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Chronic radiation proctitis is a frequent complication after radiotherapy for pelvic malignancies. It is reported that 1 to 5% of patients develop chronic radiation proctitis even with recent advances in external radiotherapy. Hematochezia, mucus discharge, urgency and tenesmus are common symptoms and they can vary in severity but bleeding is often the most debilitating to the patient. Different options are reported for treatment of this condition that always should keep in differential diagnosis in patients with history of pelvic radiotherapy. Treatments range from easy, with topic administration of formalina, to expensive and requiring specialized equipment such as hyperbaric oxygen therapy. Surgery is reserved to patients with failure of conservative treatments due to the high risk of leakage and high morbidity up to 60%. KEY WORDS: Argon beam, Bleeding, Formalin, Radiation, Proctitis, Sucralfate enema.La proctite cronica da radiazioni è una complicanza frequente dopo la radioterapia per le neoplasie pelviche. È stato riferito che l’1-5% dei pazienti sviluppa proctite cronica da radiazioni anche con i recenti progressi nella radioterapia esterna. Ematochezia, secrezione di muco, urgenza e tenesmo sono sintomi comuni e possono variare in gravità, ma il sanguinamento è spesso il più debilitante per il paziente. Diverse opzioni sono riportate per il trattamento di questa condizione che dovrebbe mantenere sempre una diagnosi differenziale nei pazienti con storia di radioterapia pelvica. I trattamenti vanno da soluzioni facili ed economiche come la somministrazione topica di formalina, a costose che richiedono attrezzature speciali come l’ossigenoterapia iperbarica. La chirurgia è riservata ai pazienti con fallimento dei trattamenti conservativi a causa dell’elevato rischio di perdite e dell’elevata morbilità fino al 60%. In questo studio sono riportati due casi di pazienti trattati con radioterapia e con sintomatologia da probabile colite attinica. Entrambi i pazienti sono stati sottoposti a colonscopia ed a trattamento topico e valutazione a distanza. In uno dei casi, visto il perdurare del sanguinamento, è stato necessario eseguire un trattamento con Argon Plasma Coaguletor, per ottenere un risultato definitivo.

We have here studied the relationship between Eustachian tube dysfunction and laryngopharyngeal reflux, evaluating also the results of medical therapy in patients with such problems. Based on clinical, endoscopic and cytological investigations, we found that acid laryngopharyngeal reflux was the basis of audiological symptoms and chronic dysfunction of the Eustachian tube.

The BioEnterics Intragastric Balloon (BIB) and the Spatz Adjustable Balloon System (ABS) are in fact recommended for weight reduction as a bridge to bariatric surgery. We retrospected studied patients with body mass index (BMI) and age ranges of 37–46 and 70–80 years, respectively, who had undergone BIB from January 2010 to July 2012 and prospected studied patients who had undergone Spatz balloon from July 2012 to August 2014. The aim of this study is to compare BIB and Spatz in terms of weight loss, complications, and maintenance of weight after removal. For both procedures, the median weight loss was 20 ± 3 kg, median BMI at the end of the therapy was 32 ± 2, and no severe complication occurred.

Barrett’s Esophagus diagnosis is a combination between an endoscopic suspect and a histological confirmation of endoscopic biopsies showing intestinal metaplasia. Current guidelines codify biopsies protocols but none of these guarantees the recognition of intestinal metaplasia areas: sampling error is an-in-ambush pitfall and misdiagnosis is a concrete possibility.

