene expression of adipose tissue varied and depended on the degree of obesity. • Serum 25(OH)D was the common factor to determine VDR gene expression visceral adipose tissue in all strata of BMI groups. • BMI and HOMA-IR were the positive predictors of subcutaneous adipose tissue VDR gene expression. Abstract We aimed to illustrate determinants of VDR gene expression in visceral and subcutaneous adipose tissue among individuals without diabetes. We gathered visceral and subcutaneous adipose tissues during an elective abdominal surgery form 33 morbidly obese (BMI > 40 kg/m2), 23 obese (BMI = 30–40 kg/m2), and 35 non-obese (BMI<30 kg/m2) participants who were free of diabetes. Participants were classified according to their degree of obesity. Before the surgery, habitual dietary intake, physical activity, 25(OH)D, body mass index (BMI), waist circumference (WC), and HOMA-IR was gathered. Non-obese participants had significantly lower mean VDR gene expression in visceral adipose tissues than both the obese and morbidly obese ones and had also lower expression in subcutaneous adipose tissues than the morbidly obese participants. In multiple linear regression models, BMI and HOMA-IR were the independent positive predictors of VDR gene expression in subcutaneous fat. Among non-obese subjects, WC and 25(OH)D were the positive and negative independent predictors of visceral adipose tissue VDR gene expression, respectively. Among obese participants, 25(OH)D was negatively, and BMI and HOMA-IR were positively associated with VDR mRNA levels in visceral adipose tissue. In morbidly obese participants, the independent positive predictors of VDR gene expression in visceral fat were BMI and HOMA-IR, and negative predictors were 25(OH)D and calcium intake. Our findings suggested that 25(OH)D concentrations are the fundamental elements to determine VDR gene expression in visceral fat which by increasing fat depots, the subsequent insulin resistance became another predictor of VDR gene expression. [ABSTRACT FROM AUTHOR]

Background: Accumulating evidence indicates that mitochondrial dysfunction is considered an effective factor in the formation or development of non-alcoholic fatty liver disease (NAFLD) although the underlying mechanisms of the changes are still unclear. Objectives: The aim of the study was to determine the 4977-bp deletion levels and variations in the displacement (D) loop region of mitochondrial DNA (mtDNA) in NAFLD patients. Methods: In this case-control study, 43 NAFLD patients and 156 controls were enrolled. The blood DNA of 43 patients with NAFLD and 156 healthy individuals was investigated to determine the 4977-bp deletion and sequence changes in the D-loop region using methods such as polymerase chain reaction (PCR), multiplex PCR, and DNA sequencing. Results: The results indicated that no 4977-bp deletion was found in any of the samples. 94 variations were found in the D-loop region including two deletions, four insertions, and 88 single nucleotide polymorphisms (SNP), 16 of which were just found in patients. There was a significant difference between the NAFLD patients and controls in six variants (P < 0.05). Two novel insertions (16171 ins T and 16221 ins C) were observed in patients. Finally, the results revealed no statistically significant difference (P > 0.05) in C variations in D310 mitochondrial DNA between the two groups. Conclusions: According to the findings, we believe that the disease damages the mitochondrial DNA and leads to the formation of these mutations. Our results also showed that D-loop alterations are frequent in NAFLD and may play a significant role in the progression of NAFLD. [ABSTRACT FROM AUTHOR]

Overproduction of apelin in obesity could be one of the last protective defenses before type 2 diabetes develops. To summarize the existing evidence on the association between dietary intake and apelin gene expression and concentration. We systematically searched MEDLINE, EMBASE, and google scholar and hand-searched bibliographies, including peer-reviewed articles with English abstracts, without restriction in publication date, updated until 21 February 2016 that reported the association between dietary intake and apelin gene expression or concentration. From a total of 1075 articles, we identified 12 relevant studies. There were 6 clinical trials in human and 6 studies in animals. Overall, two of three studies conducted in humans showed that calorie-restriction diet in obese subjects decreases apelin concentration. Five animal studies reported that higher intake of fatty acids and eicosapentaenoic acid (EPA) increased apelin expression and concentration. Given the paucity of data available, the heterogeneity of study designs used, and exposures tested, no quantitative meta-analysis was justified. Based on human studies, hypocaloric diet can reduce apelin concentration in obese individuals. In addition, higher intakes of total fatty acids and EPA may increase apelin gene expression and concentration. [ABSTRACT FROM AUTHOR]

