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Purpose The variables possibly enabling the prediction of gastric wall thickness during laparoscopic sleeve gastrectomy remain undetermined. The aim of the study was to identify preoperative factors affecting gastric wall thickness in patients undergoing laparoscopic sleeve gastrectomy. Methods The measurements of the double-wall thickness of gastric specimen excised during sleeve gastrectomy were taken at three locations after 15 s of compression with an applied pressure of 8 g/mm2. Statistical calculations were used to determine the influence of preoperative weight loss and other perioperative parameters on gastric wall thickness. Results The study involved one hundred patients (78 female; 22 male). The thickest tissue was observed at the antrum with the mean value 2.55 mm (range 1.77–4.0 mm), followed by the midbody, mean 2.13 mm (range 1.34–3.20 mm), and the fundus, mean 1.69 mm (range 0.99–2.69 mm). Positive relationships were found between gastric wall thickness and both preoperative weight loss and age in all three measured locations; p Conclusion Preoperative weight loss should be considered an important factor influencing gastric wall thickness. Age and gender can also be helpful in predicting the varying tissue thickness. Anatomical region is a key factor determining thickness of the stomach walls.

Vertebral compression fractures (VCFs), which are a complication of osteoporosis, often cause diagnostic and therapeutic difficulties. The aim of this study was to find association between the characteristics of VCFs and the symptomatic status of patients.The study involved a total of 437 women with diagnosed postmenopausal osteoporosis (193 with at least one compression fracture and 244 without VCFs). To identify VCFs, all patients underwent morphometry using dual-energy X-ray absorptiometry. Based on the history of VCFs, subjects were divided into two groups: with symptomatic (n=59) and asymptomatic (n=134) VCFs.Each patient had, on average, 2.03 ± 1.50 VCFs. Patients with VCFs were older [p0.001] and shorter [p0.001] than those without VCFs. VCFs located in the thoracic spine and the lumbar spine occurred with similar frequency (p=0.112). Multiple fractures in both spine segments (50.13%) were more frequent than fractures limited to only one section of the spine, either thoracic (22.76%) or lumbar (27.11%). The decreasing number of subjects was exponentially associated with the increasing number of VCFs (p0.001). Symptomatic patients compared to asymptomatic patients had a higher serum concentration of 25-hydroxyvitamin D, and lower serum activity of alkaline phosphatase (p0.01; p0.005, respectively). In the lumbar spin, the risk of symptomatic VCFs was more than twofold higher compared to asymptomatic VCFs (p0.001, OR=2.57, 95% CI: 1.57-4.19). Symptomatic status depended on the number of lumbar VCFs (p0.001, OR=2.47, 95% CI: 1.68-3.63), as well as higher T-score L1-L4 (p=0.009, OR=1.43, 95% CI: 1.09-1.88).Patients' symptomatic status depends on the location and number of VCFs, as well as T-score L1-L4.

