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International audience; Introduction A recent meta-analysis provided proof of efficacy for mobile technology to increase physical activity or weight loss in the short term. Videoconferencing may also be effective, especially as it reduces the barriers related to face-to-face physical activity interventions. Both technologies seem particularly interesting for bariatric surgery management, but their long-term effects on physical activity maintenance are unknown. Moreover, the mechanisms underlying their effectiveness, such as technology acceptability and motivational processes, have not been examined. The objectives of this study are to determine the effects of two technology-based (mobile technology and videoconferencing) physical activity programmes after bariatric surgery compared with standard care and to assess the contribution of acceptability and motivational mechanisms in explaining these effects on physical activity, physiological measures and health indicators. Methods and analysis One hundred and twenty young women who have undergone bariatric surgery in the last 3–6 months will be included. The volunteers will be randomly assigned to one of three arms: CONTROL (standard care), ACTI-MOBIL (mobile technology) or ACTI-VISIO (videoconferencing). The primary outcome is the distance travelled during a 6 min walk test relativised according to Capadaglio’s theoretical distance. Secondary outcomes are behavioural measures of physical activity, physiological measures, health indicators, technology acceptability and motivational concepts. Data will be collected at baseline (T0), 3 months (T3) and 6 months (T6). The technology groups will receive a physical activity programme for 12 weeks (between T0 and T3). A mixed model approach will be used to analyse the change in outcomes over time for each group. Ethics and dissemination This study protocol was reviewed and approved by the French East 1 Protection of Persons Ethics Committee (number: 2020.A00172-37) and the French National Commission for Information Technology and Civil Liberties (number: UCA-R20-034). The results will be disseminated through conference presentations and peer-reviewed publications. Trial registration number NCT04478331 .

Background & Aims There is an urgent medical need to develop non-invasive tests for non-alcoholic steatohepatitis (NASH). This study evaluates the diagnostic performance of an innovative model based on mid-infrared (MIR) spectroscopy for the diagnosis of NASH. Methods Severely obese patients who underwent a bariatric procedure at the University Hospital of Nice, France (n = 395) were prospectively recruited. The clinico-biological characteristics were measured prior to surgery. Liver biopsies were collected during the surgical procedure and assessed by a pathologist. A training group (316 patients, NASH: 16.8%) and a validation group (79 patients, NASH: 16.5%) were randomly defined. MIR spectra were acquired by fiber evanescent wave spectroscopy, using chalcogenide glass fiber optic sensors and a spectrometer. This absorption spectroscopic technique delivers a spectrum that identifies the molecular composition of a sample, defining a patient's metabolic fingerprint. Results The areas under the receiver operating curve (AUROC) for the diagnosis of NASH were 0.82 and 0.77 in the training and validation groups, respectively. The best threshold was 0.15, which was associated with a sensitivity of 0.75 and 0.69, and a specificity of 0.72 and 0.76. Negative predictive values of 0.94 and 0.93 and positive predictive values of 0.35 and 0.36, as well as correctly classified patient rates of 72% and 75% were obtained in the training and validation groups, respectively. A composite model using aspartate aminotransferase level, triglyceride level and waist circumference alongside the MIR spectra led to an increase in AUROC (0.88 and 0.84 for the training and validations groups, respectively). Conclusions MIR spectroscopy provides good sensitivity and negative predictive values for NASH screening in patients with severe obesity. Lay summary There is an urgent need for tools to non-invasively diagnose and monitor non-alcoholic steatohepatitis (NASH). This study evaluates the performance of a new tool for fast NASH diagnosis based on mid-infrared (MIR) spectroscopy. Using serum samples from severely obese patients who underwent a bariatric procedure, which enabled a concomitant liver biopsy to be performed, the MIR spectroscopy model performed well in screening patients for NASH compared to a traditional, histological diagnosis., Graphical abstract Unlabelled Image, Highlights • There is no validated non-invasive diagnostic tool for NASH in routine care. • NASH follow-up requires a non-invasive diagnostic method. • Using a simple drop of serum, the mid-infrared spectrum captures a patient’s metabolic fingerprint. • A model based on mid-infrared spectroscopy provides efficient NASH screening for patients with severe obesity.

