The effect of bariatric-metabolic surgery on selected components of metabolic syndrome and visceral adipose tissue - the pilot study.

The aim of this study was to monitor changes in the components of the metabolic syndrome defined by Adult Treatment Panel III and the risk of adipose tissue. The study population consisted of 45 patients (30 women, 15 men) who underwent one bariatric procedure - partial jejuno-ileal derivation (n=17), sleeve resection (n=14) or laparoscopic gastric - plication (n=14). Components of metabolic syndrome such as waist circumference, morning glycemia/antihypertension, TAG, HDL cholesterol and blood pressure (BP)/antihypertension were monitored in probands. In addition, Dual Energy X-Ray Absorciometry measurements were performed. Parameters were monitored over the course of one year. The study shows that it is an effective method of weight reduction for the study population with metabolic effects in the risk components of metabolic syndrome - fasting glycemia, increase in HDL cholesterol and reduction in triacylglycerols in the blood, reduction in waist circumference and BP or direct disappearance of metabolic syndrome. Significantly, of the entire cohort, 68.9 % of the probands studied showed signs of metabolic syndrome when measured before the intervention. At the end of follow-up, only 22.2 % of probands showed metabolic syndrome. It was also found that if the amount of visceral fat was reduced, the overall risk of metabolic syndrome was also reduced. The study demonstrates a significant positive effect of bariatric surgery on parameters of metabolic syndrome. The study also showed a positive effect of reduced visceral fat volume on the components of metabolic syndrome.

Changes in the body composition of boys aged 11-18 years due to COVID-19 measures in the Czech Republic.

BACKGROUND: The lockdown measures related to coronavirus disease 2019 (COVID) impacted the health of adolescents by reducing physical activity (PA). The physical changes in response to decreases in PA can be measured with full body composition analysis. The aim of this study was to evaluate the effects of long-term PA restrictions on body fat (BF), fat-free mass (FFM) and skeletal muscle mass (SMM) in adolescents. METHODS: A total of 1669 boys (before PA restriction (G1): 998; after PA restrictions ended (G2): 671; between the ages of 11 and 18 were included. The measured parameters were body mass (BM), visceral fat area (VFA), BF, FFM and SMM. The whole-body composition was evaluated using bioelectrical impedance analysis (BIA). RESULTS: Compared to G1, G2 exhibited an increase in BF between 1.2 and 5.1%. This difference was significant in boys aged 13 to 18 years (p < 0.05). VFA increased between 5.3 and 20.5 cm2; this increase was significant in boys aged 13 to 18 years (p < 0.05). SMM decreased between 2.6 and 3.8%, and this decrease was significant in all age groups (p < 0.05). Changes in body composition were not accompanied by any significant changes in BM. CONCLUSIONS: COVID-19 restrictions reduced PA, resulting in a significant decrease in SMM. This decrease may impact boys' ability to engage in sufficiently varied PA, which may lead to a further decline in PA and subsequent medical consequences in adulthood.

Partial jejunal diversion (PJD) with jejunocolic anastomosis preliminary results of a pilot study.

INTRODUCTION: Bariatric-metabolic surgery is an effective tool in the treatment of severe obesity and related diseases. Its importance has increased even more in the era of the type II diabetes mellitus and COVID 19 pandemics. The aim of our study is to present the initial results of a new operation that minimizes surgical trauma. METHODS: In the prospective study, laparoscopic side-to-side anisoperistaltic jejunocolic anastomosis was constructed in order to derive part of the chyme by the anastomosis. Patients were operated in the period of IV/2018VII/2019; their mean age was 48.43±10.36 years, mean weight 112.3±16.6 kg and mean BMI 41.9±5.2. Patients were examined one month before surgery and then followed at 3, 6 and 12 months after surgery. We evaluated weight loss and changes in carbohydrate metabolism. RESULTS: We did not record any perioperative or postoperative surgical complications. There was a statistically significant weight loss during the study period. There was a significant decrease in absolute weight in kilograms (p.

The present and future of metabolic surgery.

The term metabolic surgery has become familiar to the professional and lay public with the beginning of the new millennium. The focus is not only on weight reduction, but also on the improvement of obesity-related medical conditions. This is reflected in guidelines of surgical societies as well as in the therapeutic algorithms of other, for instance diabetology, societies. Standard procedures which represent a significant portion of the operations performed worldwide, along with procedures still lacking adequate proof of effectiveness, have been defined. There are also new types of interventions focusing rather on comorbidity treatment than on weight reduction. Effort to reduce invasiveness of the procedures has been evident, paving the way for endoscopic procedures with laparoscopic assistance or purely endoscopic procedures. The authors present the current view on the status of metabolic surgery, reporting on the most frequently performed procedures and also introducing newer surgical and endoscopic interventions which may represent the future of metabolic surgery.

