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Few studies compare the efficacy of the key bariatric procedures in type 2 diabetes management over the long term. None offer a reliable comparison of their respective efficacy loss over time. To analyze and compare the time evolution of the antidiabetic effects of the key bariatric procedures. Obesity surgery departments in America, Europe, and Asia. All the randomized clinical trials assessing the efficacy of bariatric surgery in type 2 diabetes management with 1–5 years of follow-up were reviewed. A network meta-analysis with meta-regression was performed to compare the effectiveness of each technique and its respective efficacy loss temporal dynamics. Thirty-one trials involving 1906 patients were included. In comparison to Roux-en-Y gastric bypass, the 5-year complete or partial diabetes remission rates were inferior with medical treatment (odds ratio [OR] =.05; 95% credible interval [CrI]:.02–.13) and gastric banding (OR =.38; 95% CrI:.16–.87), equivalent with sleeve gastrectomy (OR = 1.08; 95% CrI:.59–1.97), and superior with 1 anastomosis gastric bypass (OR = 3.00; 95% CrI: 1.12–8.33) and biliopancreatic diversion and its affiliated techniques (OR = 3.71; 95% CrI: 1.16–12.55). However, remission rates and glycemic control progressively decreased whatever the treatment option evaluated. Moreover, this loss of efficacy followed a statistically comparable temporal dynamic to those of Roux-en-Y gastric bypass regardless of the therapeutic strategy implemented. No therapeutic modality offered stable antidiabetic effects. The gap observed between the techniques after a 5-year follow up concerning remission rates and glycemic control could depend essentially on the magnitude of the effects initially obtained. However, these results need to be confirmed over longer follow-up periods. • Diabetes remission time evolution is analyzed by a meta-analysis with meta regression • The temporal dynamics of loss of efficacy is equivalent whatever the surgery • No surgery offers stability for diabetes remission rates over time • Long term outcomes may mostly depend on the surgery initial effects on A1C and FPG [ABSTRACT FROM AUTHOR]

Background The feasibility, safety, and efficacy of programs for enhanced recovery after bariatric surgery (ERABS) are now well established. However, data concerning their large-scale implementation remain insufficient. Objectives The objective of the present study was to review the multicenter implementation of ERABS Setting This retrospective analysis of a prospective database was conducted in 15 Groupe francophone de Rehabilitation Améliorée après ChirurgiE centers from data from March 2014 to January 2017. Methods The Francophone working Group for Enhanced Recovery After Surgery (Groupe francophone de Rehabilitation Améliorée après ChirurgiE) edited and released protocols of ERABS for its members. Compliance with ERABS, lengths of hospital stay, and postoperative morbidity were obtained from the Groupe francophone de Rehabilitation Améliorée après ChirurgiE–audit database. Results In this study, 1667 patients were included. Procedures were sleeve gastrectomy (n = 1011), gastric bypass (n = 300), or mini-bypass (n = 356). Mean body mass index was 41.8 ± 8.3 kg/m 2 . Global morbidity was 2.57%, and surgery-related morbidity was 1.67% (mostly anastomotic leakages and hemorrhage). Mean length of hospital stay was 2.4 ± 3.6 days. Overall compliance was 79.6%. Among the 23 elements of the ERABS program, 14 were applied in>70% of instances, 6 in between 50% and 70%, and 3 in<50%. The elements least often applied were limb intermittent pneumatic compression during surgery (23.3%), multimodal analgesia (49.5%), and optimal perioperative fluid management (43.8%). Conclusion This study shows that even if the overall compliance was good, the large-scale implementation of ERABS can still be improved, as several elements remain insufficiently applied. This finding highlights the importance of thorough, continuous training in addition to the need for repeated audits by centers involved in ERABS programs. [ABSTRACT FROM AUTHOR]

