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Background: Cardiovascular diseases are characterized by chronic inflammation, leading to increased inflammatory markers that can cause cell damage and death. Phase angle has emerged as a marker of cellular health. It is considered a prognostic factor in various acute and chronic conditions. However, few studies have examined its association with cardiovascular disease risk measures. This study aims to investigate the relationship between phase angle, the general Framingham risk score, and the HEARTS cardiovascular risk score., Methods: This cross-sectional study included a convenience sample of adult patients of 2 primary health care services. Phase angle was measured using multifrequency bioimpedance analysis at 50 kHz. The risk of cardiovascular events was calculated using the Framingham and HEARTS risk scores. Statistical analysis included generalized linear regression models, unadjusted and adjusted according to sex and age, to determine the association between scores, risk factors, and phase angle., Results: The study included 164 individuals with a mean age 52.2 (SD 17.9). According to the HEARTS score, low-risk patients had higher phase angle values than those with high or very high risk [ß = -0.57 (95% CI -0.95; -0.19), P = 0.003]. Framingham scores showed a trend toward significance for higher mean phase angle values in low-risk than high-risk patients [ß = -0.43 (95% CI -0.88 to 0.02), P = 0.06]., Conclusion: Phase angle values were lower in high and very high-risk patients than in low-risk patients, which shows that phase angle is a promising risk predictor for patients with cardiovascular diseases., (© 2024. The Author(s).)

Background: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition affecting communication, social interaction, and behavior. Evidence suggests that environmental pollutants are associated with ASD incidence. This review aimed to analyze the effect of environmental pollutants on ASD., Methods: Systematic review and meta-analysis of cohort studies evaluated the association between exposure to environmental pollutants and ASD. We searched COCHRANE CENTRAL, MEDLINE, CINAHL, LILACS, EMBASE, PsycINFO, Web of Science, SciELO, and gray literature from inception to January 2023. The model used for meta-analysis was inverse variance heterogeneity (IVhet). The effect measures were the beta coefficient (β) and the relative risk (RR) with their 95% confidence intervals (95% CI). Sensitivity analyses were carried out using an instrument to screen or diagnose autism., Results: A total of 5,780 studies were identified; 27 were included in the systematic review, and 22 were included in the meta-analysis. These studies included 1,289,183 participants and 129 environmental pollutants. Individual meta-analyses found a significant association between nitrogen dioxide RR = 1.20 (95% CI: 1.03 to 1.38; I 2 : 91%), copper RR = 1.08 (95% CI: 1.03 to 1.13; I 2 : 0%), mono-3-carboxy propyl phthalate β = 0.45 (95% CI: 0.20 to 0.70; I 2 : 0%), monobutyl phthalate β = 0.43 (95% CI: 0.13 to 0.73; I 2 : 0%) and polychlorinated biphenyl (PCB) 138 RR = 1.84 (95% CI: 1.14 to 2.96; I 2 :0%) with ASD. Subgroup meta-analyses found a significant association with carbon monoxide RR = 1.57 (95% CI: 1.25 to 1.97; I 2 : 0%), nitrogen oxides RR = 1.09 (95% CI: 1.04 to 1.15; I 2 : 34%) and metals RR = 1.13 (95% CI: 1.01 to 1.27; I 2 :24%)., Conclusion: This study found positive associations nitrogen dioxide, copper, mono-3-carboxypropyl phthalate, monobutyl phthalate, and PCB 138, and the development of ASD, likewise, with subgroups of pollutants carbon monoxide, nitrogen oxides, and metals. Therefore, it is important to identify these risk factors in children and adolescents to contribute to ASD and identify prevention strategies effectively., (© 2024. The Author(s).)

Background: Bariatric surgery is an effective intervention that causes a series of metabolic changes related to inflammatory processes; however, the variation of biomarkers related to these processes is not entirely understood. Our objective was to investigate the variation of modulation and expression of biomarkers associated with inflammation in patients who underwent bariatric surgery., Methods: We searched the MEDLINE (via PubMed), EMBASE (via Elsevier), Cochrane Central Register of Controlled Trials, Latin American and Caribbean Literature on Health Sciences (via virtual health library), Cumulative Index to Nursing and Allied Health Literature (via EBSCO), Web of Science core collection, and Scopus (via Elsevier) databases, and the gray literature was examined from inception to January 2022. Three pairs of reviewers performed data screening, extraction, and quality assessment independently. Meta-analysis with random effects models was used for general, subgroup, and sensitivity analyses. The I 2 statistic was used to assess heterogeneity between studies., Results: In total, 96 articles were included in this systematic review; of these, 87 studies met the criteria for the meta-analysis, involving 3,533 participants. Five biomarkers were included in the meta-analysis (tumor necrosis factor alpha; interleukin 6; leptin; interleukin 1 beta, and lipopolysaccharides). Only leptin showed a significant decrease in the first month after surgery (mean difference -20.71; [95% confidence interval: -28.10 to -13.32, P < .0001; I 2  = 66.7%), with moderate heterogeneity. The 12 months after surgery showed a significant decrease in tumor necrosis factor alpha (mean difference -0.89; [95% confidence interval: -1.37 to -0.42], P = .0002; I 2  = 94.7%), interleukin 6 (mean difference -1.62; [95% confidence interval: -1.95 to -1.29], P < .0001; I 2  = 94.9%), leptin (mean difference -28.63; [95% confidence interval: -34.02 to -23.25], P < .0001; I 2  = 92.7%), and interleukin 1 beta (mean difference -2.46; [95% confidence interval: -4.23 to -0.68], P = .006; I 2  = 98.3%), all with high heterogeneity. The type of surgery did not show significant differences for the biomarkers at the first month and 12 months, and the results have not changed with high-quality studies. In the 12-month measurement, variations in tumor necrosis factor alpha and leptin were associated with body mass index., Conclusion: The findings of this meta-analysis suggest that Roux-en-Y gastric bypass and sleeve gastrectomy bariatric surgeries are associated with a significant reduction in leptin at 1 month after bariatric surgical intervention and tumor necrosis factor alpha, leptin, and interleukin 1 beta after 12 months., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Adipose-derived stem cells (ADSC) are multipotent cells implicated in tissue homeostasis. Obesity represents a chronic inflammatory disease associated with metabolic dysfunction and age-related mechanisms, with progressive accumulation of senescent cells and compromised ADSC function. In this study, we aimed to explore mechanisms associated with the inflammatory environment present in obesity in modulating ADSC to a senescent phenotype. We evaluated phenotypic and functional alterations through 18 days of treatment. ADSC were cultivated with a conditioned medium supplemented with a pool of plasma from eutrophic individuals (PE, n = 15) or with obesity (PO, n = 14), and compared to the control., Results: Our results showed that PO-treated ADSC exhibited decreased proliferative capacity with G2/M cycle arrest and CDKN1A (p21 WAF1/Cip1 ) up-regulation. We also observed increased senescence-associated β-galactosidase (SA-β-gal) activity, which was positively correlated with TRF1 protein expression. After 18 days, ADSC treated with PO showed augmented CDKN2A (p16 INK4A ) expression, which was accompanied by a cumulative nuclear enlargement. After 10 days, ADSC treated with PO showed an increase in NF-κB phosphorylation, while PE and PO showed an increase in p38MAPK activation. PE and PO treatment also induced an increase in senescence-associated secretory phenotype (SASP) cytokines IL-6 and IL-8. PO-treated cells exhibited decreased metabolic activity, reduced oxygen consumption related to basal respiration, increased mitochondrial depolarization and biomass, and mitochondrial network remodeling, with no superoxide overproduction. Finally, we observed an accumulation of lipid droplets in PO-treated ADSC, implying an adaptive cellular mechanism induced by the obesogenic stimuli., Conclusions: Taken together, our data suggest that the inflammatory environment observed in obesity induces a senescent phenotype associated with p38MAPK/NF-κB axis, which stimulates and amplifies the SASP and is associated with impaired mitochondrial homeostasis., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: This study aimed to develop the Brazilian instrument for assessing eating disorders in children and adolescents and test its psychometric quality using item response theory (IRT)., Design: Cross-sectional study., Participants: Participants aged between five and twelve years old of both sexes., Main Measures: IRT logistic model of two parameters was used to evaluate the item's severity and discrimination and test information curve of symptoms of eating disorders' latent trait symptoms. Content validity and reliability were also assessed. The IRT evaluation suggested that the instrument contained items that performed differently concerning severity, discrimination, and test information curve presented good accuracy., Results: There was agreement on the clarity of language (83.3%) and theoretical relevance (91.7%), indicating good content validity. The value of the Cronbach's Alpha was 0.63 (95% confidence interval), and the result of the Spearman-Brown test was 0.65., Conclusion: These results indicate good performance of the screening tool in assessing the level of eating disorders in children and adolescents., (Copyright © 2023 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The aim of this study was to evaluate the influence of the body mass index (BMI) on laboratory, clinical outcomes and treatment costs of assisted reproduction, as there are still controversial and inconclusive studies on this subject., Methods: This research was retrospective cohort study, including women undergoing assisted reproduction in a Reproductive Medicine Center between 2013 and 2020. The participants were divided into groups according to BMI (kg/m 2 ): Group 1 < 25; Group 2, 25-29.9 and Group 3, ≥ 30. A total of 1753 in vitro fertilization (IVF) fresh embryo transfer (ET) cycles were included for assisted reproduction outcomes analysis and 1869 IVF-ET plus frozen embryo transfer (FET) for cumulative pregnancy analysis., Results: As higher the BMI, higher was the proportion of canceled IVF cycles (G1 (6.9%) vs. G2 (7.8%) vs. G3 (10.4%), p = 0.002) and gonadotropin's total dose (IU) and treatment costs (G1 (1685 ± 595, U$ 683,02) vs. G2 (1779 ± 610, U$ 721,13) vs. G3 (1805 ± 563, U$ 764,09), p = 0.001). A greater number of mature oocytes was observed in G1 and G2 (6 [6.4-7.0] vs. 6 [5.6-6.6] vs. 4 [4.6-6.7], p = 0.011), which was not found in oocyte maturity rate (p = 0.877). A significant linear tendency (p = 0.042) was found in cumulative pregnancy rates, pointing to worse clinical outcomes in overweight and obese patients., Conclusion: These findings highlight the importance of considering the higher treatment costs for these patients, beyond all the well-known risks regarding weight excess, fertility, and pregnancy, before starting IVF treatments., (© 2022. The Author(s).)