International audience; In this contribution, delivered after more than one month of nationwide lockdowns of European countries, we discuss side-effects of the COVID-19 pandemic on citizens' access to medical care and the efficiency of national health systems in care provision. In the first section, we stress the importance of indirect mortality, i.e. non-diagnosis of non-COVID diseases whose standard-of-care management could have avoided death during the pandemic. We highlight how indirect mortality is linked to patients' psychological attitudes and behavioral responses to the unforeseen contingencies that the spread of COVID-19 has brought with it. The second section complements the first one by delving into the issue of the sustainability of financing and organization of national hospital systems, framing the discussion within the financial problems that the European Community is facing, which have been exacerbated by the current COVID-19 infection spread. Our interdisciplinary approach combines insights from academic surgery and psychiatry on the one side and behavioral and political economy on the other side.

International audience

Non-invasive approaches are useful to differentiate simple steatosis from non-alcoholic steatohepatitis (NASH) in obese and morbidly obese patients.To develop a new scoring system to diagnose definitive NASH.Preoperative clinical and biological data including serum caspase 3-generated cytokeratin-18 fragments (CK18) and surgical liver biopsies were obtained from 464 morbidly obese patients who had undergone bariatric surgery. The cohort was divided into two groups: training group (n = 310) and validation group (n = 154). Definitive NASH was defined according to Kleiner's classification with a Non-alcoholic fatty liver disease Activity Score (NAS) ≥5. Alanine aminotransferase (ALT), CK18 fragments and the presence of metabolic syndrome were independent predictors for discriminating patients with NAS ≥5 in the training group. These three parameters were used to carry out a scoring system for the prediction of NAS ≥5. Whereas serum CK18 fragment alone had an area under the receiver operating characteristic (AUROC) curve = 0.74, AUROC curves of the scoring system were 0.88 and 0.83 in the training group and the validation group, respectively.A simple and non-invasive composite model (the Nice Model) including metabolic syndrome, ALT and CK18 fragments is able to predict accurately a non-alcoholic fatty liver disease activity score ≥5 in morbidly obese subjects.

We report a case of TVT infec-tion due to actinomycosis presenting as recurrent vaginalerosions of the mesh.A 46-year-old woman presented with dyspareunia andvaginal discharge. She had had a TVT (Gynecare) insertedtwo years before for urinary stress incontinence. Pelvicexamination revealed the exposure of a 1 0.5 cm portionof mesh within the vagina. She underwent transvaginal ex-cision of the exposed part of the mesh. Postoperative coursewas uneventful, and bacterial cultures were sterile. Twomonths later, a pelvic examination revealed a new area ofmesh erosion away from the previous one. The patient un-derwent a transvaginal removal of the entire sling, and mul-tiple biopsies of vaginal tissue around the eroded area weretaken and sent for histological examination. Postoperativecourse was uneventful. Histology of the biopsy specimenand mesh revealed PAS-positive granules with structuresradiating from the periphery, characteristic of Actinomycessp infection, although cultures remained sterile. The pa-tient received a one-month course of intravenous peni-cillin G (10

In 1941, Schaffner et al. reported a case of a patient suffering from cascade stomach (CS) who underwent surgical exploration, using these words: “the fundus of the stomach was very much larger than usual, somewhat thickened, but atonic and flaccid. The space above the pancreas and behind the fundus was deeper and larger than usual. The fundus was freed. Its superior attachments appeared elongated and lax. The entire fundus was resected laterally to below the level of the splenic artery, leaving only a strip on the lesser curvature side about one and one-half inches wide. This was converted into a tube not much larger than the esophagus itself”. This is very likely the first description of a sleeve gastrectomy (SG) ante litteram