Abstract: INTRODUCTION: Intestinal malrotations are rare and may be asymptomatic until adulthood. There are only a few descriptions of gastric bypass with intestinal malrotation. If the duodenojejunal angle is not correctly seen, as is generally the case, there is a risk of creating an antiperistaltic anastomosis. PRESENTATION OF CASE: We describe required attitude and cases of gastric bypass performed on two patients who had a complete common mesentery. In both of our patients, the transverse colon was not running across the abdomen and the duodenojejunal angle was “absent”. We therefore looked for the caecum in order to unravel all of the small intestine. We were able to carry out Roux en Y gas- 42 tric bypass with uncomplicated post-operative courses for both 43 patients. The result in weight loss was perfect and identical to that of patients without anatomical abnormality. DISCUSSION: In our cases, ultrasound to investigate for gallstones did not provide a pre-operative diagnosis. It is extremely difficult to investigate for the mesenteric vessels by ultrasound in obese patients and for this reason the finding was not made preoperatively. The most important thing to do is make the diagnosis of malrotation preoperatively. For this reason the golden rule in performing a gastric bypass is to clearly visualise the duodenojejunal angle which allows an unknown bowel malrotation to be identified. Following these cases, the study of the oeso-gastro-jejeunal transit is now part of our pre-operative assessment. CONCLUSION: Bariatric surgeons need to be aware of these abnormalities. If a common mesentery is present the gastric bypass can still be performed. [Copyright &y& Elsevier]

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Abstract: We report the case of a 58-year-old man presenting with successive development of two uncommon tumors of soft tissue in the gastric location. The initial histological examination diagnosed a gastrointestinal stromal tumor (GIST) which was treated by surgical resection. Two years later a new tissue infiltration appeared at this surgical site. Our hypothesis suggested a GIST recurrence, but histological examination and genetic analysis diagnosed a desmoid tumor. Association of these two rare tumors localised at the same site has never been described. [Copyright &y& Elsevier]

It is a challenge to manage patients with ulcerative proctitis (UP) refractory to standard therapy. We investigated the effectiveness of tumor necrosis factor (TNF) antagonists in a large cohort of patients with refractory UP. We conducted a nationwide retrospective cohort study of 104 consecutive patients with active UP refractory to conventional therapies, treated at 1 of 15 centers in France or 1 center in Belgium (the GETAID cohort). Patients received at least 1 injection of anti-TNF (infliximab, adalimumab, golimumab) from October 2006 through February 2017. Clinical response was defined as significant improvement in UC-related symptoms, and remission as complete disappearance of UC-related symptoms, each determined by treating physicians. We collected demographic, clinical, and treatment data. The median duration of follow-up was 24 months (interquartile range, 13–51 months). The primary outcome was clinical response of UP to anti-TNF treatment. Overall, 80 patients (77%) had a clinical response to anti-TNF therapy and 52 patients (50%) achieved clinical remission. Extra-intestinal manifestations (odds ratio OR, 0.24; 95% CI, 0.08–0.7), ongoing treatment with topical steroids (OR, 0.14; 95% CI, 0.03–0.73), and ongoing treatment with topical 5-aminosalycilates (OR, 0.21; 95% CI, 0.07–0.62) were significantly associated with the absence of clinical remission. Sixty percent (38/63) of the patients who had endoscopic assessment during follow up had mucosal healing. Among the overall population (n = 104), the cumulative probabilities of sustained clinical remission were 87.6% ± 3.4% at 1 year and 74.7% ± 4.8% at 2 years. In a retrospective study of 104 patients with refractory UP, anti-TNF therapy induced clinical remission in 50% and mucosal healing in 60%. About two thirds of the patients were still receiving anti-TNF therapy at 2 years. [ABSTRACT FROM AUTHOR]

Abstract: This study evaluates the influence of both dietary protein and methionine on amino acid trans- and deamination (alanine aminotransferase, ALAT and glutamate dehydrogenase, GDH) in three tissues (muscle, hepatopancreas, gills) of the marine black tiger shrimp (Penaeus monodon). Shrimp (2.4g) were fed one of the six semi-purified diets containing 14, 34 or 54% crude protein (% dry matter) with two levels of methionine (normal or 30% reduced) for 6weeks. Both ALAT and GDH activities were the highest in the muscle. ALAT activity in muscle significantly decreased when feeding the low vs. high protein diets. Compared to those fed the intermediate protein level, GDH activity in muscle decreased (by 35%) when fed the low and increased (by 26%) when fed the high protein diets (P<0.05). A significant interaction between dietary protein and methionine was observed on GDH activity in gills which, due to the relative methionine deficiency, increased 4-fold at the intermediate protein level. In summary, our results demonstrate for the first time the capacity of up and downregulation of enzyme activity by dietary protein levels in the muscle of P. monodon, and the active role played by branchial tissue in ammoniogenesis in response to a relative indispensable amino acid (methionine) deficiency. [ABSTRACT FROM AUTHOR]