Background: In spontaneous pregnancies, maternal weight and gestational diabetes are independent risk factors for macrosomia and large-for-gestational-age newborns. Furthermore, maternal body mass index (BMI) of ≥25 kg/m 2 is associated with worse neonatal vitality, classified as an Apgar score of < 7 at the fifth minute of life. However, few studies have evaluated the influence of BMI on perinatal outcomes in pregnancies resulting from assisted reproduction. Therefore, this study aimed to analyze whether the perinatal outcomes of assisted reproduction are influenced by BMI., Methods: This was a retrospective cohort study performed at a reproductive medicine center. Patients undergoing assisted reproduction (2013-2020) were divided into three groups according to their BMI (kg/m 2 ): group 1, < 25; group 2, 25-29.9, and group 3, ≥30. In total, 1753 in vitro fertilization embryo transfer cycles were analyzed. Data were expressed as mean ± standard deviation or frequency (%). The analysis of variance and chi-square test were performed for comparison. To determine the participants and number of cycles for these analyses, generalized estimating equations were used, considering p < 0.05., Results: In groups 1, 2, and 3, the rates of live birth were 33.5, 32.3, and 29.9% (p = 0.668); preeclampsia were 2.9, 6.1, and 6.3% (p = 0.268); small-for-gestational-age newborns were 23, 23.2, and 21.7% (p = 0.965); macrosomia were 1.9, 0.9, and 2.7% (p = 0.708); Apgar score > 7 at the fifth minute were 97.6, 98.2, and 100% (p = 0.616); and preterm birth were 29.6, 30.1, and 35.1% (p = 0.970), respectively., Conclusions: In conclusion, although the three groups had similar perinatal outcomes in this study, the study population was too small for conclusive results. The higher the BMI, the lower the chances of clinically relevant LBR and the higher the chances of premature labor and preeclampsia., (© 2022. The Author(s).)

Purpose: Evaluation of obstetric and neonatal outcomes in a Brazilian retrospective cohort of pregnancies after Roux-en-Y gastric bypass (RYGB), regarding the 2009 Institute of Medicine (IOM) recommendations about gestational weight gain (GWG) and RYGB-conception interval. Additionally, search for intrapopulation risk factors for small gestational age (SGA) offspring and mental health assessments., Material and Methods: Retrospective analysis of 132 singleton pregnancies after RYGB. Obstetric and neonatal outcomes were analyzed with stratification in above, below, or meeting the target regarding GWG guidance, and 0-12, 12-47, and ≥48 months for RYGB-conception interval. SGA risk factors were identified through Poisson regression analysis., Results: GWG below the recommendations was associated with prematurity (p 0.003). Late conceptions (≥48 months) were associated with iron deficiency (p 0.025). Parenteral iron prescription was a protective factor for SGA, with a relative risk of 0.41 (95% CI, 0.20-0.85; p 0.017), and GWG below target was a SGA risk factor, with a relative risk of 4.68 (95% CI, 1.48-14.8; p 0.008). In all, 15.2% of patients had psychopharmacological treatment during pregnancy, and 7.6% received a diagnosis of postpartum depression. Any alcohol and tobacco consumption were reported in 3.8 and 6.8% of patients, respectively., Conclusion: The recommendations regarding GWG apply to the RYGB population, and surgery-conception intervals should be individualized. The parenteral iron prescription was a protective factor for SGA, and GWG below the recommendations of the IOM was a risk factor for SGA. Psychological and psychiatric care should be offered to every possible pregnancy after RYGB.