Introduction: Osteoporosis leads to an increased risk of vertebral compression fractures (VCFs). Most of them are spontaneous, which makes early diagnosis difficult. The aim of the study was to find parameters that distinguish osteoporotic women with and without vertebral compression fractures. Material and methods: A total of 437 women with postmenopausal osteoporosis were enrolled to the study. Based on the results of densitometric vertebral fracture assessment, patients were divided into 2 groups: with (n = 193) and without (n = 244) VCFs. Then selected anthropometric, laboratory, and densitometric parameters as well as questionnaire data were compared. Results: The following distinguishing factors were found among patients with VCFs in comparison to patients without such fractures: older age — 73.93 years vs. 69.63 years [p(1) < 0.001, p(2) < 0.001], shorter height — 1.56 m vs. 1.58 m [p(4) < 0.001], lower value of glomerular filtration rate (GFR) according to Cockcroft-Gault formula — 58.22 mL/min. vs. 66.25 mL/min. [p(1) < 0.025, p(2) = 0.002], lower peripheral blood haemoglobin and serum albumin concentration (OR = 1.24, 95% CI: 1.02–1.51, p(5) = 0.03; OR = 2.29, 95% CI: 1.09–4.80, p(5) = 0.03, respectively), and higher 10-year risk of major osteoporotic fracture (FRAX MOF) –12.01% vs. 9.69% [p(1) < 0.01, p(2) < 0.001] and hip fracture (FRAX HIP) — 3.85% vs. 2.55% [p(1) < 0.01, p(2) < 0.001]. In addition, among patients with VCFs a greater severity of back pain was found in the 11-grade scale of pain intensity — 6.12 vs. 4.29 [p(1) < 0.001, p(2) < 0.001, p(3) < 0.001]. The bone mineral content (BMC) and bone mineral density (BMD) of the hip were lower in patients with VCFs — 25.25 vs. 26.2 g and 0.72 g/cm 2 vs. 0.75 g/cm 2 , respectively [p(4) = 0.04 and p(4) < 0.001, respectively]. Conclusions: Patients with VCFs were characterised by greater back pain intensity, higher fracture risk according to the FRAX calculator, and lower values of the following: GFR according to Cockcroft-Gault formula, peripheral blood haemoglobin and serum albumin concentration, and BMD of the hip. Further studies are required to validate the FRAX calculator to assess not only the risk of future fractures but also unrecognised VCFs.

Background The aim of the study was to assess changes in body composition in patients subjected to laparoscopic sleeve gastrectomy (LSG). Methods Changes in body composition following LSG were determined in a group of 155 patients with obesity (117 women and 38 men), with dual-energy X-ray absorptiometry (DXA). Whole body fat mass (FM) and lean body mass (LBM) were determined, and abdominal fat mass (AbdF) was assessed within the region extending from the top of the pubic bone up to the line between 12th thoracic and 1st lumbar vertebras. Results Over the period of 12 months following LSG, body mass index decreased by 28.2 ± 9.0% (p p p p p p Conclusions Over the period of 12 months following LSG, the reduction of FM was more than twice as much as decrease of LBM. The loss of AbdF was slower than a loss of peripheral subcutaneous fat.

BACKGROUND The incidence of unspecific back pain and osteoporotic vertebral compression fractures increases significantly with age. Considering the difficulties in the diagnosis of spontaneous osteoporotic vertebral fractures, this retrospective study aimed to compare the characteristics of back pain in women with postmenopausal osteoporosis with and without vertebral compression fractures. MATERIAL AND METHODS This study enrolled 334 women with postmenopausal osteoporosis; 150 had vertebral fractures, and 184 had no vertebral fractures. Densitometric vertebral fracture assessment and bone mineral density measurements in the central skeleton were performed for each patient. The participants completed a survey about features of their back pain. RESULTS Patients with vertebral fractures had more severe back pain based on the numeric rating scale: 6.14 vs. 4.33 (P

Background Obesity is recognized as a major health problem. Vitamin D is involved in maintaining energy metabolism by regulation of glucose transporters, uncoupling proteins, and normal brain function. We aimed to explore a relationship between impulsivity, eating behaviors, and 25-hydroxyvitamin D concentration in a sample of 322 bariatric surgery candidates. Methods Participants completed a questionnaire on their health, eating habits and The Eating Disorders Examination-Questionnaire (EDE-Q). Impulsivity was evaluated with the Barratt Impulsiveness Scale (BIS-11). Blood samples were obtained to measure levels of 25(OH)D, lipids (cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol), and glucose. Results Overall scores on the BIS-11, along with scores on the Attentional Subscale of the BIS were significantly higher in participants with higher frequency of snack food consumption. Scores on the Attentional Subscale of the BIS were higher in participants who self-reported eating in response to emotions. Participants who reported eating at night or declared intense emotions associated with a desire-to-eat had the highest global, attentional, and non-planning impulsivity levels. Scores on the Non-planning Subscale of the BIS-11 were elevated in participants with 25-hydroxyvitamin D concentrations lower than 10 ng/ml. Conclusions The results suggest that the higher level of impulsivity among the patients with obesity is associated with eating habits, and support the hypothesis that vitamin D deficiency may contribute to impulsiveness.