Ethical and medico-legal issues reviews of Percutaneous Endoscopic Gastrostomy (PEG) placement in elderly patients is an important topic of international medical literature. PEG is often inappropriately placed in patients with not spontaneous oral feeding intake, cause of unrealistic expectations. We performed a critical review of the literature for placement of PEG in geriatric patients.A literature review was performed about the positioning of the PEG in geriatric patients with dementia and severe anorexia. This assessment has served to develop an algorithm that would be able to provide adequate indications for PEG placement in this patient population.We obtained appropriate indications about PEG placement, below: 1) Esophageal obstructions (like esophageal or neck cancer) 2) neurological deficits correlated dysphagia (like ictus sequelae) 3) refusal to swallow without concomitant terminal illness (like protracted pseudo dementia caused by severe depression) 4) chronic gastric decompression in patients with benign/malignant obstruction who do not wish or can't have a nasogastric tube placed.When compared with controls matched for age, elderly patients with cognitive impairment who have feeding gastrostomy do not demonstrate improved survival.Anorexia, Dementia, Elderly, Percutaneous Endoscopic Gastrostomy.I problemi etici e medico-legali del posizionamento della gastrostomia endoscopica percutanea (PEG) nei pazienti anziani sono un argomento importante della letteratura medica internazionale. PEG è spesso posizionato in modo inappropriato in pazienti con assunzione di cibo orale non spontanea, causa di aspettative non realistiche. Abbiamo pertanto eseguito una revisione critica della letteratura sul tela dell’adozione della PEG nei pazienti geriatrici. La revisione della letteratura è stata eseguita concentrandoci sul posizionamento del PEG in pazienti geriatrici con demenza e grave anoressia. Questa analisi è servita a sviluppare un algoritmo che sarebbe in grado di fornire indicazioni adeguate per il posizionamento di PEG in questa popolazione di pazienti. Le indicazioni derivate da questo studio circa l’appropriatezza del posizionamento di PEG, riguardano: 1) ostruzioni esofagee (come il cancro esofageo o al collo); 2) deficit neurologico correlato disfagia (come sequele ictus); 3) rifiuto di deglutire senza malattia terminale concomitante (come pseudo demenza protratto causato da depressione grave); 4) decompressione gastrica cronica in pazienti con ostruzione benigna / maligna che non desiderano o non possono avere una sonda nasogastrica posizionata. In conclusione, se confrontati con i controlli corrispondenti all’età, i pazienti anziani con disabilità cognitiva alimentati con la gastrostomia non hanno dimostrato una migliore sopravvivenza.

Colorectal cancer (CRC) represents the second cause of cancer mortality in Western countries after lung tumors. Its incidence is increasing in Eastern countries too, because of westernization of eating habits and aging of the population. However, since the mid-80s we are seeing a CRC incidence decline in Western countries mainly due to the screening programs. Adenomatous polyps are the most commonly found neoplastic lesions during screening colonoscopy. Patients with adenomas have an increased risk for developing metachronous adenomas or cancers compared with patients without adenomas. Modern guidelines are based on the findings of a randomized trial conducted in 1993 comparing 1-year versus 3-year surveillance intervals after polypectomy (the American National Polyp Study). Likewise, several European countries developed their own guidelines thus pushing the launch of well-organized population-based screening programs. Current American, European, and Korean guidelines for endoscopic surveillance after colorectal polypectomy were published in 2012. Japanese endoscopy society, conversely, has not yet developed specific guidelines and refers to a position statement about management of colorectal polyps, published in 2015.

Background and Aims: In our study, we have analyzed the use of flexible video endoscopy in patients undergoing total laryngectomy and candidates for the placement of a voice prosthesis, with the creation of a tracheo-esophageal fistula in which the prosthesis is positioned, which acts as a valve one-way, which allows the passage of air from the trachea to the oesophagus and prevents the passage of liquids in the opposite direction, allowing the pulmonary air to vibrate a segment of the cervical oesophagus. The use of flexible video endoscopy for the positioning of the prosthesis can be both primary and secondary to the intervention of total laryngectomy. Endoscopy has also been used in the ontological follow-up for the assessment of the hypo pharyngeal-oesophageal-gastric district in the search for relapses or secondary tumors, which may develop in this district in more than 10% of patients with pathological neoplasia. Higher aero-digestive. Methods: We performed a complete esophagogastroduodenoscopy on 36 patients who had total laryngectomy divided into two groups of 18 patients, in group A there were patients who hadalready been prosthetic for at least one year, and in the B group the patients underwent for the first time creation of a tracheo-esophageal fistula. Results: At endoscopy we found three neoplastic recurrences in group A that did not allow the placement of a new prosthesis, in group B we excluded 3 patients who had a grade B esophagitis according to the classification of Los Angeles, in the remaining 15 patients there were minor complications, in particular two patients presented intense inflammatory reaction after the creation of the fistula, one patient had phonatory difficulties, one patient had a progressive deterioration of the phonatory function, which endoscopic control showed was determined by a too short prosthesis. Conclusions: Without a doubt the flexible video endoscopy in recent years has been very widespread, we believe that our experience has confirmed the interesting and beneficial use in patients undergoing total laryngectomy and candidates for the placement of a tracheo-esophageal voice prosthesis, in the evaluation contraindications such as recurrences or secondary neoplasm’s of the oesophagus, and in the presence of reflux esophagitis in patients with hiatal hernia and / or cardiac incontinence.