Purpose: To draw the attention of the medical community to a differential diagnosis of intestinal obstruction due to bezoar in the late postoperative period of gastric bypass that requires diagnosis and emergency management., Methods: We report 8 cases of patients with intestinal obstruction due to bezoar in the late postoperative period of gastric bypass who required surgical intervention., Conclusion: Intestinal obstruction due to fruit pomace is a late complication that may require urgent surgical intervention and should be considered in the differential diagnosis., (Copyright © 2021 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

Background: Bariatric surgery is one of the best treatments for obesity. This indication includes an evaluation of body mass index (BMI) that does not consider the body composition of an individual., Aim: To determine the body composition of bariatric surgery candidates., Methods: Patients treated at a tertiary care centre for obesity were evaluated. Body composition was measured by bioelectrical impedance analysis (BIA). All measures of BIA and surgical indication were analysed., Results: We evaluated 407 subjects, 87 (21.4%) men, with a mean age of 36 years. In men with indications for bariatric surgery, the mean ± SD body fat percentage (%BF) was 45.1 ± 5.39%, and the mean ± SD visceral fat area was 243.6 ± 33.79 cm 2 . In women with indications for bariatric surgery, the mean ± SD %BF was 50.7 ± 3.3%, and the mean ± SD visceral fat area was 241.7 ± 24.77 cm 2 ., Conclusion: This study showed different body compositions between men and women and parameters of %BF and visceral fat area evaluated by BIA., Competing Interests: Declaration of competing interest The authors have no conflict of interest., (Copyright © 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: One of the most important concerns on health is the increased rates of obesity in population and the speed in which this number is increasing. This number translates a serious public health problem, since it also increases the risk of several other diseases associated with obesity resulting in significant morbidity and mortality. Among them, it seems to be connected to several neoplasms, such as colorectal carcinoma., Aim: To evaluate the impact of obesity as a risk factor for colorectal carcinoma through the detection of adenoma, and to discuss the mechanisms that could establish a link between obesity and neoplasm., Methods: Patients who underwent colonoscopy were included. Personal and anthropometric data, clinical history, and results of the tests were analyzed in order to verify the correlation of BMI and the presence of adenomatous polyps., Results: A total of 142 patients were studied, which a mean age of 62 years. Of the patients, 74 (52.1%) were men and 68 (47.9%) were. Obesity was identified in 16.2% of the patients. Polyps were found in 61 (42.9%), mostly smaller than 1 cm. Obese individuals were 1.56 times more likely to present colorectal adenoma than patients with normal weight., Conclusion: This study, although showing the greater presence of colorectal adenomas in obese individuals, did not show a significant difference in the occurrence of pre-malignant lesions.

Background: The potential effect of bariatric surgery on weight reduction and improvement of associated comorbidities is known, but the ratio obtained between the components of body weight, including lean body mass, body fat mass, and bone mass, is still not determined. This study aims to verify the changes in body composition during the first year after bariatric surgery., Methods: We conducted a prospective observational cohort study. Fifty patients who underwent bariatric surgery and maintained follow-ups were selected. Patients were assessed preoperatively and postoperatively for periods of 1, 3, 6, and 12 months using tetrapolar bioelectrical impedance analysis and laboratory testing of lipids and serum albumin levels. Data were statistically analyzed., Results: Statistically significant differences (p < 0.001) were obtained between the preoperative and 12-month evaluation respectively, for body mass index (BMI) (45.8 ± 7.5 to 30.0 ± 4.8 kg/m 2 ), FM (64.7 ± 15.5 to 30.6 ± 9.8 kg), PFM (51.6 ± 4.17 to 37.3 ± 7.6%), and total cholesterol levels (197.1 ± 49.8 to 169.8 ± 31.0 mg/dL). The decrease in PFM shows a better proportion between the body components. PFM showed significantly higher decrease in males than in females (p = 0.012). Lean body mass (p = 0.000) reduction was highest for patients operated by the Unified Health System (SUS, Government of Brazil) probably because of its few financial resources to maintain postoperative care., Conclusion: The change in body composition of patients who underwent Roux-en-Y gastric bypass was statistically significant for all variables examined during the first year postoperatively. This shows the effectiveness of the surgical procedure and clinical protocol set, which tends to favor a better health prognosis and weight maintenance in the long term.

Objective: To evaluate the relationship between physical activity and phase angle., Design: Systematic Review and Meta-analysis., Data Sources: Electronic searches of MEDLINE (via PUBMED), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), SciELO, LILACS, SPORTDiscus, Scopus, and Web of Science from inception to December 10th, 2017., Eligibility Criteria for Selecting Studies: The PICOS strategy was defined, in which "P" corresponded to participants of any age, sex or ethnicity, "I" indicated any type of physical activity program, "C" denoted lack of exercise or irregular physical activity, "O" corresponded to the phase angle obtained by bio-impedance, and "S" indicated longitudinal or cross-sectional studies., Results: In cross-sectional studies the phase angle was higher among the active individuals (MD = 0.70; 95% CI: 0.48, 0.92, P < 0.001), with low heterogeneity (I 2  = 0%; P = 0.619). In longitudinal studies, the mean of the difference of phase angles from the baseline was significantly higher for the active group than the control group (MD = 0.30; 95% CI: 0.11, 0.49, P = 0.001), with low heterogeneity (I 2  = 13%, P = 0.331). No evidence of publication bias was found and the overall risk of bias was moderate to high., Summary/conclusion: The positive association of physical activity with phase angle reinforces the importance of routinely including exercise in health care. We also identified the need for further studies to define with different types, intensities and frequencies of exercises should be conducted in order to find the best dose-effect relationship., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Purpose: The aim of this study was to evaluate changes in urinary incontinence (UI) before and after surgery for obesity in female patients and to identify factors related to the remission of symptoms., Materials and Methods: This was a prospective cohort study with female patients over 18 years old who underwent surgery for obesity and weight-related diseases between June 2016 and September 2017. Urinary symptoms and quality of life related to UI were assessed based on a structured interview and the results of the validated questionnaires., Results: Two hundred twenty-one patients were assessed pre-operatively, and 118 (53.3%) reported UI. Eighty-eight patients (74.6%) completed the pre- and postoperative questionnaires. After 6 to 12 months, patients were revaluated, and 50 (56.8%) were considered to be in remission of urinary symptoms. Women who had only a cesarean birth had a 117% increase in the probability of achieving remission of UI compared with women who had both vaginal and cesarean deliveries, and patients with an additional point in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score at the beginning had a 4% lower probability of having remission of symptoms., Conclusions: Improvement in UI may be an important outcome of surgery for obesity and weight-related diseases. In this study, previous cesarean section was only associated with the highest rate of remission of symptoms, and patients with higher scores in the ICIQ-UI-SF had a lower probability of remission.

