Reversal to normal anatomy after one-anastomosis/mini gastric bypass,indications and results: a systematic review and meta-analysis

This review evaluates the indications and outcomes of one-anastomosis/mini gastric bypass (OAGB/MGB) reversal to normal anatomy. A systematic literature search and meta-analysis was performed in PubMed, Web of Science, and Scopus for articles published by October 1, 2020, including the keywords “one anastomosis gastric bypass,” “OAGB,” “mini gastric bypass,” “MGB,” “reversal,” “reverse,” “malnutrition,” and “reversal bariatric surgery”. After examining 182 papers involving 11,578 patients, 14 studies were included. A reversal was performed in 119 patients on average 23.6 months after the primary OAGB/MGB surgery. The mean body mass index (BMI) was 22.92 ± 3.47 kg/m² and the mean albumin level was 25.17 ± 4.21 g/L at reversal. The mean length of the common channel (CC) was 383.57 ± 159.35 cm, with a mean biliopancreatic limb (BPL) length of 214.21 ± 48.45 cm. Pooled estimation of the meta-analysis of prevalence studies reported a prevalence of 1% for reversal. The major signs and symptoms of protein-energy malnutrition were the leading causes of the reversal of OAGB/MGB. Bleeding, leakage, and death due to severe liver failure were the most reported complications after reversal, with an overall incidence of 10.9%. In conclusion, OAGB/MGB reversal has a prevalence of 1% and has a complication rate of 10.9%. Protein-energy malnutrition with hypoalbuminemia was the most common etiology. The mean lengths of BPL and CC were reported as 215 cm and 380 cm, respectively, in the cases. Therefore, special attention should be paid to malnutrition in all OAGB/MGB patients during follow-up to prevent severe malnutrition and subsequent increase in reversal procedures.     

Effect of endurance training on retinol‐binding protein 4 gene expression and its protein level in adipose tissue and the liver in diabetic rats induced by a high‐fat diet and streptozotocin

Aims/Introduction

The present study was designed to investigate from which tissues the decrease in retinol‐binding protein 4 (RBP4) expression could contribute to the improvement of serum RBP4 and insulin resistance (IR) after endurance training.

Materials and Methods

Male 7‐week‐old Wistar rats were randomly assigned into four groups including control (C), trained (T), diabetic control (DC) and trained diabetic (TD). At 8 weeks‐of‐age, diabetes was induced by a high‐fat diet and intraperitoneal injection of low‐dose streptozotocin (STZ; 35 mg/kg). Rats in the T and TD groups carried out a 7‐week exercise program on a motorized treadmill (15–20 m/min for 20 min/day for 5 weeks), whereas the C and DC remained sedentary in their cages. Tissues gene expression and protein levels of RBP4 were assessed by using real‐time polymerase chain reaction and western blot, respectively, while serum RBP4 was measured using an enzyme‐linked immunosorbent assay kit.

Results

Exercise significantly improved IR and reduced serum concentration of RBP4 in the TD group. This reduction of serum RBP4 was accompanied by decreased RBP4 protein expression in visceral fat tissue. In contrast, exercise had no significant effect on RBP4 expression in liver and subcutaneous fat tissue in the TD group. Exercise also significantly decreased RBP4 gene expression in visceral fat tissue and muscle, whereas the effect of exercise on liver RBP4 messenger ribonucleic acid expression was not significant.

Conclusions

The present study showed that the mechanism for RBP4 reducing the effect of endurance training could involve decreased RBP4 messenger ribonucleic acid expression and its protein level in adipose tissue in STZ‐induced diabetic rats.     

Selenium Deficiency After Bariatric Surgery,Incidence and Symptoms: a Systematic Review and Meta-Analysis

Obesity Surgery - This study review the prevalence of selenium deficiency after bariatric surgery, incidence, and symptoms. A systematic literature search and meta-analysis was performed...     

Sex differences in adenosine deaminase activity of stroke patients.