BACKGROUND: In this study is evaluated the role of Endoscopic Mucose Resectin (EMR) in the treatment of flat lesions and sessile colorectal cancer, diagnosed during colonoscopy and evaluated with Flexible Spectral Imaging Color Enhancement (FICE) and High-frequency Endoscopic Ultrasonography (HFEUS), to determine the invasiveness degree of the colon wall. Colorectal polypoid lesions are not always identified during a colonoscopy. The complete endoscopic resection of intramucosal carcinoma is accepted as curative, when there is a low degree of invasion of the submucosal layer, so evaluation of the infiltration depth submucosa is crucial. For this purpose we used the FICE and HFEUS. METHODS: Forty-seven patients (27 males, 20 females) with lesions of the colorectal polypoid were included in the study. The localization of the tumor, the shape, the size and penetration have been determined by endoscopy and endoscopic ultrasound, before performing a mucosectomy intervention. RESULTS: The comparison between FICE and HFEUS magnification revealed significant differences in the sensitivity, specificity, positive predictive value and negative predictive value between the two techniques. Mucosectomy was performed successfully in 45 patients, it was not able to proceed in 2 patients endoscopically, for failure to lift, and were subjected to surgical resection, revealing adenocarcinoma T2 in both cases. There was a complication with bleeding endoscopically treated. CONCLUSIONS: Non-polypoid colorectal lesions and cancers at an early stage can be treated with endoscopic resection. The colonic adenomas are considered as precursors of most colorectal cancers. Certainly early diagnosis and endoscopic treatment can reduce mortality from colorectal cancer. The most used techniques include endoscopic polypectomy for resection of the polypoid lesions and the EMR (EMR) for the treatment of sessile lesions. EMR is a safe procedure for the treatment of carcinomas in situ too. Many authors have demonstrated the effective implementation of the EMR technique in colorectal cancers with results comparable to surgical procedures. In this study we assessed the usefulness of EMR for the treatment of neoplastic colorectal flat and sessile, evaluated for the degree of invasion of the wall with FICE and HFEUS.

Placement and removal of the intragastric balloon for obesity are performed endoscopically often under general anesthesia. We propose a safer and faster technique for endoscopic removal of the intragastric balloon using standard sedation. In 87 obese patients, we performed 3 removal techniques: 1) standard gastroscope and foreign body forceps, 2) standard gastroscope and retrieval snare, 3) double-channel gastroscope and foreign body forceps plus symmetrical “shark model–polypectomy snare. Balloon retrieval time, number of times the grasping devices lost the balloon, amount of antispasmodic drug, symptoms cumulative score and VAS score for discomfort were evaluated. The technique by double-channel gastroscope and foreign body forceps plus symmetrical polypectomy shark retrieval snare showed a significantly lower balloon retrieval time, number of lost balloons, total number of ampoules used, symptoms cumulative score and VAS score compared to the other two techniques (Dunn’s P–lt;–.05). Number of lost balloons was positively associated with number of antispasmodic ampoules used, balloon retrieval time and VAS score. Technique by double-channel gastroscope and foreign body forceps plus symmetrical polypectomy shark retrieval snare, allows balloon removal safely, quickly and easily, avoiding loss of the balloon, with good patient endurance.

Background and study aims: Thermal injury of the colonic wall during polypectomy may induce complications such as bleeding and perforation. To date, the role of the snare material in these injuries has not been examined. The aim of this study was to evaluate the depth of colonic post-polypectomy thermal wall injury induced by tungsten and steel endoscopic snares, in an effort to reduce electrosurgery-related complications. Materials and methods: This was a single tertiary center experimental study in a porcine model. A total of 90 polypectomies where performed in three live pigs under general anesthesia, using both steel and tungsten snares by cut, coagulation, and blend current modes. The pigs were then euthanized and their colons examined histologically. Results: Steel snares induced significantly deeper tissue injury than tungsten snares in the pure cut mode (Pearson χ 2 = 6.136, P = 0.013). The ordinal logistic regression analysis showed that the current mode and snare material were significantly associated with the ordinal score for the depth of injury. Thus, cut mode was positively associated with a lower score and coagulation mode with a higher score. In addition, tungsten was significantly associated with a lower depth of tissue injury. Conclusions: Due to its inherent electrical properties, tungsten is very well suited for manufacture into electrosurgical endoscopic devices. Thus, tungsten snares may be advantageous for routine use in endoscopic polypectomy, although further studies are needed to confirm these promising findings in human patients.

