The Relationship Between Visceral Obesity and Post-operative Complications: A Meta-Analysis.

BACKGROUND: Body composition can have important influence on surgical outcome. There is substantial literature examining sarcopenia, however much less in known about the impact of fat. Visceral fat area (VFA) is a reliable measures of fat distribution that can be quantified with CT scan. The aim of this study is to determine the impact of VFA to predict complications and mortality after emergent or elective surgery. MATERIALS AND METHODS: A systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary objective was to determine impact of VFA, quantified by preoperative CT scan, has on in-hospital complications and 30-day mortality after emergent or elective surgery. We included peer review English studies of adult patients who underwent elective or emergency surgery and had VFA quantified on preoperative CT scan. Obstetrical patients, case studies, and case series were excluded. RESULTS: Our search strategy identified 3782 citations. After removal of duplicates, application of inclusion criteria and full text review, 19 studies were included. Methodological quality of all studies was fair to good as assessed by Newcastle-Ottawa Scale. There were no significant differences between patients with visceral obesity compared to normal VFA for 30-day mortality or overall postoperative complications. Our analysis did demonstrated an association between visceral obesity and increased surgical site infection, pneumonia, and postoperative pancreatic fistula. CONCLUSIONS: Our findings suggest further studies are necessary to determine the impact of VFA on postoperative outcomes and identifies the importance of establishing standardized assessment for body composition on CT.

Entamoeba histolytica contains an occludin-like protein that can alter colonic epithelial barrier function.

The exact mechanism by which Entamoeba histolytica disrupts the human colonic epithelium and invades the mucosa has yet to be clearly elucidated. E. histolytica produces a diverse array of putative virulent factors such as glycosidase, cysteine proteinases and amebapore that can modulate and/or disrupt epithelial barrier functions. However, it is currently thought that E. histolytica produces numerous other molecules and strategies to disrupt colonic mucosal defenses. In this study, we document a putative mechanism whereby the parasite alters the integrity of human epithelium by expressing a cognate tight junction protein of the host. We detected this protein as "occludin-like" as revealed by immunoblotting and immunoprecipitation studies and visualization by confocal microscopy using antibodies highly specific for human occludin. We propose that E. histolytica occludin-like protein might displace mucosal epithelial occludin-occludin tight junction interactions resulting in epithelial disruption analogous to sub mucosal human dendritic cells sampling luminal contents. These results indicate that E. histolytica occludin is a putative virulent component that can play a role in the pathogenesis of intestinal amebiasis.