Obesity is a prevalent multifactorial chronic disorder characterized by metabolic dysregulation. Sustained pro-oxidative mediators trigger harmful consequences that reflect at systemic level and contribute for the establishment of a premature senescent phenotype associated with macromolecular damage (DNA, protein, and lipids). Telomeres are structures that protect chromosome ends and are associated with a six-protein complex called the shelterin complex and subject to regulation. Under pro-oxidant conditions, telomere attrition and the altered expression of the shelterin proteins are central for the establishment of many pathophysiological conditions such as obesity. Thus, considering that individuals with obesity display a systemic oxidative stress profile that may compromise the telomeres length or its regulation, the aim of this study was to investigate telomere homeostasis in patients with obesity and explore broad/systemic associations with the expression of shelterin genes and the plasma redox state. We performed a cross-sectional study in 39 patients with obesity and 27 eutrophic subjects. Telomere length (T/S ratio) and gene expression of shelterin components were performed in peripheral blood mononuclear cells by qPCR. The oxidative damage (lipid peroxidation and protein carbonylation) and non-enzymatic antioxidant system (total radical-trapping antioxidant potential/reactivity, sulfhydryl and GSH content) were evaluated in plasma. Our results demonstrate that independently of comorbidities, individuals with obesity had significantly shorter telomeres, augmented expression of negative regulators of the shelterin complex, increased lipid peroxidation and higher oxidized protein levels associated with increased non-enzymatic antioxidant defenses. Principal component analysis revealed TRF1 as a major contributor for firstly telomeres shortening. In conclusion, our study is first showing a comprehensive analysis of telomeres in the context of obesity, associated with dysregulation of the shelterin components that was partially explained by TRF1 upregulation that could not be reversed by the observed adaptive non-enzymatic antioxidant response., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective:  To analyze the prevalence of urinary incontinence (UI) in female patients with an indication for bariatric surgery, to investigate the potential risk factors and the impact on quality of life., Methods:  A cross-sectional study with female patients with obesity. The evaluation consisted of a structured interview, a specific study form and quality of life questionnaires. The Poisson regression was performed to identify independent risk factors related to UI., Results:  A total of 221 patients were enrolled; 118 of the study participants (53.4%) reported UI episodes. Mixed UI (MUI), stress UI (SUI) only, and urgency UI (UUI) only were reported by 52.5% (62), 33.9% (40) , and 13.5% (16) of these patients respectively. The prevalence of UI was increased by 47% among the women who had given birth vaginally and by 34% of the women who had entered menopause. Vaginal delivery and menopause were identified as independent risk factors related to UI. The mean International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) score was 9.36 ± 4.9. The severity of symptoms was considered moderate in 53.3% (63) of the patients with UI., Conclusion:  Urinary incontinence impacts quality of life negatively, and the prevalence of UI is high among obese patients. In the present study, vaginal delivery and menopause were independently associated with UI., Competing Interests: The authors have none to declare., (Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.)

Background: The carcinoembryonic antigen level in peritoneal lavage has been showing to be a reliable prognostic factor in gastric cancer., Aim: To identify any association between carcinoembryonic antigen level in peritoneal lavage, in gastric cancer patients, with mortality, peritoneal recurrence, tumor relapse or other prognostic factors., Methods: In total, 30 patients (22 men, 8 women; median age 66 years) with resectable gastric cancer (mainly stage III and IV) were studied. Carcinoembryonic antigen level in peritoneal lavage was detected at operation by immunocytochemical method and a level over 210 ng/g of protein was considered as positive., Results: There were detected 10 positive cases (33.3%) of plCEA levels. These levels were associated with mortality, RR: 2.1 (p=0.018); peritoneal recurrence, OR: 9.0 (p=0.015); and relapse or gastric cancer progression, OR: 27.0 (p=0.001)., Conclusion: Increased levels of plCEA fairly predicts mortality, peritoneal recurrence tumor relapse or cancer progression.

Background: Obesity is a major global epidemic and a burden to society and health systems. This study aimed to estimate and compare the anual costs of clinical and surgical treatment of severe obesity from the perspective of the Brazilian Public Health System., Methods: An observational and cross-sectional study was performed in three reference centers. Data collection on health resources utilization and productivity loss was carried out through an online questionnaire. Participants were divided in clinical (waiting list for a bariatric surgery) and surgical groups (open Roux-en-Y gastric bypass), and then allocated by the time of surgery (up to 1 year; 1-2 years; 2-3 years; and >3 years). Costs of visits, medications, exams, and surgeries were obtained from government sources. Data on non-medical costs, such as transportation, special diets, and caregivers, were also colleted. Productivity loss was estimated using self-reported income. Costs in local currency (Real) were converted to international dollars (Int$ 2015)., Results: Two hundred and seventy-four patients, 140 in surgical group and 134 in clinical group were included. In first postoperative year, the surgical group had higher costs than clinical group (Int$6005.47 [5000.18-8262.36] versus 2148.14 [1412.2-3506.8]; p = 0.0002); however, from the second year, the costs decreased progressively. In the same way, indirect costs decreased significantly after surgery (259.08 [163.63-662.72] versus 368.17 [163.62-687.27]; p = 0.06)., Conclusion: Total costs were higher in the surgical group in the first 2 years after surgery. However, from the third year on, the costs were lower than in the clinical group.

Objective: To evaluate the consequences of plasma from individuals with obesity on parameters associated with immunosenescence in unrelated healthy peripheral blood mononuclear cells (PBMC)., Methods: Freshly isolated PBMC were incubated in media supplemented with 10% of plasma from individuals with obesity or control subjects for the first 4 hours of 24 to 120 hours of culture., Results: Plasma from individuals with obesity modulated the phenotype of healthy PBMC, leading to a higher rate of apoptosis, lower amounts of phospho-γH2AX and -p53, and mitochondrial dysfunction. After 120 hours, there was a higher secretion of inflammatory cytokines IL-1β and IL-8. CD8 + T lymphocytes presented decreased expression of CD28, which is associated with the immunosenescent phenotype. CD14 + macrophages showed increased expression of CD80 and CD206, suggesting a modulation in the activation of macrophages., Conclusions: These results demonstrate that chronic systemic inflammation observed in obesity induces dysfunctional features in PBMC that are consistent with premature immunosenescence., (© 2017 The Obesity Society.)

Imbalances in the gut microbiota, the bacteria that inhabit the intestines, are central to the pathogenesis of obesity. This systematic review assesses the association between the gut microbiota and weight loss in overweight/obese adults and its potential manipulation as a target for treating obesity. This review identified 43 studies using the keywords 'overweight' or 'obesity' and 'microbiota' and related terms; among these studies, 17 used dietary interventions, 11 used bariatric surgery and 15 used microbiota manipulation. The studies differed in their methodologies as well as their intervention lengths. Restrictive diets decreased the microbiota abundance, correlated with nutrient deficiency rather than weight loss and generally reduced the butyrate producers Firmicutes, Lactobacillus sp. and Bifidobacterium sp. The impact of surgical intervention depended on the given technique and showed a similar effect on butyrate producers, in addition to increasing the presence of the Proteobacteria phylum, which is related to changes in the intestinal absorptive surface, pH and digestion time. Probiotics differed in strain and duration with diverse effects on the microbiota, and they tended to reduce body fat. Prebiotics had a bifidogenic effect and increased butyrate producers, likely due to cross-feeding interactions, contributing to the gut barrier and improving metabolic outcomes. All of the interventions under consideration had impacts on the gut microbiota, although they did not always correlate with weight loss. These results show that restrictive diets and bariatric surgery reduce microbial abundance and promote changes in microbial composition that could have long-term detrimental effects on the colon. In contrast, prebiotics might restore a healthy microbiome and reduce body fat., (© 2017 World Obesity Federation.)