BACKGROUND: Adenosine deaminase (ADA) catalyzes the irreversible hydrolytic deamination of adenosine to inosine. The purpose of this study was to determine the plasma activities of total adenosine deaminase (ADA T), and its isoenzymes, ADA1 and ADA2, and ADA1/ADA2 ratio of male and female ischemic stroke patients. METHODS: We determined activities of plasma ADA T, ADA1, ADA2 and ADA1/ADA2 ratio in 30 patients (15 men and 15 women) with acute ischemic stroke within 12 h of the onset of the attack, as well as in 30 control subjects (15 men and 15 women) of comparable age. RESULTS: There were significant differences between the ADA1 activity and ADA1/ADA2 ratio in male and female stroke patients (p<0.05). Compared with male stroke subjects, females had higher ADA1 activity and ADA1/ADA2 ratios. There were no significant differences between activities of ADA T and ADA2 in men and women of the stroke and control groups. In addition, the Canadian Neurological Scale in men was significantly higher than that of women in the stroke group (p<0.05). CONCLUSIONS: Our results suggest that the primary mechanism in men with ischemic stroke might involve the reduction of ADA1 activity. The reduction is probably an adaptation mechanism for induced increase in adenosine availability and protection of brain to ischemic injury.     

Hyaluronidase in sub-Tenon's anesthesia for phacoemulsification, a double-blind randomized clinical trial

AIM: To investigate the effect of hyaluronidase use on the quality of sub-Tenon's anaesthesia for phacoemulsification. METHODS: This was a randomized, double-blind clinical trial which was conducted at Nikookari Eye Hospital for 5 months. Forty-two eyes of candidates for phacoemulsification under sub-Tenon's anaesthesia were randomly allocated to two equal groups and received either 2 mL of lidocaine 2% solution with (LH), or without (L) addition of hyaluronidase (150IU/mL). Akinesia was assessed 15 minutes after sub-Tenon’s injection. Patients and surgeon’s satisfaction, as well as the postoperative pain (the visual analogue scale, VAS) were investigated after operation. The contingency tables (including the Chi-square or Fisher's exact tests, when appropriate) and parametric analysis (the independent samples t test) were used for statistical analysis. RESULTS: Complete akinesia (33.3% vs 4.8%, P=0.04), as well as the patients (85.7% vs 57.1%, P=0.04) and surgeon’s satisfaction (87.5% vs 52.4%, P=0.02) were significantly more frequent in LH than in L group. The mean VAS was significantly lower in the same group (1.90±1.45 vs 3.00±1.55, P=0.04). CONCLUSION: Addition of hyaluronidase to lidocaine solution for sub-Tenon's anesthesia significantly improves the ocular akinesia, enhances the intra-operative patients and surgeons' satisfaction, and attenuates the postoperative pain.     

Apolipoprotein E genotypes of fertile and infertile men

Lipid components of spermatozoa have an important role in the functional activity of this cell. The protein, apolipoprotein E (apoE), has a central role in lipid transport. The aim of this study was to investigate the distribution of APOE genotypes, ?3?3, ?3?4, and ?2?3, and the corresponding alleles in fertile and infertile males, and to assess the semen parameters from the patients carrying the different alleles. In addition, the levels of cholesterol, phospholipid, and triacylglycerol in spermatozoa, isolated by PureSperm gradient and from seminal plasma in samples from infertile males was compared with respect to the APOE genotype. APOE genotypes were determined by PCR-RFLP on DNA extracted from peripheral blood leucocytes in 108 fertile and 107 infertile men. There was a significant difference between the distribution of APOE genotypes in fertile as compared to infertile males (χ(2)?=?9.1, df?=?2, p?=?0.011). The presence of genotype ?3?4 conferred a 3.82 risk factor for male infertility {Odds ratio?=?3.82 (1.46-10, p?=?0.006)}. Our findings showed that the distribution of APOE genotypes and alleles differed between fertile and infertile individuals and may be a risk factor for male infertility. We suggest that the effects of APOE genotypes may be linked to differences in the efficacy of the expressed apoE isoforms in promoting sperm maturation during epididymal transit.     

