Comparison of Great Curvature Plication with Duodenal-Jejunal Bypass (GCP-DJB) and Sleeve Gastrectomy (SG) on Metabolic Indices and Gut Hormones in Type 2 Diabetes Mellitus Rats.

OBJECTIVE: The present study compared the therapeutic effects of great curvature plication with duodenal-jejunal bypass (GCP-DJB) and the commonly used sleeve gastrectomy (SG) in rats with type 2 diabetes mellitus (T2DM). METHODS: The rats were randomly divided into three groups: Control group (n = 6), SG group (n = 6), and GCP-DJB group (n = 6). Body weight, daily food intake, fasting blood glucose level, fasting insulin level, insulin resistance index, and fasting serum concentrations of glucagon-like peptide-1 (GLP-1), peptide tyrosine tyrosine (PYY), and bile acid were measured. In addition, postoperative changes in body weight and daily food intake at 2, 4, 6, 8, 10, and 12 weeks were also recorded. At week 12, an oral glucose tolerance test (OGTT) and insulin release test were performed to determine glucose tolerance. The insulin resistance index (IRI) was also measured. The postprandial secretion curves and area under the curve (AUC) of GLP-1, gastric inhibitory polypeptide (GIP), PYY, and bile acid were also calculated. RESULTS: Before surgery, no significant differences in body weight, daily food intake, fasting blood glucose, fasting insulin, insulin resistance index, fasting GLP-1, PYY, and bile acid were found among the three groups (P > 0.05). At postoperative week 12, body weight and food intake in the SG and GCP-DJB groups were lower than those in the Control group (P < 0.05), and body weight in the GCP-DJB group was lowest (P < 0.05). Glucose tolerance, postprandial serum insulin (INS), GLP-1, PYY, and bile acid were significantly higher in the SG and GCP-DJB groups than in the Control group (P < 0.05). The parameters related to glucose metabolism in the GCP-DJB group were higher than those in the SG group with the exception of serum insulin (P < 0.05). In addition, IRI and GIP secretion were significantly lower in the SG and GCP-DJB groups than in the Control group (P < 0.05) and were lowest in the GCP-DJB group (P < 0.05). CONCLUSION: Both GCP-DJB and SG are surgical options for the treatment of T2DM. The underlying mechanism of these treatments may be related to the decrease in body weight, food intake, GIP, IRI, and the increase in INS, GLP-1, PYY, and bile acid. According to the various metabolic indicators related to the hypoglycemic effects in T2DM, GCP-DJB was superior to SG.

Effects of Diet on Bile Acid Metabolism and Insulin Resistance in Type 2 Diabetic Rats after Roux-en-Y Gastric Bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is effective for the treatment of type 2 diabetes mellitus; however, the mechanism remains unclear. METHODS: The effects of RYGB on postprandial responses to three different diets (low carbohydrate (CH)-rich diet, high CH-rich diet, and fat-rich diet) of different nutritional composition in a Goto-Kakizaki (GK) diabetic rat model were assessed by measuring glucose tolerance, insulin resistance, incretin responses, and bile acid (BA) metabolism. RESULTS: GK-RYGB group rats lost weight and preferred low CH-rich diet, but there were no significant differences in BW among the different diets. Glucose tolerance and insulin resistance were improved in rats who underwent RYGB, together with higher levels of circulating BAs, plasma GLP-1, and PYY levels. GK-RYGB rats fed high CH-rich or fat-rich diet showed increased glucose level and insulin resistance, together with high plasma BA, GIP, and PYY levels compared to those fed a low CH-rich diet. CONCLUSION: RYGB improves glucose tolerance and insulin resistance which may be related to BA metabolism and hormone levels, and the nutrient composition of the diet affects the treatment effect of RYGB on T2DM.

Greater Curvature Plication with Duodenal-Jejunal Bypass: a Novel Metabolic Surgery for Type 2 Diabetes Mellitus.