Importance: Within cosmetic facial plastic surgery, there is considerable difficulty in producing high-quality scientific publications because of the lack of scientific tools that serve to transform sensations, such as more beautiful or rejuvenated, into numbers capable of being used in statistical analysis., Objective: To validate an objective evaluation method that can be used to define the perception of facial age in scientific studies., Design, Setting, and Participants: This is a cross-sectional, observational study of evaluation by plastic surgeons of 70 photographs of patients from a private care hospital performed from March 1, 2015, through April 30, 2016. When evaluating the photographs, 7 plastic surgeons wrote down the perceived age of each patient. The photographs of each patient were randomly presented twice to each evaluator (photograph 1 and photograph 2) and analyzed singly using a trimmed mean. Three evaluators were randomly chosen for further statistical analysis in an attempt to make the assessment technique more practical., Exposures: Usual aging process., Main Outcomes and Measures: Estimated mean age and chronological age., Results: Photographs of 70 patients were evaluated (mean [SD] age, 41.5 [13.8] years; 48 women [68.6%]; and mean [SD] body mass index, 22.5 [2.7]). No significant differences were observed between photographs 1 and 2 for any of the evaluators. A significant difference in the mean ages was not observed when comparing evaluators. For photograph 1 (evaluated by only 3 evaluators), the difference was 0.16 years (P = .52). For photograph 2, the difference was 0.05 years (P = .86). The difference between the mean perceived age for the 3 evaluators and the chronological age was only 0.8 years (<10 months)., Conclusions and Relevance: The intraevaluator and interevaluator agreement suggests that 3 plastic surgeons can estimate the age of a person with a margin of error of 10 months by analyzing a photograph. This article is important to facial plastic surgeons because it reveals how the results of rejuvenation procedures can be assessed., Level of Evidence: NA.

Background: It has been speculated that the immediate decrease in body fat following liposuction may affect body composition by feedback mechanisms of body fat regain. Physical activity has both short- and long-term impacts on health. Although the lay public often associates higher levels of physical activity with body fat distribution changes, studies on the association between physical activity and body fat distribution present inconsistent results. The aim of this study was to investigate the cross-sectional and prospective associations between physical activity and body mass index following liposuction., Methods: This is a prospective, bidirectional, cross-sectional study, including 526 liposuction patients, who were followed up at a mean of 11.7 and 24.3 months after surgery., Results: The sum of skinfolds at 11.7 months was highly correlated with skinfolds at 24.3 months (rho = 0.74, p < 0.001). More than 85 percent of participants remained in the same quintile or changed by not more than one quintile during the 13.6-month period. Tracking of physical activity was considerably lower but still significant; the correlation was 0.24 (p < 0.001), and 61.4 percent of the patients moved one or less quintiles. In fully adjusted models, no significant cross-sectional or longitudinal associations were found between physical activity and body mass index., Conclusions: The authors provide evidence of tracking of physical activity and particularly body mass index following liposuction. The authors' results do not support the hypothesis that physical activity and fatness are strongly related following liposuction.

Background: The objective of this study was to analyze the factors associated with change in body mass index (BMI) and with percentage of excess weight loss (%EWL) in patients undergoing Roux-en-Y gastric bypass (RYGB). The following factors were analyzed: sex, age, surgical access (laparotomy vs. laparoscopy), preoperative BMI, waist circumference (WC), type 2 diabetes mellitus (T2DM), high blood pressure, and dyslipidemia., Methods: Retrospective cohort study using a convenience sample of 2070 patients of both sexes, aged 18 to 65 years, undergoing RYGB between 2000 and 2013. The outcomes of interest were BMI and %EWL at 0, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months after RYGB., Results: After 36, 48, and 60 months, approximately 50 % of patients had BMI >30 kg/m(2). As for %EWL, 60-month results were poor for 17 % of patients (%EWL <50 %), good for 40 % of patients (%EWL 50-75 %), very good for 24 % of patients (%EWL from >75-90 %), and excellent for 19 % of patients (%EWL >90 %). The four most significant predictors of BMI change 60 months after RYGB (in descending order of magnitude) were preoperative BMI, preoperative WC, surgical access, and age; and of %EWL, surgical access, preoperative BMI, preoperative WC, and age., Conclusions: After 60 months of follow-up, the most relevant predictors of weight loss after RYGB were lower preoperative BMI and WC, videolaparoscopy as surgical access, and younger age. Further studies must be carried out to elucidate the impact of these factors on RYGB outcomes.

Introduction: The prevalence of smoking habits in severe obesity is higher than in the general population. There is some evidence that smokers have different temperaments compared to non-smokers. The aim of this study is to evaluate the associations between smoking status (smokers, ex-smokers and non-smokers) and temperament characteristics in bariatric surgery candidates., Methods: We analyzed data on temperament of 420 bariatric surgery candidates, as assessed by the AFECTS scale, in an exploratory cross-sectional survey of bariatric surgery candidates who have been grouped into smokers, ex-smokers and non-smokers., Results: We detected significant statistical differences in temperament related to the smoking status in this population after controlling the current use of psychiatric medication. Smokers had higher anxiety and lower control than non-smokers. Ex-smokers with BMI >50 kg/m(2) presented higher coping and control characteristics than smokers., Conclusions: Smoking in bariatric surgery candidates was associated with lower control and higher anxious temperament, when controlled by current use of psychiatric medication. Smokers with BMI >50 kg/m(2) presented lower coping and control than ex-smokers. Assessment of temperament in bariatric surgery candidates may help in decisions about smoking cessation treatment and prevention of smoking relapse after surgery.

Background: There is no consensus on the ideal size of intestinal loops in gastric bypass of bariatric surgeries., Aim: To evaluate the metabolic outcome of patients submitted to gastric bypass with alimentary and biliopancreatic loops of different sizes., Methods: Was conducted a retrospective cohort study in diabetic obese patients (BMI≥35 kg/m2) with metabolic syndrome submitted to gastric bypass. The patients were divided into three groups according to the size of the intestinal loop: group 1, biliopancreatic limb 50 cm length and alimentary limb 100 cm length; group 2 , biliopancreatic limb 50 cm length and alimentary limb 150 cm length; and group 3, biliopancreatic limb 100 cm length and alimentary limb 150 cm length. The effect of gastric bypass with different sizes of intestinal loops in relation to the parameters that define metabolic syndrome was determined., Results: Sixty-three patients were evaluated, and they had a mean age of 44.7±9.4 years. All were diabetics, with 62 (98.4%) being hypertensive and 51 (82.2%) dyslipidemic. The three groups were homogeneous in relation to the variables. In 24 months, there was a remission of systemic arterial hypertension in 65% of patients in group 1, 62.5% in group 2 and 68.4% in group 3. Remission of diabetes occurred in 85% of patients in group 1, 83% in group 2 and 84% in group 3. There was no statistical difference in %LEW between the groups, and waist measurements decreased in a homogeneous way in all groups. The size of loops also had no influence on the improvement in dyslipidemia., Conclusion: Variation in size of intestinal loops does not appear to influence improvement in metabolic syndrome in this group of patients., Competing Interests: none

Importance: Postoperative edema and ecchymosis following rhinoplasty are a cause of anxiety for both patients and physicians and can affect the cosmetic results. Corticosteroids have been used to reduce these events., Objective: To determine whether preoperative use of dexamethasone sodium phosphate alters the occurrence of edema and ecchymosis following rhinoplasty., Design, Setting, and Participants: Randomized, double-blind, placebo-controlled clinical trial at an institutional referral center among a sample of individuals with rhinomegaly., Interventions: Patients were randomized into 2 groups. In group 1, dexamethasone was intravenously injected before surgery. In group 2, normal saline solution was intravenously injected before surgery., Main Outcomes and Measures: When patients returned at 1 week after surgery, standardized photographs were obtained. The photographs were analyzed by 5 plastic surgeons who were blinded as to whether dexamethasone or normal saline solution had been injected. The plastic surgeons rated the degree of edema and ecchymosis., Results: Forty-two patients participated in the study. Randomization by lottery resulted in 20 patients in group 1 and 22 patients in group 2. Group 1 showed lower rates of postoperative ecchymosis than group 2; the difference of 0.62 (P = .02) reflects less perceived ecchymosis when dexamethasone was administered. Group 1 also showed lower rates of postoperative edema than group 2; the difference of 0.68 (P = .01) reflects less perceived edema when dexamethasone was administered., Conclusions and Relevance: Preoperative use of dexamethasone reduced edema and ecchymosis at 7 days after rhinoplasty. Rigorous methods in this trial demonstrate the beneficial effect of preoperative corticosteroid administration in this surgical procedure., Level of Evidence: 1.