Background Patients who are slated for bariatric surgery vary in terms of their age at onset of obesity, duration of obesity, and their health complications. Therefore, we aimed to explore a relationship between the age at onset of obesity, metabolic parameters, and health problems in bariatric surgery candidates. Methods A total of 469 unrelated adults with obesity prior to bariatric surgery were included in this study. The study group consisted of 246 individuals who became obese

Introduction Interaction between obesity and genetic factors involved in the regulatory pathways of glucose homeostasis may play a significant role in diabetes development in the obese. The aim of this study was to investigate the associations between the TCF7L2 rs7903146 polymorphism, adiponectin levels, age at onset of obesity and the occurrence of type 2 diabetes (T2D) in a sample of obese Polish adults. Material and methods A total of 474 unrelated obese subjects were included in this study. Real-time PCR was used to detect the TCF7L2 rs7903146 polymorphism. Serum level of adiponectin was determined by the ELISA method. Standard assays were used to measure total cholesterol, HDL cholesterol, triglycerides, glucose and HbA 1c concentrations. We used multiple logistic regression to identify factors associated with type 2 diabetes. Results We found that the T allele of rs7903146 was significantly associated with T2D risk (odds ratio of 1.59 for T allele, p = 0.005). This association persisted after adjusting for confounders in the recessive model (odds ratio of 3.54 for TT genotype, p = 0.011). Serum adiponectin levels were significantly lower in diabetic subjects than in nondiabetic individuals (3.6 vs. 5.6 µg/ml, p < 0.001). Participants who were obese at age ≥ 20 years had significantly higher odds of having T2D (OR = 4.94) than those with the onset of obesity before 20 years (p < 0.001). Conclusions Our study highlights the significance of the relationship between the TCF7L2 polymorphism, a person’s age at onset of obesity and the prevalence of T2D, and confirms lower adiponectin levels in obese diabetics in comparison to obese nondiabetics.

Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are endogenous inhibitors of nitric oxide (NO) synthesis, and play a critical role in the process of endothelial dysfunction, and are considered markers of oxidative stress. The aim of the present study was to explore relationships between ADMA and/or SDMA and the occurrence of OSA in obese patients as well as the effect of the endothelial nitric oxide synthase (eNOS) gene polymorphism, which may modify the influence of ADMA or SDMA on NO production. A total of 518 unrelated obese subjects were included in this study. Body weight, height and blood pressure were measured and data on self-reported smoking status were collected. Obstructive sleep apnea (OSA) was assessed by the apnea hypopnea index (AHI). Blood samples were collected to measure serum concentrations of glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, creatinine, HbA1c (%), folic acid, vitamin B12, C-reactive protein (CRP), aspartate aminotransferase (ASP), alanine aminotransferase (ALT) and IL-6 by routine methods. The NOS3 gene G894T and 4a/4b polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. ADMA, SDMA and arginine concentrations were assessed simultaneously using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) method. Adjusted multivariate logistic regression analysis showed a significant association between the occurrence of OSA and high serum ADMA levels, BMI above 40, age &gt, 43 years, hypertension and male sex. Heterozygotes for the G894T eNOS polymorphism have the lowest serum concentrations of ADMA and SDMA, while no effect of the 4a/4b variants was observed. The results indicate that OSA in obese individuals can coexist with high ADMA levels, which appear as a potential OSA predictor.