Partial magnetic jejunal diversion (PMJD) in severely obese patients.

Most patients with type 2 diabetes mellitus suffer from obesity. Studies show that surgical intervention is a suitable method for the improvement or remission of type 2 diabetes mellitus. However, a very small percentage of the total number of obese patients (diabetics in addition) undergo surgery. For this reason, less invasive endoscopic methods appear to be an appropriate alternative. The primary aim of a pilot study of partial jejunal diversion using the SFM (Self-Forming Magnetic) device for the creation of jejuno-ileal anastomosis was to verify the technical feasibility and safety of the new procedure. Secondary goals included achieving weight reduction and improving metabolic parameters in patients with type II diabetes. Key words.

Age of obesity onset in MC4R mutation carriers.

OBJECTIVES: The mutations in gene for the melanocortin-4 receptor (MC4R) are the most common etiology factors of monogenic obesity development. Recently, it has been shown that current life style has a significant impact on the phenotype of MC4R mutation carriers - increases the penetrance of the mutations. We aimed to study the impact of the current age on the time of obesity onset among MC4R mutation carriers. METHODS: DNA analysis of the MC4R gene was performed in 268 unrelated Slovak and Moravian obese children and adolescents 18 years and 28 blood relatives >18 years of the probands with a mutation. RESULTS: Three different previously described heterozygous loss of function MC4R mutations (p.Ser19Alafs*34, p.Ser127Leu, and p.Gly181Asp) were found in 3 <18 years probands, 3 adult probands, and 6 adult obese/overweight family relatives. The age of obesity onset in mutation carriers was 1 year in all probands in the children group and 1-35 years (median 11 years) in adults. The age of the obesity onset significantly correlated (R=0.809, p=0.028) with the current age in all of the MC4R mutation carriers. CONCLUSIONS: The age of obesity onset in the present child generation of MC4R mutation carriers is decreasing compared to the age of onset in their parents' generation. This is in agreement with similarly increasing penetrance of obesity in MC4R mutation carriers and it points out to escalation of obesogenic potential of environment.

Body Size, Bone Mineral Density, and Body Composition in Obese Women After Laparoscopic Sleeve Gastrectomy: A 1-Year Longitudinal Study.

Changes in body weight, waist and hip circumferences, body composition, and skeletal status in women after bariatric surgery were evaluated. Thirty-six women [mean age 41.2 ± (SD) 9.5 years, weight 115.7±18.0 kg, and BMI 42.1±5.3 kg/m(2)] underwent laparoscopic sleeve gastrectomy. Bone mineral density (BMD) at lumbar spine, femoral neck, total hip, and total body, and body composition were evaluated at baseline and 3, 6, and 12 months after surgery.Weight, BMI, waist and hip circumferences decreased significantly. Total body bone mineral content (TBBMC) increased by 2.5±3.5%, and fat, lean body mass, total mass and fat-% decreased significantly by 38.9±12.0%, 15.4±5.9%, 26.5±8.1%, and 17.6±8.9%, respectively. Slight decreases in total body (0.6±2.2%) and spine (1.2±7.1%) BMD were not significant, whereas total hip and femoral neck BMD decreased significantly by 5.3±8.2%, and 6.2±7.0% (p<0.001). Change (Δ) in TBBMC correlated only with Δ in weight (r=0.38, p<0.05) whereas Δ in all other body composition parameters correlated significantly with Δ in body weight and circumferences (r=0.46-0.98). The Δ in BMD (except total body BMD) correlated significantly with Δ in body composition parameters (r=0.34-0.59). Baseline fat and lean content besides changes in body fat and lean mass accounted for bone changes. In conclusion, bone loss after bariatric surgery is related to post-operative changes in body composition, as well as to weight loss and decrease in waist and hip circumferences.

Effect of reoxygenation on the electrical stability of the rat heart in vivo: a chronobiological study.

Reoxygenation following hypoxic episodes can increase the risk for the development of ventricular arrhythmias, which, in addition to circadian aspects of reoxygenation arrhythmias has not been studied extensively. The aim of the present study was to evaluate circadian changes in the electrical stability of the rat heart during reoxygenation following a hypoventilatory episode. The electrical stability of the heart, defined in the present study as the ventricular arrhythmia threshold (VAT), was measured at 3 h intervals at clock times 09:00, 12:00, 15:00, 18:00, 21:00, 24:00, 03:00, 06:00 and 09:00 during 20 min hypoventilation (20 breaths/min, tidal volume = 0.5 ml/100 g body weight [n=17]) and subsequent 20 min reoxygenation (50 breaths/min, tidal volume = 1 ml/100 g body weight [n=4]) intervals. The experiments were performed using pentobarbital-anesthetized (40 mg/kg intraperitoneally) female Wistar rats that first underwent a four-week adaptation to a 12 h light:12 h dark regimen. Detailed analysis showed that circadian VATs changed to biphasic rhythms at 10 min of hypoventilation. The VAT circadian rhythms were observed immediately following the commencement of reoxygenation, with the highest values measured between 12:00 and 15:00, and the lowest values between 24:00 and 03:00. These results suggest that myocardial vulnerability is dependent on the light:dark cycle and characteristics of pulmonary ventilation.

