Extracellular vesicles (EVs) are cell-derived membrane vesicles which play an important role in cell-to-cell communication and physiology. EVs deliver biological information from producing to recipient cells by transport of different cargo such as proteins, mRNAs, microRNAs, non-coding RNAs and lipids. Adipose tissue EVs could regulate metabolic and inflammatory interactions inside adipose tissue depots as well as distal tissues. Thus, adipose tissue EVs are assumed to be implicated in obesity-associated pathologies, notably in insulin resistance and type 2 diabetes mellitus (T2DM). In this study we for the first time characterize EVs secreted by visceral (VAT) and subcutaneous adipose tissue (SAT) of patients with obesity and T2DM with standard methods as well as analyze their morphology with cryo-electron microscopy. Cryo-electron microscopy allowed us to visualize heterogeneous population of EVs of various size and morphology including single EVs and EVs with internal membrane structures in samples from obese patients as well from the control group. Single vesicles prevailed (up to 85% for SAT, up to 75% for VAT) and higher proportion of EVs with internal membrane structures compared to SAT was typical for VAT. Decreased size of single and double SAT EVs compared to VAT EVs, large proportion of multilayered EVs and all EVs with internal membrane structures secreted by VAT distinguished obese patients with/without T2DM from the control group. These findings could support the idea of modified biogenesis of EVs during obesity and T2DM.

Type 2 diabetes prevalence is increasing dramatically worldwide. Conservative therapy doesn’t bring stable effect and is often insufficient, not to mention the lack of prospects to cure the disease. Fortunately, accumulating evidence points towards the notion that a complete remission of type 2 diabetes is feasible following a choice of surgical interventions. The efficacy of bariatric surgery in particular for achieving glycemic control has highlighted surgery as a candidate curative intervention for type 2 diabetes. When compared to intensive medical therapy and lifestyle intervention, metabolic surgery has shown superiority in achieving reducing number of medications and metabolic factors improvement, which translates in long-term benefits on diabetes progression and complications. Understanding factors that predict diabetes remission can help to select patients who will benefit most from bariatric surgery and to choose the most effective type of operation. This literature review analyzes studies of the most significant clinical and biochemical predictors of remission of type 2 diabetes mellitus after bariatric interventions, as well as highlights well-known mathematical prediction models.

The OBJECTIVE was to increase the safety of laparoscopic decompression of the abdominal trunk.METHODS AND MATERIALS. The results of treatment of 30 patients who underwent laparoscopic decompression of the celiac trunk were analyzed. Intraoperative bleeding requiring conversion to laparotomy occurred in two (6.7%) cases.RESULTS. To prevent such a complication, a method of preventive installation of a balloon catheter into the celiac trunk was introduced, which allows creating a temporary occlusion of the vessel in case of damage. A similar approach was used in 10 (33.3%) patients. The need to cover the lumen of the vessel with a balloon arose in one observation (3.3% of all patients and 10.0% using this technique). Bleeding from the inferior phrenic artery, which originated from the celiac trunk, was stopped by laparoscopic access.CONCLUSION. The experience presented in this paper allows us to consider the installation of a balloon boat in the celiac trunk as one of the possible ways to improve the safety of its laparoscopic decompression. Further research is needed to obtain a definitive picture of the effectiveness of this approach.

This original article discusses the main concomitant diseases and psychological problems of patients with morbid obesity seeking help from bariatric (metabolic) surgeons. The study was conducted on the basis of St. Petersburg State Medical University n. a. I. P. Pavlov, it was the most voluminous laboratory-instrumental and psychological examination, on the basis of which a peculiar portrait of a Russian patient with morbid obesity was compiled. Gastroenterological symptoms were predominant in patients with morbid obesity. Heartburn was the most common complaint. Non-erosive reflux disease was diagnosed in 35.0 % of patients, erosive esophagitis in 20.5 %, hiatal hernia of the 1st degree in 41.2 %, of the 2nd degree in 32.3 % of patients.