Overproduction of apelin in obesity could be one of the last protective defenses before type 2 diabetes develops. To summarize the existing evidence on the association between dietary intake and apelin gene expression and concentration. We systematically searched MEDLINE, EMBASE, and google scholar and hand-searched bibliographies, including peer-reviewed articles with English abstracts, without restriction in publication date, updated until 21 February 2016 that reported the association between dietary intake and apelin gene expression or concentration. From a total of 1075 articles, we identified 12 relevant studies. There were 6 clinical trials in human and 6 studies in animals. Overall, two of three studies conducted in humans showed that calorie-restriction diet in obese subjects decreases apelin concentration. Five animal studies reported that higher intake of fatty acids and eicosapentaenoic acid (EPA) increased apelin expression and concentration. Given the paucity of data available, the heterogeneity of study designs used, and exposures tested, no quantitative meta-analysis was justified. Based on human studies, hypocaloric diet can reduce apelin concentration in obese individuals. In addition, higher intakes of total fatty acids and EPA may increase apelin gene expression and concentration. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence that deficiencies observed in the mitochondrial DNA (mtDNA) functions could play an important role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). We hypothesized that genetic variations in mtDNA could affect the mitochondrial function and contribute to the NAFLD susceptibility. Objectives: In this study, the possible association of the mtDNA copy number and 4,977-bp deletion levels with NAFLD susceptibility in a sample of Iranian population was evaluated. Methods: This case-control study included 43 NAFLD patients and 20 control subjects. Genomic DNA was extracted from fresh liver tissue samples by using a DNA isolation kit. The mtDNA copy number and mtDNA deletion levels were measured by quantitative real-time PCRand multiplex PCR. Results: The relative expression of mtDNA copy number was 3.7 fold higher in NAFLD patients than healthy controls (P< 0.0001). The results remained significant after adjustment for age, BMI, and gender (P = 0.02). In addition, the mtDNA copy number was 4.3 (P< 0.0001) and 3.2-fold (P< 0.0001) higher in nonalcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH) patients than healthy controls, respectively. Finally, the results showed that the 4,977-bp deletion is not detected in any of liver tissue samples obtained from the 20 control subjects whereas 8 out of 43 NAFLD patients (18.6%) showed the 4,977 -bp deletion in their liver tissues (P = 0.039). Conclusions: This study indicated an association between mtDNA content in the liver tissue and NAFLD susceptibility that may be a consequence of compensatory response to the cumulative exposures to oxidative damage. [ABSTRACT FROM AUTHOR]

• P53 mRNA expression of obese participants was significantly higher than the non-obese, only in VAT. • Dietary intake of fruit and green vegetables was associated with P53 gene expression in VAT and SAT of obese participants. • Higher dietary fruit intake was inversely associated with PTEN mRNA levels in non-obese participants. • Dietary fruit intake was positively associated with PTEN gene expression in VAT and SAT of obese participants. The present study investigates the association of dietary intake of fruit and green Vegetables with PTEN and P53 mRNA gene expression in visceral (VAT) and subcutaneous adipose tissues (SAT) of obese and non-obese adults. VAT and SAT were obtained from 151 individuals, aged ~40 years, who had undergone elective abdominal surgery. The participants were grouped according to their body mass index (BMI), as obese (BMI > 30 kg/m2) and non-obese (BMI = 18.5–30 kg/m2). Dietary intakes were obtained using a valid and reliable food-frequency questionnaire (FFQ). Real-time PCR was carried out for PTEN and P53 mRNA expressions. Associations between expression levels and dietary parameters were analyzed. P53 mRNA expression of obese participants was significantly higher than the non-obese, only in VAT (p < 0.001). After adjusting for total energy intake, age and BMI, fruit intake was inversely associated with P53 gene expression in both VAT (β = −0.38, P = 0.01) and SAT (β = −0.35, P = 0.03) among non-obese participants. Furthermore, fruit consumption was inversely associated with P53 gene expression in obese individuals, only in VAT (β = −0.21, P = 0.05). More so, intake of green vegetables in obese subjects was negatively associated with P53 gene expression in VAT (β = −0.27, P = 0.01) and SAT (β = −0.28, P < 0.001). On the other hand, after adjustment for total energy intake, age and BMI, a positive association was observed between fruit intake and PTEN in VAT (β = 0.27, P = 0.01) and SAT (β = 0.34, P < 0.001) among obese participants. In addition, dietary consumption of fruits in non-obese individuals was negatively associated with PTEN expression in SAT (β = −0.48, P < 0.001). Dietary intake of fruit and green vegetables was associated with P53 gene expression in VAT and SAT of obese participants, suggesting their protective role in regulating P53 mRNA expression in adipose tissue. Furthermore, higher fruit intake was inversely associated with PTEN mRNA levels in non-obese participants, implying the anti-adipogenic role of PTEN gene expression. [ABSTRACT FROM AUTHOR]

Background: Apelin, as an adipokine, plays an important role in the pathogenesis of insulin resistance and type 2 diabetes. This study aimed to determine whether the quality and quantity of dietary carbohydrates were associated with apelin gene expression in subcutaneous and visceral adipose tissues. Methods: In this cross-sectional study, 102 adults who underwent minor abdominal surgery were selected. Approximately 100 mg of subcutaneous and visceral adipose tissues were collected during the surgery to measure apelin gene expression. Anthropometric measurment, blood samples, and dietary intakes were collected before surgery. The dietary carbohydrate intake, glycemic index (GI), and glycemic load (GL) were determined. Results: The average apelin concentration was 269.6 ± 98.5(pg/mL), and 16.3% of participants were insulin resistant. There was a correlation between insulin (p-value = 0.043), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)(p-value = 0.045) and apelin gene expression in visceral adipose tissue. There was a positive association of apelin gene expression with dietary GI and GL after adjustment for age, sex, and waist circumference in visceral and subcutaneous adipose tissues(p < 0.05). Apelin gene expression in visceral(p = 0.002) and subcutaneous(p = 0.003) adipose tissues was directly associated with foods with a higher GI. There was no association between total carbohydrate intake and apelin gene expression in both visceral and subcutaneous adipose tissues. Conclusions: Dietary GI and GL, not total carbohydrate intake, were positively associated with apelin gene expression in both visceral and subcutaneous adipose tissues. Future studies are warranted to illustrate the chronic and acute effect of carbohydrate quality on apelin homeostasis. [ABSTRACT FROM AUTHOR]