Aim: Establishing by statistical analyses whether the analyses of auto-modified poly(ADP-ribose)polymerase and erythrocyte membrane fatty acid composition (Fat Profile®), separately or in tandem, help monitoring the physio-pathology of the cell, and correlate with diseases, if present. Patients & methods: Ninety five subjects were interviewed and analyzed blindly. Blood lymphocytes and erythrocytes were prepared to assay poly(ADP-ribose)polymerase automodification and fatty acid based membrane lipidome, respectively. Results: Poly(ADP-ribose)polymerase automodification levels confirmed their correlation with DNA damage extent, and allowed monitoring disease activity, upon surgical/therapeutic treatment. Membrane lipidome profiles showed lipid unbalance mainly linked to inflammatory states. Statistically both tests were separately significant, and correlated each other within some pathologies. Conclusion: In the laboratory routine, both tests, separately or in tandem, might be a preliminary and helpful step to investigate the occurrence of a given disease. Their combination represents a promising integrated panel for sensible, noninvasive and routine health monitoring.

The authors evaluated the role of endoscopic techniques in the diagnosis and in the potential treatment of neuroendocrine tumors (NET) localized in the gastro-entero-pancreatic system, on the basis of their experience and of the international literature. NET are rare tumors that arise from neuroendocrine cells of the gastrointestinal tract and pancreas. It is a possibility that both the digestive endoscopy and EUS play an important role in the diagnosis, staging and surveillance of this disease. In some cases, especially in the early stages, surgical endoscopy allows the treatment of such tumors.

The presence of trans fatty acids in mammalians is attributed to exogenous sources; nevertheless, trans isomers could be easily formed by free radical-catalyzed isomerization processes in vivo. The isomerization of methyl arachidonate (all-cis isomer) catalyzed by thiyl radical is proposed as a methodology applicable in biochemical laboratories, which produces mono- and di-trans isomers. Carbon-13 nuclear magnetic resonance spectroscopy shows that the carbon atom in position 15 is characteristic for each mono- and di-trans isomer. Antioxidants, such as α-tocopherol and all-trans-retinol acetate, inhibited the isomerization process. Trans phospholipids are formed in erythrocyte membranes by exposing blood to γ-irradiation in the presence of thiols, which is in contradiction with the known role of these compounds as radioprotectors. Trans isomers are also analyzed in tissues harvested from breast cancer patients and compared to the adipose breast tissue taken a few centimeters from the edge of the tumor from the same patient. This work is generally aimed at contributing to the debate on trans fatty acids and stimulating a reconsideration of the current view on the exclusive presence of cis double bonds in cell membranes by studying radical processes that could affect or protect this natural configuration.

After publication of our article [1], it has come to our attention that Professor Cesare Formisano was incorrectly excluded from the list of authors in the initial version of this manuscript. We publish this correction to update the author list to include Professor Formisano as an author. The correct author list is as follows

Poly(ADPribosyl)ation, catalysed by poly(ADP-ribose)polymerases, affects many cellular events and has a recognized epigenetic role. Nuclear poly(ADP-ribose)polymerases 1 and 2 are hyper activated by DNA strandbreaks. They auto-modify with large polymers of ADP-ribose and recruit DNA repair proteins. The more the DNA strand-breaks, the more poly(ADP-ribose) polymerase modifies itself. On the other hand, dietary lipids can be signaling molecules, lead to pro-(ω6)/ anti-(ω3) inflammatory compounds, and be included in biomembranes, good biomarkers of their unbalance. Here, we report the results obtained from an epidemiological study to establish whether the combination of two different analyses, i.e. detecting auto-modified poly (ADP-ribose) polymerase levels and analyzing erythrocyte membrane fatty acid composition, might help to monitor the physio-pathological state of the cell, and to correlate with lifestyle, diet or diseases. The two analyses were carried blindly on 70 subjects undergoing endoscopy. They were first interviewed, to collect anamnesis and clinical data, if present. Lymphocytes and erythrocytes were prepared from venous blood to assay poly (ADP-ribose) polymerase auto modification and membrane fatty acid content, respectively. The results were statistically evaluated. The measure of poly (ADP-ribose) polymerase automodification confirmed that its levels correlate with DNA damage extent, within the same pathology, and allowed to monitor the clinical activity of the disease, depending on ongoing therapeutic/surgical treatment. Membrane fat profile was able to evidence unbalance of lipids linked to both diet/lifestyle and inflammatory states leading to diseases. Both analyses provide possible biomarkers for sensible, non-invasive and routine monitoring.

