Background/Objectives: The histone deacetylases SIRT1 and SIRT2 have been shown to be involved in the differentiation of rodent adipocyte precursors. In light of the differences in gene expression and metabolic function of visceral (V) and subcutaneous (S) adipose tissue (AT) and their resident cells, the aim of this study was to investigate the role of SIRT1 and SIRT2 in the differentiation of adipose stem cells (ASCs) isolated from SAT and VAT biopsies of non-diabetic subjects with varying levels of BMI.Methods: Human ASCs were isolated from paired SAT and VAT biopsies obtained from 83 of non-diabetic subjects and 92 obese individuals.Results: Visceral but not subcutaneous ASCs from obese subjects showed an intrinsic increase in both adipogenesis and lipid accumulation when compared to ASCs from nonobese subjects, and this was associated with reduced SIRT1 and SIRT2 mRNA and protein levels. Moreover, adipose tissue mRNA levels of SIRT1 and SIRT2 showed an inverse correlation with BMI in the visceral but not subcutaneous depot. Overexpression of SIRT1 or SIRT2 in visceral ASCs from obese subjects resulted in inhibition of adipocyte differentiation, whereas knockdown of SIRT1 or SIRT2 in visceral ASCs from non-obese subjects enhanced this process. Changes in SIRT1 or SIRT2 expression and adipocyte differentiation were paralleled by corresponding changes in PPARG, CEBPA and other genes marking terminal adipocyte differentiation. Conclusions:These observations indicate that reduced SIRT1 and SIRT2 expression in visceral ASCs may promote visceral adipose tissue expansion in human obesity by enhancing the differentiation capacity of these adipocyte precursors.
The results of treatment with the intragastric balloon appear to be affected by binge eating pattern in morbidly obese patients, even if the presence of this behavior does not prevent a successful reduction in the BMI. Binge eating does not seem to be a contraindication for the adjuvant use of the BIB before a bariatric operation. A limitation of our study is the short period of observation, related to the period of the BIB in the gastric lumen (not more than 6 months). Further studies may show whether the association of psychiatric treatment with the BIB in patients affected by binge eating may enhance the results of the treatment.
Patient: Male, 67Final Diagnosis: Gastric GISTSymptoms: Chest pain • hematemesis • melena • shockMedication: —Clinical Procedure: Laparoscopic sleeve gastrectomySpecialty: SurgeryObjective:Management of emergency careBackground:Gastrointestinal stomal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and the stomach is the most commonly involved organ. Complete surgical resection with negative margins is the primary and only potentially curative treatment. Surgeon experience with minimally invasive gastric resections in addition to the tumor size and site has to be considered in the choice of laparoscopic or open surgical approach in order to remove the lesion.Case Report:A 67-year-old male patient with an history of gastric ulcer presented 2 days after an esophagogastroduodenoscopy with an incidental finding of a 30-mm gastric submucosal lesion that was not histologically defined (biopsies were taken), chest pain in association with hematemesis, and melena. An initial attempt to achieve endoscopic hemostasis with epinephrine injection was followed by the recurrence of the gastric bleeding until the presentation of hemorrhagic shock. An emergent laparoscopic sleeve gastrectomy was then performed for hemorrhage control. There were no intra- or postoperative major complications and the histological findings led to the diagnosis of a gastrointestinal stromal tumor (GIST).Conclusions:Laparoscopic sleeve gastrectomy is a bariatric surgical treatment of morbid obesity. This report describes the application of a bariatric procedure in a life-threatening situation and illustrates how safe and effective it can be when performed by surgeons with excellent laparoscopic skills.
Highlights• A staple-line reinforcement with cyanoacrylate is proposed.• Cyanoacrylate allows a chemical omentoplasty restoring the anatomy. • Cyanoacrylate could decrease the incidence of postoperative complication in LSG. IntroductionLaparoscopic sleeve gastrectomy (LSG) is currently unanimously considered a simple, fast and less invasive bariatric procedure than others, such as the gastric bypass (L-RYGB) and biliopancreatic diversion (BPD). The major complications are leaks and bleeding (3.93 and 4.07%) (1) and are related to the long suture line. This implies an unfavourable impact on clinical outcomes and healthcare costs, therefore most surgeons use a reinforcement of the gastric suture.Currently the validity of the use of the reinforcement is still debated.The results of a review in 2009 indicate that the reinforcement does "not necessarily" reduce the development of fistulas, even though it has a positive effect on the incidence of bleeding (2).The Parikh metanalysis (about 10.000 patients), concludes that the reinforcement with absorbable material does not cause a significant impact on the incidence of fistulas, that, on the contrary, are related to the dimension of the calibration bougie and to the long and narrow gastric remnant (3).In 2014, a systematic review on 88 studies (about 9.000 patients) highlighted that the absorbable polymer membrane (APM) seems to have a preventive effectiveness on the fistulas (with up to 1.1% reductions). APM proved more effective than the other compared options, such as non-absorbable strips in bovine pericardium, continuous reinforcement suture (oversewing or overlock) and no reinforcement (4).A prospective randomized study in 2016, comparing various reinforcement techniques to the simple section Cyanoacrylate sealant compared to fibrin glue in staple line reinforcement during laparoscopic sleeve gastrectomy. Pilot prospective observational study G. MARTINES, R. DIGENNARO, M. DE FAZIO, P. CAPUANO G Chir Vol. 38 -n. 1 -pp. 50-52 January-February 2017
Objective: To investigate the changes in the aggregation index (AI) and the elongation index (EI), in severe obese subjects (MbObS) undergoing laparoscopic adjustable gastric banding (LAGB). AI and EI are measured by Laser assisted Optical Rotational Red Cell Analyzer (LORCA) and are markers of erythrocyte aggregation and deformability, respectively. Design and subjects: Before, 3 and 6 months after LAGB plus lifestyle changes (Mediterranean diet plus daily moderate exercise), we evaluated AI, EI, body mass index (BMI), total (ToT) cholesterol (Chol), high-density lipoprotein (HDL)-Chol, lowdensity lipoprotein (LDL)-Chol, triglycerides and fasting glucose and insulin levels in 20 MbObS. The Student's t-test was used for comparisons between independent groups and the analysis of variance to assess differences in AI and EI at the 3 time points. Pearson's correlation coefficient was used to assess correlation among continuous variables and multiple linear regression analysis to assess predictive factors for AI and EI changes. Results: BMI and all blood parameters showed a statistically significant decline 3 and 6 months after LAGB as compared with basal, except for EI and HDL-Chol that significantly increased. Stepwise selection of predictors shows that at 3 and 6 months, EI values depended on HDL-Chol values at the same time point. In the EI model, blood glucose was also statistically significant at 6 months. Conclusion: Our data show a significant improvement in EI after LAGB-induced weight loss, which correlates with an improved lipid pattern and support the idea that the rapid weight loss induced by LAGB plus lifestyle changes might reduce the thromboembolic risk and the high mortality risk found in MbObS.
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