Gastropexy predicts lower use of acid-reducing medication after laparoscopic sleeve gastrectomy. A prospective cohort study.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) may induce gastro-oesophageal reflux disease and surgical techniques should be sought to reduce reflux after LSG. Gastropexy of the sleeve gastrectomy pouch to prevent kinks, torsion and intrathoracic sleeve migration was added to our standard LSG in 2012, and the aim of this study was to evaluate if adding gastropexy has influenced the occurrence of gastrooesophageal reflux symptoms (GORS) after LSG. METHODS: In this prospective two-cohort study, the group with LSG and gastropexy (G) was compared with a historical cohort who did not have gastropexy (NG). The use of acid-reducing medication (ARM) was used as a proxy measure of GORS. Gastropexy was performed by suturing the gastrocolic ligament (including the gastroepiploic arcade) to the staple line from the cardia to well below the incisura angularis. Non-resorbable sutures were used. Multiple logistic regression analysis was used to study differences in the use of ARM between the NG and G group two years after surgery. RESULTS: Patient characteristics as age, gender and BMI at baseline, and excess body mass index loss (EBMIL) and smoking at two years were similar between the NG group (n = 216) and G group (n = 116). The follow-up rate was 86.4% for the NG group and 85.3% for the G group. Adding gastropexy did not increase the morbidity rate. In the NG group, the number of patients using ARM was 21 (9.7%) preoperatively and 66 (30.6%) two years after surgery. In the G group, the number using ARM was 11 (10.4%) preoperatively and 18 (14.2%) two years after surgery. The adjusted odds ratio for postoperative GORS in group G compared to group NG was 0.32 (95% CI: 0.16-0.64, p < 0.001). CONCLUSION: Gastropexy may prevent postoperative reflux symptoms after LSG. We recommend to evaluate gastropexy in a randomized controlled trial.

Intensive lifestyle intervention provides rapid reduction of serum fatty acid levels in women with severe obesity without lowering omega-3 to unhealthy levels.

Serum fatty acid (FA) levels were monitored in women with severe obesity during intensive lifestyle intervention. At baseline, total FA levels and most individual FAs were elevated compared to a matching cohort of normal and overweight women (healthy controls). After 3 weeks of intensive lifestyle intervention, total level was only 11-12% higher than in the healthy controls and with almost all FAs being significantly lower than at baseline, but with levels of omega-3 being similar to the healthy controls. This is contrary to observations for patients subjected to bariatric surgery where omega-3 levels dropped to levels significantly lower than in the lifestyle patients and healthy controls. During the next 3 weeks of treatment, the FA levels in lifestyle patients were unchanged, while the weight loss continued at almost the same rate as in the first 3 weeks. Multivariate analysis revealed that weight loss and change of serum FA patterns were unrelated outcomes of the intervention for lifestyle patients. For bariatric patients, these processes were associated probably due to reduced dietary input and increased input from the patients' own fat deposits, causing a higher rate of weight loss and simultaneous reduction of the ratio of serum eicosapentaenoic to arachidonic acid.

The nuclear receptors NUR77, NURR1 and NOR1 in obesity and during fat loss.

BACKGROUND: Adipose tissue is critical for systemic metabolic health. Identifying key factors regulating adipose tissue function is a research priority. The NR4A subfamily of nuclear receptors (NRs) (NR4A1/NUR77, NR4A2/NURR1 and NR4A3/NOR1) has emerged as important proteins in different disease states and in the regulation of metabolic tissues, particularly in liver and muscle. However, the expression of the NR4A members in human adipose tissue has not previously been described, and their target genes are largely unknown. OBJECTIVE: To determine whether the NR4As are differentially expressed in human adipose tissue in obesity, and identify potential NR4A target genes. DESIGN: Prospective analysis of s.c. adipose tissue before and 1 year after fat loss, and during in vitro differentiation of primary human preadipocytes. Case-control comparison of omental (OM) adipose tissue. SUBJECTS: A total of 13 extremely obese patients undergoing biliopancreatic diversion with duodenal switch for fat loss, 12 extremely obese patients undergoing laparoscopic sleeve gastrectomy and 37 lean individuals undergoing hernia repair or laparotomy were included in the study. Measurements were done by quantitative PCR gene expression analysis of the NR4A members and in silico promoter analysis based on microarray data. RESULTS: There was a strong upregulation of the NR4As in extreme obesity and normalization after fat loss. The NR4As were expressed at the highest level in stromal-vascular fraction compared with adipocytes, but were downregulated in both fractions after fat loss. Their expression levels were also significantly higher in OM compared with s.c. adipocytes in obesity. The NR4As were downregulated during differentiation of primary human preadipocytes. Moreover, the NR4As were strongly induced within 30 min of tissue incubation. Finally, promoter analysis revealed potential NR4A target genes involved in stress response, immune response, development and other functions. Our data show altered adipose tissue expression of the NR4As in obesity, suggesting that these stress responsive nuclear receptors may modulate pathogenic potential in humans.

[Erysipelothrix rhusiopathiae--a cause of erysipeloid and endocarditis]. / Erysipelothrix rhusiopathiae--årsak til erysipeloid og endokarditt.

Erysipelothrix rhusiopathiae is widespread among many species of animals including fish. Erysipeloid is the most common infection caused by this bacterium in man; systemic infection, with endocarditis, is rare. Most of the affected patients risk exposure to the organism at work. Two patients with E. rhusiopathiae infections are described; one with erysipeloid after slaughtering a deer, the other with fatal endocarditis after gutting an eel. Erysipeloid may be confused with "seal finger", but this disease probably has a different microbial etiology and requires different antibiotic treatment.