Exosomes isolated from metabolically unhealthy normal weight and overweight phenotypes deteriorate the ER/PR positive breast cancer behavior.

Purpose: Obesity has been linked to a higher risk of postmenopausal breast cancer Yet, research indicates an opposite correlation between obesity and premenopausal breast cancer risk. Various obesity phenotypes based on metabolic health could play a significant part. This study aims to assess how plasma exosomes taken from women with varying obesity phenotypes impact MCF-7 cell migration, matrix metalloproteinase-2 activity, and apoptosis. Methods: The characterization of isolated exosomes and their internalization into MCF-7 cells was evaluated. The treatment of MCF-7 cells with exosomes isolated from different groups was done. Migration, the activity of MMP-2, mRNA expression of Bax and Bcl-2, protein expression of p-53 and Thr55 p-p53, and apoptosis were assessed. Results: Isolated exosomes from unhealthy obese individuals increase MCF-7 cell migration. Regarding MMP activities, unhealthy normal weight and overweight and healthy obese groups isolated exosomes increase the MMP-2 activity than the treated group with exosomes isolated from counterpart groups. Furthermore, unhealthy normal weight and overweight and healthy obese obtained exosomes decrease apoptosis compared to counterpart groups. Conclusion: Altogether, plasma exosomes derived from both unhealthy individuals with normal weight and overweight status, as well as those with unhealthy obesity, negatively impacted the behavior of estrogen/progesterone receptor-positive breast cancer cells. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01295-1.

Laparoscopic gastric plication: A long-term follow-up and comparison of outcomes in severe vs. non-severe obesity.

BACKGROUND: LGGCP is a non-gastrectomy, restrictive bariatric technique. This study aims to assess its long-term efficacy. METHODS: This is a retrospective cohort study on LGGCP patients (2010-2019) from a single tertiary center, followed for up to 60 months. RESULTS: Ninety-four patients with obesity were included in the study. The mean five-year postoperative BMI was 32.00. Excess weight loss (EWL): 30%-50% and EWL<30% occurred in 16 and 9 cases, respectively. The mean EWL was higher at 3-, 6-, and 12- months post-operation in patients with a BMI<40. Weight regain was 46.3% at the five-year follow-up. Eighty-seven patients had associated comorbidity, and 76 had improved in at least one of their comorbidities. Sixteen patients (17.0%) experienced complications. CONCLUSION: LGGCP is safe and effective, with benefits in patients with BMI<40. Thus, we suggest the usage of LGGCP, especially in this group of patients, due to its less-invasive nature and acceptable cost-benefit. Further studies with larger sample sizes are required for validation.

Metabolically healthy/unhealthy obesity and breast cancer: A possible role of plasma-derived extracellular vesicles on the cancerous behavior of triple-negative breast cancer.

PURPOSE: Obesity has known detrimental effects on breast cancer (BC) development and progression. However, it's essential to consider the obesity phenotype based on metabolic health. This study aims to evaluate the impact of circulating extracellular vesicles (EVs) from women with metabolically healthy or unhealthy normal weight, overweight, and obesity on MDA-MB-231 cell migration, invasion, and apoptosis. METHODS: Plasma EVs were isolated from different obesity phenotypes in women. EVs were characterized and EVs uptake by MDA-MB-231 cells was assessed. MDA-MB-231 cell lines were treated with EVs obtained from various studied groups, and migration, invasion, MMP-2 and MMP-9 activity, Bax and Bcl-2 mRNA expression, p-53 and Thr55 p-p53 protein expression, and apoptosis were assessed. RESULTS: EVs from obese individuals, regardless of phenotype, increased invasion and MMP-2 activity compared to healthy normal-weight EVs. Normal-weight EVs led to higher invasion under unhealthy conditions. BC cell migration was enhanced by EVs from healthy obese individuals compared to healthy normal-weight EVs. EVs from unhealthy obese women exhibited significantly lower p53/p-p53 levels and reduced apoptosis compared to healthy obese groups. CONCLUSION: It appears that EVs from both normal-weight women with unhealthy conditions and those with obesity or overweight, irrespective of metabolic status, worsened the cancerous behavior of TNBC cells. Therefore, considering metabolic health, in addition to BMI, is crucial for understanding obesity-related disorders.

Distant Metastasis as the First Presentation of Thyroid Carcinoma.