Background Fibroadenomas are the second most common breast pathology occurring in young women under the age of 35 years old. Fibroadenomas can be classified as simple or complex according to histological features. Complex fibroadenomas differ from simple fibroadenomas because of the presence of cysts (3 mm), sclerosing adenosis, epithelial calcifications, or papillary apocrine changes. Most fibroadenomas are clinically identifiable. In 25% of cases, fibroadenomas are non-palpable and are diagnosed with mammography and ultrasound. Differential diagnosis with well differentiated breast cancer is often necessary, particularly with medullary or mucinous tumors. Calcification findings within fibroadenomas by mammogram have to be investigated. The age of a lump is usually reflected by calcifications. Microcalcification can hide foci of carcinoma in situ when they are small, branching type, and heterogeneous. However, many morphological possibilities may not be reliable for deciding whether a certain calcification is the product of a malignant or a benign process. From a radiological point of view, fibroadenomas containing foci of carcinoma in situ can be indistinguishable from benign lesions, even if the incidence of carcinoma within fibroadenomas is estimated as 0.1–0.3%, and it could be a long-term risk factor for invasive breast cancer. Case presentation A 44-year-old woman presented with a 1.5-cm palpable, smooth, mobile lump in the lower-inner quadrant of her right breast. Standard mediolateral oblique and craniocaudal mammograms showed a cluster of eccentric popcorn-like calcifications within the fibroadenoma. After lumpectomy, a definitive histological examination confirmed the intra-operative diagnosis of a benign mass. However, lobular intraepithelial neoplasia foci were found, surrounded by atypical lobular hyperplasia. Conclusions The possibility of an old benign breast lump might be supported by fine needle aspiration biopsy or core biopsy before initiating follow-up. According to our experience, when patients are older than 40 years and have a familial history of breast cancer, we prefer to carry out lumpectomy with follow up to avoid the risk of underestimation in situ foci within the lump.

We analysed the differential expression pattern of the three distinct TAG-72 carbohydrate epitopes detected by monoclonal antibodies (MAbs) B72.3, CC83 and CC49 in a consecutive series of 114 patients with primary breast cancer and in 39 synchronous lymph node metastases. B72.3, CC83 and CC49 were expressed in respectively 81 (71\%), 68 (60\%) and 96 (84\%) of the 114 cases. Interestingly, MAb B72.3 was significantly expressed in a subgroup of patients characterised by larger tumour size (p=0.013), lymph node metastasis (p=0.0002), high histopathological grade (p=0.006), high cell kinetics (p=0.04) and advanced clinical stage (p=0.0019). In 20 (51\%) of the 39 pairs of matched primary breast cancers and synchronous lymph node metastases, TAG-72 was expressed in the tumour but not in the corresponding metastatic lymph node; tumours with TAG-72-negative lymph nodes appeared to be clinicopathologically more aggressive. CC49, the most immunoreactive and widely used MAb, was not detected in 34\% of the metastases of expressing primary tumours. All three MAbs were found in a significantly lower per cent of synchronous metastases with respect to primary tumours (p

Surgery for rectal cancer is impaired by a significant risk of perioperative morbidity, urinary and sexual disfunction due to nerve injuries and, obviously, the possibility of a temporary or even a permanent stoma. In order to mitigate the sequelae of such a major surgery, trans-anal local excision has been proposed in selected cases to treat rectal cancer. Aim of this prospective study is to investigate which patients might get a benefit from this less invasive treatment, evaluating both oncological and functional results.