Intravitreal clindamycin plus dexamethasone versus classic oral therapy in toxoplasmic retinochoroiditis: a prospective randomized clinical trial

Both oral and intraocular routes have been recommended for medication administration in toxoplasmic retinochoroiditis; however, available data, in support or against, are scarce. The objective of this study was to compare the efficacy of intravitreal clindamycin plus dexamethasone (IVCD) and conventional oral therapy (COT) including pyrimethamine, sulfadiazine, folinic acid and prednisone in active toxoplasmic retinochoroiditis. In this prospective randomized single-blind clinical trial, patients with active toxoplasmic retinochoroiditis received either IVCD (n = 32), or COT (n = 34) for 6 weeks. Changes of best-corrected visual acuity, retinal lesion size, and vitreous inflammation before and after treatment, as well as complications/side-effects and recurrence rate within at least 2 years of follow-up were compared between groups. Although all the variables improved significantly at 6 weeks within each group, changes were comparable between the IVCD and COT receivers. There was only one case with hepatotoxicity in the COT group which responded favorably to drug change. No injection-related complication was observed. Recurrence rates were 12.5 and 14.7 % in the IVCD and COT groups, respectively (p = 0.54). In conclusion, both IVCD and COT are equally effective against active toxoplasmic retinochoroiditis but the former is apparently safer and more convenient.     

A comparison between Goldmann applanation tonometry and dynamic contour tonometry after photorefractive keratectomy

Background

The intraocular pressure (IOP) could be measured by both Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT). Although these two methods have been discussed widely after laser-assisted sub-epithelial keratectomy (LASIK), there is little data in the cases undergoing photorefractive keratectomy (PRK). We aimed to compare the changes of IOP measurements obtained by GAT and DCT after PRK for myopia/myopic astigmatism.

Methods

This prospective study enrolled 77 candidates (154 eyes) for PRK to correct myopia or myopic astigmatism and 30 matched patients (30 eyes) with myopia or myopic astigmatism who served as controls. Changes of the IOP measurements (ΔIOP) obtained by GAT and DCT before and at 6 months after PRK in the operated eyes, and at baseline and 6 months later in the controls, were documented. Changes of the central corneal thickness (ΔCCT) were determined in the same fashion.

Results

The mean IOP readings obtained by DCT were comparable before and at 6 months after procedure (18.34 ± 3.03 mmHg and 17.87 ± 2.61 mmHg respectively, p?=?0.41); whereas the mean IOP reading obtained by GAT decreased significantly 6 months postoperatively (17.92 ± 3.63 mmHg and 16.25 ± 2.66 mmHg, p?<?0.001). A significant correlation was present between the ΔIOP obtained by GAT and ΔCCT (r?=?0.61, p?<?0.001). Similar correlation was not significant between the DCT-obtained ΔIOP and the ΔCCT (r?=?0.07, p?=?0.44). The mean ΔIOP obtained by GAT was significantly higher in the operated eyes than in the controls (?1.54?±?1.45 vs 0.07?±?0.44 mmHg, p?=?0.02). The mean DCT-obtained ΔIOP was just marginally insignificant between the operated and nonoperated eyes (?0.63?±?0.59 vs 0.02?±?0.38 mmHg respectively; p?=?0.09).

Conclusions

The authors recommend DCT after PRK in the cases with myopia or myopic astigmatism     

An inverse relation between CagA+ strains of Helicobacter pylori infection and risk of erosive GERD

OBJECTIVE: The aim of this study is investigating the association of Helicobacter pylori (H. pylori) infection and its cytotoxic-associated gene A (cagA) strain with reflux esophagitis. METHODS: In a case-control setting (May 2005-2006), patients with reflux esophagitis (case group) were compared with age and gender matched people suffering from symptoms of gastroesophageal reflux disease with normal upper gastrointestinal endoscopic findings (control group) in Imam Khomeini Hospital, Tabriz, Iran. The rates of H. pylori and its cagA positive infections were separately compared between the 2 groups and the subgroups with different severity of reflux esophagitis. RESULTS: Ninety-two and 93 patients were enrolled in the case and the control groups. The rate of H. pylori infection was insignificantly lower in the case group (81.5% versus 87.10%, p=0.29, odd ratio 0.654, 95% Confidence interval [CI] 0.293 to 1.495). The CagA positive infections were found significantly more frequent in the control group (59.1% versus 40.2%, p=0.01, odd ratio 0.465, 95% CI 0.258 to 0.836). There was no significant difference between the severity subgroups of the disease for H. pylori (p=0.30) or cagA positive infection rates (p=0.40). CONCLUSION: The CagA positive strains might have a protective effect against reflux esophagitis.