Background/Aims: The aim of this study was to identify human liver proteins that are associated with different stages of liver development. Methods: We collected liver samples from 14 fetuses between 14 and 41 weeks of development, one child and four adults. Proteins which exhibited consistent and significant variations during development by two-dimensional differential in gel electrophoresis (2D-DIGE) were subjected to peptide mass fingerprint analysis by MALDI-TOF mass spectrometry. Real-time PCR analysis confirmed, at the transcriptional level, the data obtained by the proteomic approach. Results: Among a total of 80 protein spots showing differential expression, we identified 42 different proteins or polypeptide chains, of which 26 were upregulated and 16 downregulated in developing in comparison to adult liver. These proteins could be classified in specific groups according to their function. By comparing their temporal expression profiles, we identified protein groups that were associated with different developmental stages of human fetal liver and suggest that the changes in protein expression observed during the 20- to 36-week time window play a pivotal role in liver development. Conclusions: The identification of these proteins may represent good markers of human liver and stem cells differentiation. [Copyright &y& Elsevier]

Isolated paroxysmal atrial fibrillation (AF) is commonly associated with left ventricular (LV) diastolic dysfunction but normal radial systolic contraction. We aim to investigate LV systolic function more precisely using 2-dimensional strain technique in patients with isolated paroxysmal AF and to evaluate evolution of longitudinal, circumferential, and radial (or transverse) strain components after catheter ablation of AF. Thirty patients with isolated paroxysmal AF were investigated by echocardiographic studies before and at 1-day, 1-month, 6-month, and 12-month intervals after radiofrequency ablation. Left heart dimensions and LV systolic and diastolic functions were evaluated at each time interval. LV systolic function was quantified by LV ejection fraction and by 2-dimensional strain evaluation, giving regional and global longitudinal, circumferential, transverse, and radial peak of percentage deformation. Patients with AF were compared with 30 control subjects, paired by age and by sex. Before AF ablation, LV ejection fraction, transverse and radial strains were not significantly different from control subjects. By contrast, global longitudinal and circumferential strains were significantly lower than controls (−17.7% ± 2.4% vs −21.5% ± 2.0% [p <0.01] and −16.0% ± 2.9% vs −20.7% ± 3.4% [p <0.01], respectively). At the end of follow-up, global longitudinal and circumferential strains were significantly improved (−20.8% ± 2.6% vs −17.7% ± 2.4% (p <0.01) and −18.5% ± 3.1% vs −16.0% ± 2.9% [p <0.05], respectively). Global longitudinal strain was not significantly different from normal control subjects at the end of follow-up. In conclusion, this prospective study demonstrates (1) the existence of early longitudinal and circumferential LV systolic function abnormalities in patients with isolated paroxysmal AF but normal ejection fraction and (2) reverse remodeling of these abnormalities after AF ablation. [Copyright &y& Elsevier]

Abstract: To improve the investigation of the role of human memory B lymphocytes following hepatitis B virus (HBV) infection or vaccination, we developed a method to characterize circulating memory B cells specific to hepatitis B surface antigen (HBsAg). Our approach combined: (1) purification of CD19+ cells, (2) CD40–CD40L polyclonal stimulation, and (3) enumeration of memory B cells differentiated into anti-HBs antibody (Ab)-secreting cells (HBs-SCs) by a HBs-ELISPOT assay. In this way, HBs-SCs were detected in 17 HBsAg-vaccinated and nine HBV-immunized subjects including four individuals with serum anti-HBs Ab levels <10 mIU/ml, but not in six controls. IgG+, IgA+ plus IgM+ HBs-SCs, representing 5–1736 cells/106 circulating B cells and 0.02–0.58% of total immunoglobulin-SCs generated by the B cell polyclonal stimulation, were counted by an Ig two-colour ELISPOT assay. In addition, anti-HBs Abs were found in 8/15 supernatants recovered from B cell cultures which contained HBs-SCs, suggesting that the HBs-ELISPOT assay is more reliable in tracking HBsAg-specific memory B cells than ELISA measurement of anti-HBs Abs secreted in supernatants. This new approach could be useful to explore the presence and the longevity of HBsAg-specific memory B cells in vaccinated and immunized subjects, in chronic HBV infection and after liver transplantation for HBV-related disease. [Copyright &y& Elsevier]