OBJECTIVE: The study investigated the use of great curvature plication with duodenal-jejunal bypass (GCP-DJB) in a type 2 diabetic with obesity rat model. METHODS: Twenty-two Sprague-Dawley rats were given a high fat and sugar diet with subsequent intraperitoneal injection of a small dosage of streptozotocin (30 mg/kg) and randomly assigned to either GCP-DJB (n = 12) or Sham surgery (n = 10). Body weight, peripheral blood glucose, and fasting serum insulin were assayed, and insulin resistance index (IRI) was calculated, before and at 1, 2, 4, and 8 weeks after surgery. RESULTS: No differences were found in the preoperative characteristics of the two groups (P > 0.05). At week 1, the body weights decreased significantly, but there was no significant difference between the two groups (P > 0.05).The fasting blood glucose was significantly lower in the GCP-DJB than in the Sham group (P < 0.05), serum insulin levels were higher (P < 0.05), and IRI began to decline (P < 0.05). From 2 to 8 weeks, the body weight of Sham group gradually recovered and continued to rise, while the GCP-DJB group remained at a relatively lower state. Compared to the Sham group, the body weight, fasting blood glucose as well as IRI of GCP-DJB rats had significantly decreased (P < 0.05). But, the fasting insulin concentrations had significantly increased (P < 0.05). CONCLUSION: This novel GCP-DJB procedure established a stable animal model for the study of metabolic surgery to treat type 2 diabetes mellitus (T2DM).

A novel surgical strategy for secondary hyperparathyroidism: Purge parathyroidectomy.

OBJECTIVE: This study was intended to demonstrate the feasibility and efficacy of purge parathyroidectomy (PPTX) for patients with secondary hyperparathyroidism (SHPT). METHODS: The "seed, environment, and soil" medical hypothesis was first raised, following review of the literatures, to demonstrate the possible causes of persistence or recurrence of SHPT after parathyroidectomy. Subsequently, the novel surgical strategy of PPTX was proposed, which involves comprehensive resection of the fibro-fatty tissues, including visible or invisible parathyroid, within the region surrounded by the thyroid cartilage, bilateral carotid artery sheath, and the brachiocephalic artery. The perioperative information and clinical outcomes of patients who underwent PPTX from June 2016 to December 2016 were analyzed. RESULTS: In total, PPTX was performed safely in nine patients with SHPT from June 2016 to December 2016. The operative time for PPTX ranged from 95 to 135 min, and blood loss ranged from 20 to 40 mL. No patients with perioperative death, bleeding, convulsions, or recurrent laryngeal nerve injury were reported. The preoperative concentration of PTH ranged from 1062 to 2879 pg/mL, and from 12.35 to 72.69 pg/mL on the first day after surgery. In total, 37 parathyroid glands were resected. The postoperative pathologic examination showed that supernumerary or ectopic parathyroid tissues were found within the "non-parathyroid" tissues in three patients. No cases encountered persistence or recurrence of SHPT, or severe hypocalcemia during the follow-up period. CONCLUSION: PPTX involves comprehensive resection of supernumerary and ectopic parathyroid tissues, which may provide a more permanent means of reducing PTH levels.

To assess the effects of parathyroidectomy (TPTX versus TPTX+AT) for Secondary Hyperparathyroidism in chronic renal failure: A Systematic Review and Meta-Analysis.