[The staple line in sleeve gastrectomy]. / Staplerová linie u sleeve resekce zaludku.

INTRODUCTION: Postoperative leak and bleeding from the staple line are potentially serious early complications following laparoscopic sleeve gastrectomy. AIM: This study aims to assess the significance of oversewing the staple line after laparoscopic sleeve gastrectomy in preventing leak and bleeding in our group of patients. MATERIAL AND METHODS: Patients after laparoscopic sleeve gastrectomy were included in the trial. Two different principles of oversewing the staple line (selective vs. mandatory) were analyzed. The design of the trial was retrospective-prospective, non-randomized. Postoperative complications were recorded. RESULTS: Between October 2006 and December 2011, 638 laparoscopic sleeve gastrectomies were carried out using standard laparoscopic technique. 297 of the patients belonged to the group with selective oversewing of the staple line. The remaining 341 patients belonged to the group in which the staple line was oversewn in all cases. Both groups of patients were comparable in the basic parameters. Early postoperative leak affected one patient in both groups, 0.30% versus 0.29% (p = 0.9203), respectively. The rates of postoperative bleeding were 2.7% (selective oversewing) versus 0% (mandatory oversewing) (p = 0.0023), respectively. CONCLUSION: Our study did not demonstrate the impact of oversewing the staple line on the occurrence of postoperative leak. The rates of postoperative bleeding from the resection site were statistically significantly lower in the group with the mandatory oversewing of the staple line.

Autonomic nervous system under ketamine/ xylazine and pentobarbital anaesthesia in a Wistar rat model: a chronobiological view.

The aim of the present study was to determine the effect of ketamine/ xylazine and pentobarbital anaesthesia on heart rate variability as a marker of autonomic nervous system activity. The experiments were performed in ketamine/ xylazine (10 mg/kg/15 mg/kg) and pentobarbital (40 mg/kg, i.p.) anaesthetized female Wistar rats, after adaptation to a light-dark cycle of 12 hours light: 12 hours dark. Heart rate variability parameters (RR interval, power VLF (very low frequency), power LF (low frequency), power HF (high frequency) and relative powers) were evaluated during spontaneous breathing as a function of the light-dark cycle (LD cycle). Significant LD differences were found in the duration of RR intervals in ketamine/xylazine compared with pentobarbital-anaesthetized rats. Correlation analysis revealed moderate dependency between the RR interval duration and HF and LF power parameters in ketamine/xylazine anaesthesia in both light and dark parts of the cycle. In pentobarbital-anaesthetized rats, correlation analysis demonstrated a moderate dependence between RR interval duration and HF and VLF power parameters, but only in the dark part of the LD cycle. Ketamine/xylazine anaesthesia increased parasympathetic activity, and suppressed sympathetic and baroreceptor activity independently of the light-dark cycle. LD differences in RR interval duration were not eliminated. Pentobarbital anaesthesia increased parasympathetic activity, decreased sympathetic and baroreceptor activity, and eliminated LD differences in RR interval duration.

[Densitometry findings in women using gestagen contraception]. / Denzitometrické nálezy u zen uzívajících gestagenní hormonální antikoncepci.

OBJECTIVE: To prove the influence of gestagen contraception on bone mass with x-ray osteodensitometry (DEXA) with regard to BMI. DESIGN: Cross-sectional observational descriptive study. SETTING: Osteology centre, NZZ Bormed Ostrava. METHODS: In the study premenopausal women who had been using gestagen contraception (Depo-Provera inj.) at least for one year were included. Bone density was measured in regular manner (whole-body densitometer Hologic W). Z-score at lumbar spine, whole femur and femoral neck was assessed. RESULTS AND CONCLUSIONS: 58 of 116 patients had normal bone density. In 58 ill patients the bone density dropped below the age norm. In 11 women the Z-score decreased below -2.5 SD. Inverse relationship between BMI and bone density (BMD) was found, both between BMI and Z-score (p=0.0001), and BMI and T-score (p=0.0001). The relationship between duration of gestagen use and bone density was not statistically significant. Marked decline in BMD and correlation with patients' low BMI was identified. When prescribing gestagen contraception possible negative effect on skeleton, particularly in women with low BMI should be considered.