Wstep: Wyniki badan z ostatnich lat dokumentują wiele korzyści wynikających z dzialania witaminy D na organizm czlowieka na wszystkichetapach jego zycia. Wiekszośc badan epidemiologicznych sugeruje, ze niedobor witaminy D jest powszechny wśrod mieszkancow EuropyŚrodkowej. Naturalną konsekwencją tej sytuacji jest koniecznośc ciąglego uświadamiania spoleczenstwu oraz środowisku medycznemu,jaką role odgrywa witamina D w rozwoju i funkcjonowaniu organizmu ludzkiego. Metody: Na podstawie przeglądu danych literaturowych Polski Zespol Wielodyscyplinarny opracowal tezy dotyczące zasad suplementacjiwitaminą D, ktore przeslano do czlonkow Komitetu Naukowego konferencji „Witamina D — minimum, maksimum, optimum”,19–20 Październik, 2012, Warszawa. W trakcie powyzszej konferencji z udzialem 550 delegatow oraz Ekspertow roznych dziedzin medycynyomowiono i przedyskutowano propozycje wytycznych suplementacji witaminą D populacji Europy Środkowej. Wyniki: W efekcie przeprowadzonych dyskusji Zespol Ekspertow opracowal wytyczne suplementacji witaminą D dla wszystkich grupwiekowych populacji Europy Środkowej. Określono rowniez kryteria diagnostyczne charakteryzujące stan zaopatrzenia organizmu w witamine D: deficyt witaminy D ustalono jako stezenie 25(OH)D < 20 ng/mL (< 50 nmol/L)], suboptymalne zaopatrzenie jako stezenie25(OH)D wynoszące 20–30 ng/mL (50–75 nmol/L), a stezenie 30–50 ng/mL (75–125 nmol/L) uznano za docelowe dla zapewnienia efektuplejotropowego witaminy D. Wnioski: Poprawa obecnego stanu zaopatrzenia witaminy D w grupach dzieci, mlodziezy, osob aktywnych zawodowo i seniorowpowinna zostac wlączona do priorytetow polityki zdrowotnej spoleczenstw Europy Środkowej.

Vitamin D is necessary in maintaining appropriate calcium and phosphate homeostasis in the body (classical function) and ensuring appropriate functioning of many tissues, organs and cells, unrelated to mineral economy (non-classical function). Vitamin D deficiency in adults may cause osteomalacia, increase fracture risk in osteoporosis, induce cardiovascular diseases, diabetes type 1 and 2, multiple sclerosis, Lesniowski-Crohn disease, and cancer, including colon, breast, and prostate cancer. Possible causes of vitamin D deficiency in a healthy population include decreased cutaneous synthesis and an inadequate intake of vitamin D, both in food and in supplements. Vitamin D deficiency level (25(OH) D.20 ng/mL), is fairly widespread, being found in a substantial percentage of healthy subjects around the world, regardless of race, gender and age. Daily vitamin D dose, as determined by the Food and Nutrition Board in 1997, is now rather insufficient, the biggest problem being associated with maximal vitamin D levels (50 μg/day) in actually available food supplements. Nowadays, it is recommended that adults need a minimum of 800-1,000 U/day when their exposure to the sun is inadequate (in Poland from October to April). This dosage should be provided to all subjects who avoid sunlight, as well as to those aged over 65 because of their slower skin synthesis of vitamin D and for its proven anti-fracture and anti-fall effects.

In clinical ambulatory practice, patients often, rather than discontinuing treatment, change to another one. This study aims to assess the reasons why patients with osteoporosis switch from one alendronate to another with a different brand name.A retrospective analysis of 747 bisphosphonate-treated patients was performed (651 female, average age 67.3 ± 8.9 years, BMI 26.5 ± 4.0 kg/m(2)). The frequency and reasons for drug switching during the 19.4 ± 13.4 months of observation were analysed.In 387 (51.8%) patients, treatment was not changed during the observation period, whereas in 360 (48.2%) patients, at least one drug switch occurred. Almost 40% of patients from that group (138 patients) switched from one alendronate to another alendronate with a different brand name. The most frequent reasons were: adverse event (36.9%), high price of the drug (23.2%) and request of patient (16.7%).A substantial proportion of persistent bisphosphonate-treated patients switch treatment from one alendronate to another. The most frequent reasons for that kind of switching are the occurrence of an adverse event and the high cost of treatment.