Before bariatric surgery (BS), moderate weight loss, left hepatic lobe volume reduction, and micronutrient deficiency (MD) identification and correction are desirable.The objective of this study was to assess the safety and the effectiveness of a 4-week preoperative ketogenic micronutrient-enriched diet (KMED) in reducing body weight (BW), left hepatic lobe volume, and correcting MD in patients scheduled for BS.In this prospective pilot study, a cohort of morbidly obese patients (n = 27, 17 females, 10 males) with a mean body mass index (BMI) of 45.2 kg/m(2) scheduled for BS underwent a 4-week preoperative KMED. Their BW, BMI, fat mass (FM), fat-free mass (FFM), resting metabolic rate (RMR), left hepatic lobe volume, micronutrient status, and biochemical and metabolic patterns were measured before and after the 4-week KMED. Patient compliance was assessed by validated questionnaires (3-day estimated food records and 72-h recall). Qualitative methods (5-point Likert questionnaire) were used to measure diet acceptability and side effects.All patients completed the study. We observed highly significant decreases in BW (- 10.3%, p < 0.001, in males; - 8.2%, p < 0.001, in females), left hepatic lobe volume (- 19.8%, p < 0.001), and an amelioration of patient micronutrient status. All patients showed a high frequency of acceptability and compliance in following the diet. No adverse side effect was reported.This study demonstrates that a 4-week preoperative KMED is safe and effective in reducing BW, left hepatic lobe volume, and correcting MD in obese patients scheduled for BS.

Background We recently showed that an 8-week preoperative protein-enriched diet (PED) is associated with significant reductions in body weight and fat mass (FM) without significant loss of fat-free mass (FFM) in morbidly obese patients scheduled for laparoscopic sleeve gastrectomy (LSG).Objectives The objective of this study is to evaluate the impact of PED vs a normal protein diet (NPD) on total weight loss (TWL), FM, FFM, and resting metabolic rate (RMR) in patients after LSG.Methods Before LSG and at 3, 6, and 12 months after, we prospectively measured and compared total body weight (TBW), FM, FFM, and RMR in 60 male patients who received either a NPD (n = 30) with protein intake 1.0 g/kg of ideal body weight, or a PED (n = 30) with protein intake 2.0 g/kg of ideal body weight. Compliance in following the prescribed diet was determined with food frequency questionnaires in all patients. The impact of NPD and PED on renal function was also evaluated.Results Despite non-significant variation in total body weight (TBW), FM decreased more significantly (p < 0.01) with the PED compared to the NPD. In addition, the PED group showed a significantly (p < 0.01) lower decrease in FFM and RMR when compared with the NPD group. Both groups showed high compliance in following the prescribed diets, without negative impact on renal function.Conclusion PED is more effective than NPD in determining FM loss and is associated with a lower decrease in FFM and RMR, without interfering with renal function in male patients after LSG.

Obese patients with preoperative gout often suffer of gouty attacks after bariatric surgery (BS), probably due to the lack of an adequate postoperative diet. Background: Obese patients with preoperative gout often suffer of gouty attacks after bariatric surgery (BS), probably due to the lack of an adequate postoperative diet. Objectives: The objectives of the study are to assess whether sleeve gastrectomy (SG) is effective in reducing the frequency of gouty attacks and also whether a postoperative low-purine diet (LPD) may further reduce these attacks as compared to a normal-purine diet (NPD) in a series of patients suffering of gout before SG. Methods: In this retrospective study, we measured and compared total body weight (TBW), body mass index (BMI), uric acid levels (UAL), anti-gout medication (allopurinol) requirements, and frequency in gouty attacks in 40 patients that underwent SG and who received either a LPD (n=24) or NPD (n=16). Compliance in following the prescribed diet was assessed in both groups study. Results: Before surgery, LPD and NPD patients had hyperuricemia and were receiving allopurinol. One year after SG, LPD and NPD groups showed a significant decrease in serum UAL (p&nbsp