Objectives: To evaluate whether reduced activity of the anti-inflammatory HSP70 pathway correlates with nonalcoholic fatty liver disease (NAFLD) progression and with markers of oxidative stress because obesity activates inflammatory JNKs, whereas HSP70 exerts the opposite effect., Methods: Adult obese patients (N = 95) undergoing bariatric surgery were divided into steatosis (ST), steatohepatitis (SH), and fibrosis (SH+F) groups. The levels of HSP70, its major transcription factor, HSF1, and JNKs were assessed by immunoblotting hepatic and visceral adipose tissue; data were confirmed by immunohistochemistry. Plasma biochemistry (lipids, HbA1c , HOMA, hepatic enzymes, and redox markers) was also evaluated., Results: In both liver and adipose tissue, decreased HSP70 levels, paralleled by similar reductions in HSF1 and reduced plasma antioxidant enzyme activities, correlated with insulin resistance and with NAFLD progression (expression levels were as follows: ST > SH > SH + F). The immunohistochemistry results suggested Kupffer cells as a site of HSP70 inhibition. Conversely, JNK1 content and phosphorylation increased., Conclusions: Decreased HSF1 levels in the liver and fat of obese patients correlated with impairment of HSP70 in an NAFLD stage-dependent manner. This impairment may affect HSP70-dependent anti-inflammation, with consequent oxidative stress and insulin resistance in advanced stages of NAFLD. Possible causal effects of fat cell senescence are discussed., (© 2014 The Obesity Society.)

Background. Telemedicine can be defined as the use of electronic media for transmission of information and medical data from one site to another. The objective of this study is to demonstrate an experience of telemedicine in plastic surgery. Methods. 32 plastic surgeons received a link with password for real-time streaming of a surgery. At the end of the procedure, the surgeons attending the procedure by the Internet answered five questions. The results were analyzed with descriptive statistics. Results. 27 plastic surgeons attended the online procedure in real-time. 96.3% considered the access to the website as good or excellent and 3.7% considered it bad. 14.8% reported that the transmission was bad and 85.2% considered the quality of transmission as good or excellent. 96.3% classified the live broadcasting as a good or excellent learning experience and 3.7% considered it a bad experience. 92.6% reported feeling able to perform this surgery after watching the demo and 7.4% did not feel able. 100% of participants said they would like to participate in other surgical demonstrations over the Internet. Conclusion. We conclude that the use of telemedicine can provide more access to education and medical research, for plastic surgeons looking for medical education from distant regions.

Vitamin D (VD) plays a role in the skin regulation. Striae Distensae (SD) are manifestations of epidermal atrophy that occurs after tissue tearing due to overstretching or rapid growth. The objective of this study was to investigate the relation between serum VD and occurrence of SD in women who had undergone mammaplasty with silicone implants. A case-referent study was conducted. The blood values of 25-hydroxyvitamin D (25OHD) were measured before the surgery. For each patient postoperatively diagnosed with SD, four other participants submitted to the same surgery, without the development of SD, were enrolled as the healthy controls. 67 women with SD after the surgery entered the study. 268 formed the control group. In the serum of healthy controls 25OHD mean was 27 ng/mL, and SD cases presented 20 ng/mL (P = 0.01). Scarce values of VD have been observed in 56.71% of the cases presenting SD and in 39.91% without SD (P = 0.002). Chance of having VD values lower than 20 ng/mL amongst cases with SD is 2.38 (P = 0.0001). Lower serum levels of VD are linked to a higher occurrence of SD.

Background: Bariatric surgery is the most effective therapeutic option for obesity and its complications, especially in type 2 diabetes. The aim of this study was to investigate the messenger RNA (mRNA) gene expression of proglucagon, glucose-dependent insulinotropic peptide (GIP), prohormone convertase 1/3 (PC1/3), and dipeptidyl peptidase-IV (DPP-IV) in jejunum cells of the morbidly obese (OB) non type 2 diabetes mellitus (NDM2) and type 2 diabetes mellitus (T2DM), to determine the molecular basis of incretin secretion after bariatric surgery., Methods: Samples of jejunal mucosa were obtained from 20 NDM2 patients: removal of a section of the jejunum about 60 cm distal to the ligament of Treitz and 18 T2DM patients: removal of a section of the jejunum about 100 cm distal to the ligament of Treitz. Total RNA was extracted using TRIzol. Reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) was carried out. Samples were sequenced to PC1/3 by ACTGene Análises Moleculares Ltd. Immuno content was quantified with a fluorescence microscope., Results: T2DM showed decreased PC1/3 mRNA expression in the primers tested (primer a, p=0.014; primer b, p=0.048). Many patients (36.5 %) did not express PC1/3 mRNA. NDM2 and T2DM subjects showed nonsignificantly different proglucagon, GIP, and DPP-IV mRNA expression. The immuno contents of glucagon-like peptide-1 and GIP decreased in T2DM jejunum, but incubation with high glucose stimulated the immuno contents., Conclusions: The results suggest that bioactivation of pro-GIP and proglucagon could be impaired by the lower expression of PC1/3 mRNA in jejunum cells of obese patients with T2DM. However, after surgery, food could activate this system and improve glucose levels in these patients.

Metabolic surgery for the treatment of type 2 diabetes mellitus (T2DM) in patients not morbidly obese (BMI <35) has been widely studied. Taking into account that ∼12% of pancreas transplants are performed in patients with T2DM, our goal was to evaluate the impact of metabolic surgery on the management of obese patients with T2DM on waiting lists for a pancreas transplant. We performed a Roux-en-Y gastrointestinal bypass in 5 patients with insulin-dependent T2DM who were candidates for pancreas after kidney transplant and with a BMI <35. Three patients became insulin independent by the end of the first year while the other 2 reduced their insulin requirements by 70%. Furthermore, all patients achieved improved control of lipid levels. We concluded that the surgery was effective in controlling blood glucose and lipid metabolism in these obese T2DM kidney transplant recipients. In this population, a pancreas transplant, along with its associated morbidity, may be avoided., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Because of the high prevalence of obesity, there is a growing demand for bariatric surgery worldwide. The objective of this systematic review was to analyze the difference in relation to cost-effectiveness of access route by laparoscopy versus laparotomy of Roux en-Y gastric bypass (RYGB)., Methods: A systematic review was conducted in the electronic databases MEDLINE, Embase, Scopus, Cochrane and Lilacs in order to identify economic evaluation studies that compare the cost-effectiveness of laparoscopic and laparotomic routes in RYGB., Results: In a total of 494 articles, only 6 fulfilled the eligibility criteria. All studies were published between 2001 and 2008 in the United States (USA). Three studies fulfilled less than half of the items that evaluated the results quality; two satisfied 5 of the required items, and only 1 study fulfilled 7 of 10 items. The economic evaluation of studies alternated between cost-effectiveness and cost-consequence. Five studies considered the surgery by laparoscopy the dominant strategy, because it showed greater clinical benefit (less probability of post-surgical complications, less hospitalization time) and lower total cost., Conclusion: This review indicates that laparoscopy is a safe and well-tolerated technique, despite the costs of surgery being higher when compared with laparotomy. However, the additional costs are compensated by the lower probability of complications after surgery and, consequently, avoiding their costs.

