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Obesity can not only lead to various metabolic diseases such as non-alcoholic fatty liver, hypertension, hyperlipidemia, diabetes, and cardiovascular disease, it is also closely related to the occurrence and development of heart failure. Heart transplantation is the ultimate treatment for patients with heart failure. However, heart failure patients with obesity are usually excluded from the list of heart transplants. That is to say, obesity is considered a contraindication for heart transplantation. The traditional weight loss methods, including lifestyle interventions and medications, can not effectively alleviate obesity and its comorbidities because of their limited effect and time-consuming. In addition, weight-loss drugs cannot be used in heart transplantation because they can affect the absorption of immunosuppressive drugs. At present, metabolic surgery has become the most effective method for the treatment of obesity and its comorbidities, and is now gradually applied in the field of heart transplantation most of the heart failure patients with obesity meet the standards of heart transplantation after metabolic surgery, greatly increasing the transplantation rate as well as obesity, obesity-related metabolic diseases, and cardiac function were significantly improved, even some patients with heart failure no longer need heart transplantation after their cardiac function has been significantly improved. However, the application of metabolic surgery in the field of heart transplantation has not yet reached a consensus, and only a few reviews on this topic have been published. In this article, the application status and prospects of metabolic surgery in the field of heart transplantation are reviewed so as to provided reference for clinical practice.
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Objective:To investigate the clinical efficacy of laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS) for obesity.Methods:The retrospective and descriptive study was conducted. The clinical data of 10 patients with obesity who were admitted to the China-Japan Union Hospital Affiliated to Jilin University from September 2019 to January 2020 were collected.There were 7 male and 3 females, aged (32±9)years. Patients underwent laparoscopic BPD-DS. Observation indicators:(1) intraoperative and postoperative situations;(2) follow-up.Follow-up was performed by telephone interview and wechat up to July 2020, to detect complications, physical index, remission of preoperative comorbidity and blood biochemical index at 3 months and 6 months after operation. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Repeated data were analyzed using the repeated ANOVA and pariwise comparison was done using the LSD method. Measurement data with skewed distribution were represented as M(range). Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-suqare test. Results:(1) Intraoperative and postoperative situations:10 patients underwent successfully laparoscopic BPD-DS, including 1 patient undergoing concomitant cholecystectomy due to gallstone disease. There was no obvious hemorrhage, conversion to open surgery or perioperative death for the 10 patients. The operation time and duration of postoperative hospital stay were (256±28)minutes and 11 days(range, 4-38 days). Two patients had postoperative complications. (2) Follow-up: 10 patients were followed up for 6 months. During the follow-up, 3 patients had increased frequency of defecation, with 3-5 times per day, 7 patients had defecation frequency of 1-2 times per day. Of 10 patients, 4 cases had postoperative cholestasis, 2 cases development to gallstone, and the remaining 4 patients had no abnor-mality. The body weight, body mass index, waist circumference of 10 patients were (139±22)kg, (46±10)kg/m 2,(139±14)cm before operation, (107±19)kg, (35±8)kg/m 2, (118±17)cm at 3 months after operation, and (92±17)kg, (30±6)kg/m 2, (104±12)cm at 6 months after operation, showing significant differences ( F=170.01, 104.42, 120.25, P<0.05). The excess body mass reduc-tion rates at 3, 6 months after operation of 10 patients were 58%±36% and 81%±42%, showing a significant difference ( t=73.00, P<0.05). Of 10 patients, cases with type 2 diabetes, hypertriglyceri-demia, hypercholesteremia, elevated low density lipoprotein cholesterin level, hyperuricemia, hypertension were 5, 4, 6, 8, 9, 9 before operation, cases with complete remission were 4, 2, 5, 5, 1, 1 at 3 months after operation, and cases with complete remission were 5, 3, 4, 6, 7, 5 at 6 months after operation. Cases with partial remission of hypertension were 8 and 4 at 3, 6 months after operation. For 5 patients with type 2 diabetes, the fasting blood glucose and hemoglobin Alc were (11.4±3.1)mmol/L and 9.3%±1.6% before operation, (5.6±1.0)mmol/L and 5.5%±0.5% at 3 months after operation, (4.9±0.5)mmol/L and 4.8%±0.5% at 6 months after operation, showing significant differences ( F=14.55, 39.84, P<0.05). Of 10 patients, the retinal-binding protein, vitamins E, serum iron, serum zinc were normal before operation, cases with deficiency of above indicators were 5, 2, 1, 1 at 3 months after operation and 3, 3, 2, 4 at 6 months after operation. There was no clinical symptoms in patents with nutrient deficiency. Cases with deficiency of vitamins A, hypocalcemia, folic acid deficiency were 2, 2, 0 before operation, 5, 0, 0 at 3 months after operation and 3, 0, 1 at 6 months after operation. No deficiency of vitamins D, vitamins B12, ferritin or anemia occurred to the 10 patients. Conclusion:Laparoscopic BPD-DS is safe and effective for obesity.