Background: There is evidence that body composition and resting metabolic rate (RMR) in weight stable patients after Roux-en-Y gastric bypass and duodenal switch is similar to that of nonoperated individuals within the same body mass index (BMI) interval. Currently, data concerning fat mass (FM), fat free mass (FFM), and RMR on weight-stable patients after sleeve gastrectomy (SG) are lacking.Objectives: To assess FM, FFM, and RMR, in a selected and homogenous population of weight stable SG patients (WSSG) and compare them with those obtained from healthy normal weight stable nonoperated (WSNO) volunteers controls of similar sex, age, and BMI.Setting: University hospital, Italy.Methods: We assessed total weight, FM, and FFM by bioelectrical impedance assay, and RIVER by indirect calorimetry, in 70 WSSG patients (47 females, 23 males) at a mean follow-up of 3.2 +/- 2.1 years after SG and compared them with 70 healthy WSNO volunteers, as controls (47 females, 23 males).Results: There was no significant difference between WSSG and WSNO groups concerning total weight (males, 72 +/- 2.66 versus 72.8 +/- 1.99 kg, P = .0254; females 65.1 +/- 2.53 versus 63.7 +/- 2.87 kg, P = .0139), FM (males, 17.7 +/- 1.53 versus 16.7 +/- 1.57 kg, P = .0341; females 19.6 +/- 0.50 versus 18.5 +/- 2.85 kg, P = .0104), FFM (males, 54.3 +/- 3.07 versus 56.1 +/- 3.30 kg; P = .049; females 45.5 +/- 2.29 versus 45.1 +/- 1.13 kg, P = .287), and RMR (males, 1541 +/- 121.3 versus 1463 +/- 74.4 kcal/d; P = .0118; females 1214 +/- 54.9 versus 1250 +/- 90.1 kcal/d, P = .0215).Conclusion: At a mean follow-up of 3.2 2.1 years after SG, WSSG patients of both sexes have a FM, FFM, and RMR comparable to that of healthy WSNO individuals within the same age and BMI interval. These findings further support bariatric surgery-induced weight loss as a physiologic process and indicate that young patients, in the setting of an adequate preoperative and postoperative specific diet and moderate physical activity, do not suffer from excessive FFM depletion after SG in the mid-term. (C) 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Laparoscopic sleeve gastrectomy (LSG) is considered bymost the ideal bariatric procedure because of its simple and straightforward surgical technique that does not include any digestive anastomosis or intestinal bypass. LSG is also considered as a physiologic procedure because the continuity of the digestive tract is respected. For these reasons, SG is currently the most performed bariatric procedure in many countries [1]. Hiatal hernia (HH) is a frequent condition in the obese patient. Type I HH, defined as the migration of the esophagogastric junction (EGJ) into the chest, is the most common form of HH in obese. Type II is characterized from a localized defect in the phrenoesophageal membrane, while the EGJ remains fixed to the preaortic fascia and the median arcuate ligament. Types III and IV refer to the migration of part of the stomach or other viscera, respectively, into the chest through an enlarged hiatal orifice. The main issue of HH in patients undergoing SG is the association between gastroesophageal reflux disease (GERD) and HH. Indeed, although most bariatric surgeons consider the occurrence of leak at the upper part of the staple line theAchilles’ heel of this procedure, the endeavors of the bariatric community have identified some key factors including the size of the endoluminal bougie, the technique of stapling besides the learning curve that have all contributed to the dramatic reduction in the rate of leak [2, 3]. However, the occurrence of Bde novo GERD^ in previously asymptomatic patients as well as the aggravation after LSG of preexisting reflux symptoms has now emerged as a main concern linked to this procedure. The relationship between GERD and LSG is complex andmultifactorial. The LSG implies the dismantling of some anatomic antireflux mechanisms such as the sling fibers, the His angle, and the partial opening of the hiatal orifice depending on how much the dissection is pushed into the hiatal orifice once the lateral border of the left pillar has been identified. Other factors may be responsible for the occurrence of de novo GERD and/or its aggravation including a stricture of the gastric tube either anatomical or functional, the persistence of part of the gastric fundus, and the caliber of the tube that may determine an increased intraluminal pressure in the gastric tube [4].