BACKGROUND: Secondary Hyperparathyroidism (SHPT) requiring parathyroidectomy (PTX) occurs more commonly in patients with progressive chronic kidney disease and in those on long-term lithium therapy. Successful PTX often results in a dramatic drop of parathyroid hormone level, relieves the patient from clinical symptoms, and reduces mortality. However, there is an ongoing debate on the optimal surgical treatment of SHPT. Currently, no clinical guidelines or trials have definitely answered the question of whether Total Parathyroidectomy (TPTX) is superior or equal to Total Parathyroidectomy with Autotransplantation (TPTX + AT). OBJECTIVE: The aims of the study were to compare the efficacy of two different surgical procedures and to develop evidence-based practice guidelines for the treatment of SHPT. METHODS: Citations were identified in the Medline, Cochrane, EMBASE, and Chinese Biomedical Literature databases through November 2016. The Newcastle-Ottawa Scale (NOS) score was used to assess the methodological quality of the studies included. All data were analyzed using Review Manager 5.3. RESULTS: A total of nine cohort studies and one Randomized Controlled Trials (RCT), comprising 1283 patients, were identified. The NOS score of all the studies included was 5 or above. Compared with TPTX + AT, patients in the TPTX group had lower rates of "recurrence" (OR = 0.20; 95%CI, 0.11-0.38; P < 0.01), "recurrence or persistence" (OR = 0.18; 95%CI, 0.10-0.33; P < 0.01), "reoperation due to recurrence or persistence" (OR = 0.17; 95%CI, 0.06-0.54; P = 0.002), and shorter "operative time" (WMD = -17.30; 95%CI, -30.53 to -4.06; P < 0.05), except for a higher risk of "hypoparathyroidism" (OR = 2.97; 95%CI, 1.09-8.08; P = 0.01). However, none of the patients had developed permanent hypocalcemia or adynamic bone disease. No significant difference was found for "symptomatic improvement", "complications", "drug requirements", and "hospital stay" (P > 0.05). CONCLUSION: The findings indicate that TPTX is superior to TPTX + AT, while referring to the rate of recurrent SHPT. However, this conclusion needs to be tested in large-scale confirmatory trials. TPTX seems to be a feasible alternative therapeutic option for the surgical treatment of refractory SHPT.

Application of carbon nanoparticles accelerates the rapid recovery of parathyroid function during thyroid carcinoma surgery with central lymph node dissection: A retrospective cohort study.

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the efficacy of carbon nanoparticles in identifying lymph nodes and promoting parathyroid gland function recovery after thyroid carcinoma surgery along with central lymph node dissection. METHODS: A total of 231 patients who underwent thyroid carcinoma surgery combined with central lymph node dissection were divided into two groups: the CN group (intraoperative carbon nanoparticles injections) and the control group (no injection). Datas were collected respectively on the pre-operative, 1st, 7th and 30th postoperative days and monthly thereafter. While the pathological results (e.g. amount of incidental removed parathyroid glands and lymph nodes dissected), complications (e.g. rates of vocal cord paralysis, the neuromuscular symptoms, hypocalcemia and hypoparathyroidism), as well as follow-up outcomes of the serum Ca2+ and PTH levels were gathered and measured to be included in. RESULTS: In regard to the results of the pathological tests, the control group had a relatively higher incidence of incidental parathyroidectomy when compared to the CN group (P < 0.05). The mean number of central lymph nodes dissected was rather higher in the CN group than that of the control group (P < 0.05).With respect to the follow-up results, the CN group had an earlier and faster recovery of serum PTH levels as compared to the control group (P < 0.05). The serum PTH levels of the CN group were apparently higher than that of the control group at the first week and month postoperatively (P < 0.05). No significant differences were found in rates of long-term postoperative complications between the two groups (P > 0.05). CONCLUSION: Carbon nanoparticles play a key role in accurately identifying lymph nodes, reducing mistaken excision of parathyroid glands, accelerating rapid recovery of parathyroid function during thyroid carcinoma surgery with central lymph node dissection, without increasing the probability of postoperative complications.

The role of carbon nanoparticles in identifying lymph nodes and preserving parathyroid in total endoscopic surgery of thyroid carcinoma.