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Objective To investigate the clinical efficacy of laparoscopic stomach intestinal pylorus sparing surgery (SIPS) in the treatment of severe obesity.Methods The retrospective and descriptive study was conducted.The clinical data of 5 patients with severe obesity who were admitted to the China-Japan Union Hospital Affiliated to Jilin University from October to November 2018 were collected.There was 1 male and 4 females,aged from 18 to 55 years,with an average age of 33 years.All the 5 patients underwent laparoscopic SIPS.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up.Follow-up was performed by outpatient examination,telephone interview and Wechat up to February 2019,including general condition,changes in body weight,body mass index,waistline,blood pressure,percentage of excess weight loss,fasting plasma glucose,glycosylated hemoglobin,blood lipid,and uric acid at 3 months after surgery.Measurement data with normal distribution were represented as Mean±SD,and they were tested with Hotelling T2 test.Measurement data with skewed distribution were represented as M (range).Results (1) Surgical situations:5 patients underwent successfully laparoscopic SIPS under clear surgical field,without obvious bleeding,conversion to open surgery or perioperative death.The operation time was 240 minutes (range,165-345 minutes).(2) Postoperative situations:the time to initial out-of-bed activity,time to first and flatus,and time to initial drinking and liquid intake were 2 days (range,2-3 days),3 days (range,2-3 days),and 3 days (range,3-4 days),respectively.On the third day after surgery,all the 5 patients were confirmed anastomotic patency,without gastric leakage,stenosis,or obstruction by upper gastrointestinal contrast.The abdominal drainage-tube was removed on the fourth day after feeding without obvious discomfort and foreign substances extraction from the drainage-tube.The duration of postoperative hospital stay was 6 days (range,6-7 days).(3) Follow-up:5 patients with severe obesity were successfully followed up for 3 months.During the follow-up,one patient had significantly increased frequency of defecation,roughly 5-8 times a day,especially after eating greasy food.According to the dietary guidance of the case manager,diarrhea was improved significantly after reducing the intake of oily food.Of the 5 patients with severe obesity,color doppler ultrasonography examination revealed that cholestasis was found in 2 patients at 3 months after operation,which may be related to significant weight loss,ratio imbalance of bile acid to and cholesterol,intestinal microbiota,injury of vagus nerve,significant increasing in mucin of gallbladder,and without oral ursodeoxycholic acid as prescribed by the doctor.The body weight,body mass index,waistline,systolic blood pressure,and diastolic blood pressure of 5 patients with severe obesity were (100± 15)kg,(36±4)kg/m2,(111±10)cm,(130±12)mmHg (1 mmHg=0.133 kPa),and (78±14)mmHg at 3 months after operation,respectively,showing significant differences compared with these of preoperation (F=61.631,75.558,87.045,9.501,16.248,P＜0.05).The percentage of excess weight loss was 44％±9％.Among the 5 patients with severe obesity,the fasting plasma glucose of 2 patients with type 2 diabetes mellitus decreased from 9.55 mmol/L and 13.49 mmol/L to 5.18 mmol/L and 5.62 mmol/L after operation,respectively.Level of glycated hemoglobin decreased from 10.0％ and 9.9％ to 5.2％ and 6.2％ after operation,respectively.In the 2 patients with hyperlipidemia,one patient with hypertriglyceride had level of triglyceride,total cholesterol,and low density lipoprotein increased from preoperative 2.24 minol/L,4.84 mmol/L and 2.92 mmol/L to 2.47 mmol/L,6.68 mmol/L and 5.51 mmol/L after operation,another patient with hypercholesterol had cholesterol level decreased from preoperative 5.97 mmol/L to postoperative 5.75 mmol/L after operation.In the 3 patients with hyperuricemia,two patients had the uric acid decreased from 404 μmol/L and 484 μmol/L to 319 μmol/L and 417 pmol/L after operation,respectively,one had the uric acid increased from 531 pmol/L to 674 μmol/L after operation.Conclusions Laparoscopic SIPS has a significant short-term effect on patients with severe obesity,but its long-term safety and efficacy need to be further followed up.