Background: The significant increase in the popularity of breast augmentation surgeries has led to an increase in the number and types of complications; among these is the postoperative occurrence of Striae Distensae (SD). The objective of this study was to investigate the incidence of SD and describing its occurrence in association with age, breast implant volume, history of SD, history of pregnancies and breastfeeding, body mass index (BMI), changes in postoperative weight, smoking habits, and use of oral contraceptives., Methods: A cohort study was conducted and the patient data from a specific social group that underwent augmentation mammaplasty with silicone breast implants in a private clinic was analyzed., Results: 563 patients entered the cohort, while 538 completed the study. The SD incidence was 7.06%. The risk was almost the double at 22-28 years of age and triple in women of 21 years of age or less. The women who did not use oral contraceptives were 2.59 times more likely of developing SD. A higher incidence of SD was observed among those with normal or low BMI values, smokers, and in those who had implants larger than 300 ml., Conclusions: Young age, larger implant volumes, smoking, and normal or low BMI values were the risk factors responsible for the development of SD; while using oral contraceptives was found to be a protective factor.

Background: Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy., Aim: 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures., Methods: A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed., Results: From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy., Conclusion: 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy.

Background: The consequences of obesity include musculoskeletal pain and its influence on a person's social, personal, and professional life, which is a great challenge for the multidisciplinary team in the treatment of obesity. The objective of this work was to evaluate musculoskeletal pain in the work activities of obese individuals., Methods: An uncontrolled cross-sectional study was conducted. During 8 months, all obese individuals seen in the preoperative period at a tertiary care referral center for the treatment of obesity and metabolic syndrome were invited to participate in the study. Ninety-five persons filled out the Nordic questionnaire for the analysis of musculoskeletal symptoms (Nordic musculoskeletal questionnaire (NMQ)) after having signed an informed consent form and having met the inclusion criteria of the study., Results: Of the 95 patients assessed, 71 were females, the mean age was 39.3 ± 10.1 years, and mean body mass index was 47.25 ± 8.72 kg/m(2). Sixty-three (66.31 %) individuals felt musculoskeletal pain in some region of the body in the last 12 months, and 42 (44.21 %) sometimes gave up working in the same period because of musculoskeletal pain. There was a statistical association between BMI and the three aspects evaluated by the NMQ., Conclusions: Musculoskeletal pain was very related to obese individuals who participated in this study, and in the majority cases, execution of the work activities of these persons was impeded. This indicates a need for further studies that address this subject to better attend to and intervene in the health of this population.

Background: Obesity is a pathologic condition that causes functional incapacity, with reduction of quality of life and life expectancy and an increase in mortality. Bariatric surgery is indicated to alleviate associated comorbidities and increase physical capacity. The objective of this work was to evaluate the functional capacity of patients with morbid obesity before and after (3 months) bariatric surgery., Methods: This was a cross-sectional study involving 67 patients, where 61 were women and six men, with a mean age of 38 ± 10 years and mean BMI of 50.45 ± 8.5 kg/m2. All patients were assessed before surgery and 3 months afterwards. The following assessments were performed: 6-min walk test (6MWT), functional independence measure (FIM), and test for risk of falling and transfer capacity, called the timed up-and-go test., Results: The study demonstrated a reduction in parameters evaluated in 6MWT with a statistically significant difference at two times (rest and final) when evaluated before and after bariatric surgery (p < 0.001). In relation to the FIM and timed up-and-go test, the patients showed a statistically significant improvement (p < 0.001) for both when comparing the tasks evaluated at the pre- and postoperative moments., Conclusions: Obesity has an impact on the functioning and quality of life of patients. We observed an improvement in all instruments used for assessment before and after bariatric surgery, where a linear component was demonstrated in relation to diminution of body mass index and functioning.

Purpose: To describe the results in patients treated with distraction osteogenesis combined with free nail graft after distal phalanx amputation., Methods: We analyzed 14 patients with distal phalanx amputation (13 women). Mean age was 35 years. There were 9 amputations of the index finger, 3 of the middle finger, and 1 each of the thumb and ring finger. We started bone distraction 7 days after surgery, with 1 mm distraction every 3 days. After bone elongation, we inserted a free composite nail graft at the dorsal tip of the distracted finger. We evaluated distraction length, consolidation time, aesthetic result (using the Foucher and Leclère score), and complications., Results: The mean bone elongation was 17 mm and mean consolidation time was 149 days. Nail cosmetic results were satisfactory; the mean total Foucher score was 14 out of 20. Mean individual scores were patient's opinion (7.8 out of 10), adequate length (1.2 out of 2.5), adequate alignment (1 out of 1), adequate width (1.8 out of 4), and dorsal scar quality (2.2 out of 2.5). The mean total Leclère score was 14 out of 20. All patients retained sensibility in the grafted area and none had healing abnormalities. The mean opinion about the donor site was 7.5 out of 8. Nail growth less than 50% occurred in 2 patients. Mean follow-up was 62 months., Conclusions: Distraction osteogenesis combined with free nail graft is a therapeutic option when replantation is not an option or when it fails. However, treatment takes time and requires the involvement of the patient, family, and medical team., (Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Bariatric surgery is considered the most effective treatment for obesity class II and III. However, postoperative side effects may occur, such as nutritional deficiencies resulting from reduced gastric capacity and alterations in nutrient absorption along the gastrointestinal tract., Methods: A total of 170 patients (136 women and 34 men) submitted to Roux-en-Y gastric bypass (RYGB) between 2000 and 2005 were retrospectively assessed. Anthropometric and laboratory data were evaluated and the use of vitamin and mineral supplements, before and 1, 6, 12, 24, and 36 months following surgery, was assessed, as well., Results: Mean excess weight loss at 24 and 36 months was 81.5 ± 19.2 and 78.5 ± 20.8 %, respectively. Anemia was present in 6.5 % of subjects prior to the surgery and increased to 33.5 % at 36 months. The levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, and glycemia were reduced, while high-density lipoprotein cholesterol was increased. Albumin and vitamin B12 levels showed no significant differences at the end of the study compared to the preoperative evaluation. Folic acid levels increased significantly during the follow-up. Almost 6 % of the patients had used standard vitamin and mineral supplements in the preoperative period and 72.4, 85.3, 74.7, 77.1, and 72.4 % at 1, 6, 12, 24, and 36 months following RYGB, respectively., Conclusions: Bariatric surgery is an effective treatment for long-term weight loss. However, nutritional deficiency is one of its side effects and should be properly diagnosed and handled, aimed at improving the patient's quality of life and preventing severe complications.