Ductal carcinoma in situ (DCIS) is a proliferation of presumably malignant epithelial cells within the ducto-lobular units of the breast without evidence by light microscopy of invasion trough the basement membrane in to the surrounding stroma. DCIS presents as a heterogeneous group of lesions with different clinical presentation, histologic features and malignant potential. DCIS patients have an increased risk of developing an ipsilateral invasive breast cancer, generally within the same quadrant as the initial DCIS. Before the mammographic era the frequency of DCIS was 1-5% of all breast cancer, now DCIS represents between 15-25% of newly reported breast cancer diagnosis. For most of the 20 century the major of patients with DCIS were symptomatic, palpable mass or nipple discharge, bloody or serous.With development and utilization of high quality mammography during the last 20 years the number of new cases of DCIS is increased rapidly and presentation changes. Today most patients with DCIS present with nonpalpable lesions (microcalcifications) and without symptoms. Percutaneous core biopsy with dedicated table represent the most important option to detecting DCIS. It is clearly less invasive, offers better cosmesis and is less expensive than open surgical biopsy. Diagnosis of DCIS by core biopsy offers the opportunità for planning the treatment of choice for DCIS patients. The goal of treatment of DCIS is breast conservation with optimal cosmesis and a minimum risk of subsequent invasive or in situ recurrence. There are some for whom mastectomy remains the optimal treatment but most women with DCIS are candidate for breast conservation. A minority of patients with DCIS requires mastectomy, probably less than 25% but mastectomy could be performed if it were the patient’s preference. Breast conservation for DCIS implies: • post excision mammographic control, this step could be avoided only if the specimen radiograph performed at the time of the initial surgery show that all the suspicious calcifications are well within the excised tissue and that the margins are widely clear macroscopically; • radiation therapy, follow-up alone or tamoxifen is an optimal treatment. Clinical trials have shown that local excision and radiation therapy in patients with negative margins provides excellent rates of local control. Patients treated by excision alone have grater chance of local failure. The available data indicate that the likelihood of developing invasive cancer of the breast following breast conservation with or without radiation is approximately 1% or less for year following the initial diagnosis and treatment of DCIS. Although adding radiation therapy to wide local excision benefits all groups of DCIS patients the magnitude of that benefit may be small. However patients who may avoid radiation therapy have not be reproducibly and really identified by any clinical trials. Clear surgical margins are a major criterion for treatment of DCIS (whether or not RT is employed). 10 mm margin represents the best compromise between removal of so match tissue that the cosmetic result would be less than desirable and the likelihood of local recurrence. An axillary dissection is not requie in patients with DCIS; the incidence of axillary metastases is so infrequent that this possibility should not provoke a therapeutic option to dissect the axilla. The role of sentinel node biopsy is controversial. If, by definition, DCIS does not spread to lymph nodes, a procedure to address lymph nodes status should not be necessary. The addition of tamoxifen, 20 mg daily decreases the incidence of both in situ or invasive cancer recurrence. No overall survival benefits were observed in patients with DCIS related any form of treatment. In conclusion the treatment of DCIS is constantly being refined, and the observations and recommendations, made at any time may be influenced by new data reported almost contemporaneously as well as in the future.

Monounsaturated fatty acids (MUFA) are emerging health biomarkers, and in particular the ratio between palmitoleic acid (9cis-16:1) and palmitic acid (16:0) affords the delta-9 desaturase index that is increased in obesity. Recently, other positional and geometrical MUFA isomers belonging to the hexadecenoic family (C16 MUFA) were found in circulating lipids, such as sapienic acid (6cis-16:1), palmitelaidic acid (9trans-16:1) and 6trans-16:1. In this work we report: i) the identification of sapienic acid as component of human erythrocyte membrane phospholipids with significant increase in morbidly obese patients (n = 50) compared with age-matched lean controls (n = 50); and ii) the first comparison of erythrocyte membrane phospholipids (PL) and plasma cholesteryl esters (CE) in morbidly obese patients highlighting that some of their fatty acid levels have opposite trends: increases of both palmitic and sapienic acids with the decrease of linoleic acid (9cis,12cis-18:2, omega-6) in red blood cell (RBC) membrane PL were reversed in plasma CE, whereas the increase of palmitoleic acid was similar in both lipid species. Consequentially, desaturase enzymatic indexes gave different results, depending on the lipid class used for the fatty acid content. The fatty acid profile of morbidly obese subjects also showed significant increases of stearic acid (C18:0) and C20 omega-6, as well as decreases of oleic acid (9cis-18:1) and docosahexaenoic acid (C22:6 omega-3) as compared with lean healthy controls. Trans monounsaturated and polyunsaturated fatty acids were also measured and found significantly increased in both lipid classes of morbidly obese subjects. These results highlight the C16 MUFA isomers as emerging metabolic marker provided that the assignment of the double bond position and geometry is correctly performed, thus identifying the corresponding lipidomic pathway. Since RBC membrane PL and plasma CE have different fatty acid trends, caution must also be used in the choice of lipid species for the interpretation of lipidomic profiles. Copyright: CC BY