Vitamin D is necessary in maintaining appropriate calcium and phosphate homeostasis in the body (classical function) and ensuring appropriate functioning of many tissues, organs and cells, unrelated to mineral economy (non-classical function). Vitamin D deficiency in adults may cause osteomalacia, increase fracture risk in osteoporosis, induce cardiovascular diseases, diabetes type 1 and 2, multiple sclerosis, Lesniowski-Crohn disease, and cancer, including colon, breast, and prostate cancer. Possible causes of vitamin D deficiency in a healthy population include decreased cutaneous synthesis and an inadequate intake of vitamin D, both in food and in supplements. Vitamin D deficiency level (25(OH) D. 〈 20 ng/mL), is fairly widespread, being found in a substantial percentage of healthy subjects around the world, regardless of race, gender and age. Daily vitamin D dose, as determined by the Food and Nutrition Board in 1997, is now rather insufficient, the biggest problem being associated with maximal vitamin D levels (50 μg/day) in actually available food supplements. Nowadays, it is recommended that adults need a minimum of 800-1,000 U/day when their exposure to the sun is inadequate (in Poland from October to April). This dosage should be provided to all subjects who avoid sunlight, as well as to those aged over 65 because of their slower skin synthesis of vitamin D and for its proven anti-fracture and anti-fall effects.

Leptin is considered to exert dual effect on bone metabolism: anabolic (through peripheral pathways) and antiosteogenic (through central nervous system). The total leptin's effect on bone is not known. The aim of the study was to examine bone metabolism and leptin concentration in patients with morbid obesity before and after bariatric surgery (BS).Forty one patients with morbid obesity selected for BS were included in the prospective study. Body mass index (BMI), serum leptin, parathyroid hormone (PTH), 25-hydroxy vitamin D (25(OH)D) concentrations and bone mineral density (BMD) in the lumbar spine (LS) and proximal femur (PF) were examined before and 6 months after BS.Before operation (mean BMI 44.0 kg/m(2)) mean leptin and PTH concentration was increased (accordingly 37.1 ng/ml and 82.7 pg/ml), mean 25OHD concentration was decreased to 4.3 ng/ml. Mean BMD was within the upper limit of the population reference range. Leptin concentration was positively correlated with BMI. There was no correlation of leptin with BMD (in LS and PF), PTH and 25(OH)D. Following the operation (mean BMI 31.8 kg/m(2)) mean leptin concentration decreased by 30.6 ng/ml (p0.001), PTH decreased by 38.9 pg/ml (p0.001), 25(OH)D increased by 2.1 ng/ml (NS). Mean BMD in LS increased by 0.067 g/cm(2) (p0.005), in PF decreased by 0.044 g/cm(2) (p0.02). Leptin was positively correlated with BMI but not with BMD (in both sites), PTH, 25(OH)D.Weight loss in patients with morbid obesity after BS leads to decrease in serum leptin, increase in BMD in LS and decrease in PF. These changes are accompanied by regression of hyperparathyroidism, which is probably secondary to vitamin D deficiency.

Background and aims: In clinical trials, the most frequent reasons for treatment discontinuation are adverse events and personal conflicts with medical staff. However, in ‘real life’, i.e. not in the frame of a controlled and monitored trial, other reasons are also possible, when not only discontinuation, but also switching of treatment happens. The aim of this study was to estimate how often and why persistent osteoporosis patients switch from one treatment to another. Methods: A retrospective analysis of 1314 ambulatory treated persistent osteoporosis patients was performed (1180 F, 134 M, mean age±SD: 66.5±10 yrs, BMI 26.4±4.2 kg/m2). Drugs used for osteoporosis, duration of treatment, frequency and reasons for drug switching were all analyzed. Results: In 530 (40.3%) patients, treatment was not changed during the observation period (16.1±9.1 months). In 784 (59.7%) patients at least one drug switch happened, and the total number of switches was 1117 (1–5 switches/patient). The mean time of observation in this group was 22.3±14.9 months. The most frequent reasons for drug switching were: adverse event (34.6% of all switches), high price of the drug (28.7%) and ineffective treatment (13.3%). Conclusions: In almost 60% of the persistent patients, at least one switch of antiosteoporotic treatment occurred in the nearly 2-year observation period. The most frequent reasons for drug switching were adverse reactions, the high price of the drug, and ineffective treatment.