Background: Evidence indicates that eating habits established during childhood related to food intake persist when the child becomes an adult. Parental obesity is positively associated with the development of obesity in the offspring, who tend to become sick and obese young adults during the reproductive phase and end up looking for bariatric surgery in order to reverse the non-communicable diseases (NCDs) already established., Methods: This cross-sectional study evaluated 40 children aged 0 to 10 years, whose mothers underwent bariatric surgery at the Center of Morbid Obesity, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL PUCRS)., Results: Among these children, 45 % were overweight and 16 had high waist circumference values. The total energy intake and sodium consumption were above the Dietary Reference Intakes (DRIs) for the age group, while dietary fiber and potassium intakes were below DRIs. Obese children had higher percentage of lipid caloric intake (28.3 vs. 25.3 %, p < 0.025), while the non-obese group tended to have an increased consumption of carbohydrate (62.6 vs. 60 %, p < 0.066) when compared to the respective DRIs. The presence of NCDs in children's relatives was 100 %., Conclusions: There is probably a significantly higher prevalence of obesity among children of morbidly obese parents when compared to the general child population. Since the familial aggregation of NCDs was absolute, these results point to the need for careful evaluation when dealing with children. However, further studies with a larger number of individuals are needed to confirm these results.

Background: Although bariatric surgery has been shown to improve hepatic steatosis in morbidly obese patients, the effect of weight loss on hepatic fibrosis has not been determined. Since the prognosis of patients with nonalcoholic fatty liver disease is closely related to the development of hepatic fibrosis, it is important to determine the hepatic histology of these patients after weight loss. We therefore evaluated the prevalence of hepatic fibrosis in morbidly obese patients undergoing bariatric surgery and assessed the correlation of histologic changes with weight loss., Methods: We retrospectively evaluated 78 morbidly obese patients who underwent gastric bypass. Liver biopsies were taken during surgery and after weight loss, and the correlations between histologic findings and hepatic fibrosis were determined., Results: Of the 78 patients, 35 (44.8%) had fibrosis at first biopsy, and 24 (30.8%) had hepatic fibrosis after weight loss, including 19 of the 35 patients (54.3%) with fibrosis at first biopsy and 5 of the 43 (11.6%) without hepatic fibrosis at first biopsy (P = 0.027)., Conclusions: Weight loss in morbidly obese patients was associated with a reduction in the prevalence of hepatic fibrosis.

With the high prevalence of obesity and associated comorbidities, the costs of health services produce a great economic impact. The objective of this work was to evaluate the economic benefits of bariatric surgery and to relate the costs to the impact on the health of the individual. A historic cohort study was conducted, with review of medical charts of 194 patients who fulfilled the inclusion criteria for the study. The costs for medications, professional care, and examinations in the pre- and postoperative periods were analyzed, taking into consideration the comorbidities DM2, SAH, and dyslipidemia. The study demonstrated a reduction in the medical costs in the course of the postoperative period, in relation to expenses for medications, professional care, and examinations in the preoperative period. Comparing the preoperative expenses with different times in the postoperative period, a statistically significant difference was seen at all time evaluated (p < 0.001). The resolution of comorbidities was higher than 95% at 36 months after surgery. No statistically significant difference was seen with respect to the prevalence of comorbidities between the sexes in the pre- and postoperative periods (p > 0.05). With regard to age, younger patients showed lower rates of comorbidities in the pre- and postoperative periods (p < 0.001). The costs of the surgery are high, but the expenditures for medications, professional care, and examinations decrease progressively after the operation, where this is more evident in patients with more associated comorbidities.

Objective: Adipose tissue is responsible for secretion of several cytokines that mediate systemic effects on obesity and insulin resistance. Subcutaneous abdominal adipose tissue (SAT) and visceral adipose tissue (VAT) are metabolically different and have differences in their gene expression profile. Our study evaluated the expression of adiponectin, FOXO1, PPARγ, and SIRT1 in VAT and SAT of non-obese and class III obese subjects., Methods: The adipose tissue samples were obtained by surgery. Reverse transcripts of studied genes were determined by quantitative real-time polymerase chain reaction (qRT-PCR)., Results: Comparing the different lipid depots, adiponectin expression was lower only in VAT of obese individuals (p = 0.043); FOXO1 and PPARγ levels were decreased in VAT of both groups. When non-obese and obese were compared, only adiponectin expression was lower in SAT and in VAT of obese subjects (p = 0.004 and p = 0.002, respectively). No difference was found with regard to SIRT1 levels in VAT or SAT in both groups. FOXO1 expression in SAT of obese subjects had a negative correlation with age (r = -0.683; p = 0.029) and triglyceride serum levels (r = -0.794; p = 0.006)., Conclusion: The decrease mRNA expression of this genes in VAT, responsible for central adiposity, may be associated with an increased risk of obesity and co-morbidities.

Background: We investigate the outcomes of pregnancy in women who undergone restrictive-malabsorptive procedure at Centro da Obesidade Mórbida-Hospital São Lucas (COM HSL-PUCRS), Porto Alegre, Brazil., Methods: All pregnancies started after the bariatric surgery and with estimated due date until June 2008 were eligible for the study. Only the first pregnancy of each patient was included in the data analysis. Data was collected from medical records., Results: Forty seven pregnancies were identified in 41 women. Eight of them were ineligible. There were 30 complete pregnancies and nine miscarriages (23%). Cesarean delivery was performed in 69% of the complete pregnancies. Mature infants occurred in 93.1%. Twelve pregnancies (30.8%) occurred in the first year after surgery. Vitamin B12 was low in 53.4% patients; folic acid in 16.1%, iron in 6.7%, ferritin in 41.7%, calcium in 16.7%, and albumin in 10.3% of the patients. Nineteen women (79.2%) had no complication during the pregnancy and two (8.3%) presented with internal hernia. The average of newborns weight and length on delivery were 3,037 g and 48.07 cm, respectively. Children from pregnancies started in the first year of post operatory had similar outcomes of children from pregnancies started after 1 year of surgery., Conclusions: Pregnancy after bariatric surgery is safe and has fewer complications than pregnancy in morbidly obese women. However, the recommendation to delay the pregnancy for at least 12-18 months post-operatively should be kept.

Purpose: To evaluate the long-term (6-y) results of Wilhelm's wrist denervation technique used as an isolated procedure for painful conditions of the wrist., Methods: We conducted a retrospective review of 49 wrist denervations that were performed as isolated procedures in patients with painful wrist conditions. Indication for surgery was degenerative osteoarthritis of the wrist caused by scaphoid nonunion advanced collapse in 19 patients, Kienböck's disease in 13 patients, and primary degenerative osteoarthritis in 17 patients., Results: The results were analyzed as a group and by comparing the 3 etiologies. Average pain improvement after surgery for all groups was 68% ± 8% after the first month and reached a plateau at the end of the first year, with the percentage remaining stable at 36 months at 79% ± 4%. Grip strength on the treated side improved from 43% of the opposite side before denervation to 69% of the opposite side. The range of motion showed improvements in all axes of movement, without statistical differences between groups. Radiological evaluation after 72 months revealed worsening in 34 patients. There was no difference in results between the 3 groups with regard to grip strength, range of motion, or pain relief obtained., Conclusions: Wrist denervation resulted in improvement in pain scores in 39 patients despite radiological deterioration noted in 34 after 6 years., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)