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Objective@#To investigate the clinical efficacy of laparoscopic stomach intestinal pylorus sparing surgery (SIPS) in the treatment of severe obesity.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 5 patients with severe obesity who were admitted to the China-Japan Union Hospital Affiliated to Jilin University from October to November 2018 were collected. There was 1 male and 4 females, aged from 18 to 55 years, with an average age of 33 years. All the 5 patients underwent laparoscopic SIPS. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was performed by outpatient examination, telephone interview and Wechat up to February 2019, including general condition, changes in body weight, body mass index, waistline, blood pressure, percentage of excess weight loss, fasting plasma glucose, glycosylated hemoglobin, blood lipid, and uric acid at 3 months after surgery. Measurement data with normal distribution were represented as Mean±SD, and they were tested with Hotelling T2 test. Measurement data with skewed distribution were represented as M (range).@*Results@#(1) Surgical situations: 5 patients underwent successfully laparoscopic SIPS under clear surgical field, without obvious bleeding, conversion to open surgery or perioperative death. The operation time was 240 minutes (range, 165-345 minutes). (2) Postoperative situations: the time to initial out-of-bed activity, time to first and flatus, and time to initial drinking and liquid intake were 2 days (range, 2-3 days), 3 days (range, 2-3 days), and 3 days (range, 3-4 days), respectively. On the third day after surgery, all the 5 patients were confirmed anastomotic patency, without gastric leakage, stenosis, or obstruction by upper gastrointestinal contrast. The abdominal drainage-tube was removed on the fourth day after feeding without obvious discomfort and foreign substances extraction from the drainage-tube. The duration of postoperative hospital stay was 6 days (range, 6-7 days). (3) Follow-up: 5 patients with severe obesity were successfully followed up for 3 months. During the follow-up, one patient had significantly increased frequency of defecation, roughly 5-8 times a day, especially after eating greasy food. According to the dietary guidance of the case manager, diarrhea was improved significantly after reducing the intake of oily food. Of the 5 patients with severe obesity, color doppler ultrasonography examination revealed that cholestasis was found in 2 patients at 3 months after operation, which may be related to significant weight loss, ratio imbalance of bile acid to and cholesterol, intestinal microbiota, injury of vagus nerve, significant increasing in mucin of gallbladder, and without oral ursodeoxycholic acid as prescribed by the doctor. The body weight, body mass index, waistline, systolic blood pressure, and diastolic blood pressure of 5 patients with severe obesity were (100±15)kg, (36±4)kg/m2, (111±10)cm, (130±12)mmHg (1 mmHg=0.133 kPa), and (78±14)mmHg at 3 months after operation, respectively, showing significant differences compared with these of preoperation (F=61.631, 75.558, 87.045, 9.501, 16.248, P<0.05). The percentage of excess weight loss was 44%±9%. Among the 5 patients with severe obesity, the fasting plasma glucose of 2 patients with type 2 diabetes mellitus decreased from 9.55 mmol/L and 13.49 mmol/L to 5.18 mmol/L and 5.62 mmol/L after operation, respectively. Level of glycated hemoglobin decreased from 10.0% and 9.9% to 5.2% and 6.2% after operation, respectively. In the 2 patients with hyperlipidemia, one patient with hypertriglyceride had level of triglyceride, total cholesterol, and low density lipoprotein increased from preoperative 2.24 mmol/L, 4.84 mmol/L and 2.92 mmol/L to 2.47 mmol/L, 6.68 mmol/L and 5.51 mmol/L after operation, another patient with hypercholesterol had cholesterol level decreased from preoperative 5.97 mmol/L to postoperative 5.75 mmol/L after operation. In the 3 patients with hyperuricemia, two patients had the uric acid decreased from 404 μmol/L and 484 μmol/L to 319 μmol/L and 417 μmol/L after operation, respectively, one had the uric acid increased from 531 μmol/L to 674 μmol/L after operation.@*Conclusions@#Laparoscopic SIPS has a significant short-term effect on patients with severe obesity, but its long-term safety and efficacy need to be further followed up.
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With the development of social economy and the change of lifestyle and working environment, the number of obese and diabetic population has increased significantly. Obesity is closely related to diabetes mellitus with interaction. Among the patients with type 1 diabetes mellitus (T1DM), the cardiovascular risk of T1DM with obesity is significantly higher than those of lean T1DM. The mortality of T1DM with obesity is significantly higher than that of the general population, which poses a great threat to human health, making it become one of the serious public health problems we have to face at present. However, the traditional treatment method of obesity and diabetes has limited effects and fails to effectively solve obesity, diabetes mellitus and its complications. The birth of bariatric surgery brings a new hope to the treatment of obesity and diabetes. After more than half of a century progress, bariatric surgery has become an effective way to cure or relieve obesity, type 2 diabetes and other metabolic syndromes, which is included in the diabetes treatment guidelines. In patients with diabetes, there are a large number of T1DM patients with obesity being in urgent need of surgical treatment, but only a few patients were reported. From the existing papers and case reports , we can see parameters in many aspects, such as BMI, insulin requirement per day, blood pressure and blood plasma lipid, were significantly reduced after bariatric surgery as well as insulin resistance, diabetic complications, polycystic ovarian syndrome and obstructive sleep apnea hypopnea syndrome were improved or even reversed. However, bariatric surgery in treating T1DM with obesity has not yet reached a consensus in the medical community and not been written to diabetes treatment guidelines. In this paper, the operation methods and mechanism, curative effects, disadvantages and its preventive measures, current status and perspective of bariatric surgery in treating T1DM with obesity are reviewed so as to provide reference for clinical practice.
Subject(s)
Humans , Bariatric Surgery , Diabetes Mellitus, Type 1 , General Surgery , Insulin , Obesity , General SurgeryABSTRACT
The cloned cDNA sequence of rice (Oryza sativa L. Cpslo17) chitinase gene Oschi was cloned, (which was registered in GenBank, the accession number: EU045451) ligated with the expression vector pGEX-4T-1, and transformed into E. coli BL21(DE3). The expression of Oschi was induced by IPTG, and the conditions were optimized. After purification the in vitro activity of Oschi chitinase was analyzed, and the results indicated that it could efficiently degrade chitin.