AIM: To evaluate the efficacy of carbon nanoparticles (CNs) in identifying lymph nodes and preserving parathyroids in endoscopic total thyroidectomy (ETT) with central neck dissection (CND), and to further explore the role of CNs in recovering postoperative parathyroid function. METHOD: Fifty-five patients with papillary thyroid carcinoma were randomized to either CN group (n = 28) or control group (n = 27). The primary outcome measures were pathological results (e.g., amount of incidental removed parathyroids and lymph nodes dissected) and follow-up results [e.g., recovery of serum calcium and parathyroid hormone (PTH) levels]. The secondary end-points were the rates of neuromuscular symptoms, in-hospital postoperative hormonal assay, and lymph node metastases. RESULTS: A total of 193 lymph nodes in the CN group and 123 lymph nodes in the control group were detected. The mean number of detected lymph nodes was significantly higher in the CN group than in the control group (P = 0.009). Parathyroids were present in the thyroid or central nodal specimens of five patients, which were all in the control group. The control group had a relatively higher incidence of incidental parathyroidectomy compared to the CN group (P = 0.023). Compared to the CN group, the incidence of paresthesia was higher in the control group even if not statistically significant. During follow-up, the serum calcium levels were higher in the CN group than in the control group; however, there was no statistically significant difference. For the serum PTH levels, the CN group recovered rapidly to the preoperative levels, whereas the control group climbed steadily to the normal range. The serum PTH levels in the CN group were apparently higher than in the control group at 1 week and 1 month postoperatively. CONCLUSION: CNs play an important role in protecting parathyroid glands, dissecting lymph nodes thoroughly, and promoting rapid recovery of parathyroid in ETT with CND (ChiCTR-TRC-14005042).

Does the hepatic branch of vagus mediate the secretion of glucagon-like peptide-1 during the Roux-en-Y gastric bypass surgery?

OBJECTIVES: The purpose of this study is to investigate the impact of the hepatic branch of the vagus and Roux-en-Y gastric bypass (RYGB) on the level of fasting and postprandial serum glucagon-like peptide-1 (GLP-1) in type 2 diabetic mellitus rats. METHODS: Randomized block design, factorial experiment. Forty-five type 2 diabetic rats were divided into four groups: sham operation (S, n = 10) and sham operation with the hepatic branch of the vagotomy (SV, n = 11), Roux-en-Y gastric bypass (RYGB, n = 12) and RYGB without preservation of the vagus (RYGBV, n = 12). Levels of fasting and postprandial serum GLP-1 30 min after 50 % glucose solution (2 g/kg) by gavage were determined before surgery and postoperatively at 1, 4, and 8 weeks. Interactions between RYGB and the common hepatic branch were also assessed. RESULTS: Roux-en-Y gastric bypass surgery significantly increased the concentration of postprandial serum GLP-1 and maintained it at a higher level (P < 0.05). Preservation of vagus hepatic branch only increased the concentration of postprandial serum GLP-1 at the initial stage (P < 0.05), which gradually weakened over time (P > 0.05). Both RYGB and vagotomy of the hepatic branch had no influence on fasting serum GLP-1 (P > 0.05). CONCLUSIONS: During RYGB surgery for the long-term treatment of T2DM, preservation of the hepatic branch of the vagus might have no impact on serum GLP-1 level.

Impact of the hepatic branch of the vagus and Roux-en-Y gastric bypass on the hypoglycemic effect and glucagon-like peptide-1 in rats with type 2 diabetes mellitus.

BACKGROUND: The impact of the hepatic branch of the vagus and Roux-en-Y gastric bypass (RYGB) on the hypoglycemic effect and glucagon-like peptide-1 (GLP-1) in rats with type 2 diabetes mellitus (T2DM) was investigated, and interactions were preliminarily analyzed. METHODS: A total of 45 rats with T2DM were divided into four groups: sham operation (S, n = 10), sham operation with the hepatic branch of the vagus resected (SV, n = 11), RYGB (n = 12), and RYGB without preservation of the vagus (RYGBV, n = 12). Body mass, fasting blood glucose (FBG), fasting serum insulin, and concentrations of fasting serum GLP-1 were examined in the first, second, fourth, and eighth week before and after surgery. The effects of RYGB and the hepatic branch of the vagus on GLP-1 levels in the eighth postoperative week were also analyzed. RESULTS: RYGB caused a significant reduction in the weight of rats with T2DM (P < 0.05), improved the levels of serum GLP-1 and insulin (P < 0.05), and decreased FBG level (P < 0.05). Retention of the hepatic branch of the vagus maintained weight reduction for a longer period (P < 0.05) and increased the levels of serum GLP-1 and insulin (P < 0.05), but had no impact on FBG level (P > 0.05). CONCLUSIONS: RYGB had better therapeutic efficacy in rats with T2DM. Care should be taken during RYGB surgery to preserve the hepatic branch of the vagus.