The primary goal in the treatment of osteoporosis is to prevent skeletal fractures. Modern antiresorptive drugs reduce the number of fractures in patients with moderate osteoporosis, but they cannot repair serious damage to bone structure. Both experimental investigations and clinical trials have shown that daily injections of parathyroid hormone or its amino-terminal fragment (1-34) increase the number and activity of osteoblasts, and accelerate formation of new bone tissue. In postmenopausal women with severe osteoporosis, treatment with the amino-terminal fragment of recombinant human parathyroid hormone, given once a day as a subcutaneous injection, results in a significant increase in the bone mineral density of the spine and proximal femur, without impairing bone quality. 18-month treatment with PTH decreases the risk of both compression fractures of the spine and nonvertebral osteoporotic fractures by more than 50%. Parathyroid hormone in the recommended dose of 20 g daily has proved to be a safe and effective drug, stimulating the reconstruction of structurally damaged bone and significantly decreasing fracture risk in patients with severe osteoporosis.

Sixty-two outpatients were assessed and divided into the following groups: 20 patients who had had partial gastrectomy (PG group), 22 patients who had had truncal vagotomy and pyloroplasty (TV group) or high selective vagotomy (HSV group), and 20 patients who had had cholecystectomy (CH group). The patients' age ranged from 35 to 64 years (mean 45 years), and the average postoperative period was 9 years. None of the patients evidenced clinical or biochemical symptoms of malnutrition or malabsorption or of diseases affecting vitamin D metabolism. The function of the kidneys and the liver was normal. An age-matched group of volunteers served as a control group. The calcium dietary intake was determined using a standardized questionnaire; and the levels of serum calcium (Cas), phosphate (Ps), alkaline phosphatase (AP), and 25-hydroxyvitamin D [25(OH)D] and the excretion of Ca in a sample of fasting urine corrected for concurrent creatine excretion (FuCa/cr) were assessed by means of standard laboratory techniques. The bone mineral density (BMD) of the lumbar spine (L2-4) and femoral neck (neck-L) was determined by means of dual energy x-ray absorptiometry (DXA). The daily Ca dietary intake was lower than recommended (RDA) in 80% of the patients, with most of them ingesting less than 300 mg daily. The mean values of Cas, Ps, AP, and FuCa/cr did not differ from those in the controls. Significantly reduced 25(OH)D levels were observed in the PG group (7.0 ng/ml) (p < 0.001) and CH group (12.5 ng/ml) (p < 0.01) compared with the values in the control group (20.0 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Examinations were performed in 20 adult male and female patients (pts) suffering from acute back pain due to vertebral compression fracture secondary to osteoporosis proved by lateral X-rays of the dorso-lumbar spine (Th3-L5), and bone mineral density with the method of dual energy X-ray absorptiometry. The synthetic human calcitonin (SUC) (0.5 mg) was injected I.M. every day during 28 days. Analgesic effect was evaluated on 0, 3, 7, 14, 21 and 28th day by patient's assessment of functional capacity, and physician's assessment of pain and mobility. On the same days biochemical variables of Ca-P homeostasis were determined. Treatment with calcitonin resulted in a positive analgesic effect. The functional capacity and mobility of pts increased with diminution of pain. No significant alterations of Ca-P homeostasis was observed. Mild and transient side effects as nausea and tachycardia were negligible. SHC appears to have a significant analgesic effect in treatment of primary osteoporosis.