Introduction: Thyroid carcinoma is the most common endocrine cancer which may manifest with unusual presentations. We addressed distant metastases as the first presentations of thyroid carcinoma in several patients, though previously considered to occur rarely. Methods: In this case series, 10 patients are introduced with signs and symptoms of distant metastasis. Detailed history, physical examination, laboratory data, and histopathologic final report of thyroid cancer are presented. Conclusion: Although it seems unusual to discover a distant metastasis without abnormal thyroid examination, several reports of similar findings urge the need to improve screening process. It is prudent to bear in mind these presentations for early detection of thyroid carcinoma.

Principal component analysis of adipose tissue gene expression of lipogenic and adipogenic factors in obesity.

OBJECTIVE: A better understanding of mechanisms regulating lipogenesis and adipogenesis is needed to overcome the obesity pandemic. We aimed to study the relationship of the transcript levels of peroxisome proliferator activator receptor γ (PPARγ), CCAAT/enhancer-binding protein alpha (C/EBP-α), liver X receptor (LXR), sterol regulatory element-binding protein-1c (SREBP-1c), fatty acid synthase (FAS), and acetyl-CoA carboxylase (ACC) in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) from obese and normal-weight women with a variety of anthropometric indices, metabolic and biochemical parameters, and insulin resistance. METHODS: Real-time PCR was done to evaluate the transcript levels of the above-mentioned genes in VAT and SAT from all participants. RESULTS: Using principal component analysis (PCA) results, two significant principal components were identified for adipogenic and lipogenic genes in SAT (SPC1 and SPC2) and VAT (VPC1 and VPC2). SPC1 was characterized by relatively high transcript levels of SREBP1c, PPARγ, FAS, and ACC. However, the second pattern (SPC2) was associated with C/EBPα and LXR α mRNA expression. VPC1 was characterized by transcript levels of SREBP1c, FAS, and ACC. However, the VPC2 was characterized by transcript levels of C/EBPα, LXR α, and PPARγ. Pearson's correlation analysis showed that unlike SPC2, which disclosed an inverse correlation with body mass index, waist and hip circumference, waist to height ratio, visceral adiposity index, HOMA-IR, conicity index, lipid accumulation product, and weight-adjusted waist index, the VPC1 was positively correlated with above-mentioned obesity indices. CONCLUSION: This study provided valuable data on multiple patterns for adipogenic and lipogenic genes in adipose tissues in association with a variety of anthropometric indices in obese subjects predicting adipose tissue dysfunction and lipid accumulation.

Alterations of SOCS1 and SOCS3 transcript levels, but not promoter methylation levels in subcutaneous adipose tissues in obese women.

BACKGROUND: Animal model studies suggest that change in the members of the suppressor of the cytokine signaling (SOCS) family (mainly SOCS1 and SOCS3) is linked to the pathogenesis of obesity-related metabolic disorders. Moreover, epigenetic modification is involved in the transcriptional regulation of the SOCS gene family. Here, we aimed to evaluate the mRNA expression as well as gene promoter methylation of SOCS1 and SOCS3 in subcutaneous adipose tissue (SAT) from obese women compared to normal-weight subjects. We also intend to identify the possible association of SOCS1 and SOCS3 transcript levels with metabolic parameters in the context of obesity. METHODS: This study was conducted on women with obesity (n = 24) [body mass index (BMI) ≥ 30 kg/m 2] and women with normal-weight (n = 22) (BMI < 25 kg/m 2). Transcript levels of SOCS1 and SOCS3 were evaluated by real-time PCR in SAT from all participants. After bisulfite treatment of DNA, methylation-specific PCR was used to assess the putative methylation of 10 CpG sites in the promoter of SOCS1 and 13 CpG sites in SOCS3 in SAT from women with obesity and normal weight. RESULTS: It was found that unlike SOCS3, which disclosed an elevating expression pattern, the expression level of SOCS1 was lower in the women with obesity as compared with their non-obese counterparts (P-value = 0.03 for SOCS1 transcript level and P-value = 0.011 for SOCS3 transcript level). As for the analysis of promoter methylation, it was found that SOCS1 and SOCS3 methylation were not significantly different between the individuals with obesity and normal weight (P-value = 0.45 and P-value = 0.89). Correlation analysis indicated that the transcript level of SOCS1 mRNA expression had an inverse correlation with BMI, hs-CRP levels, HOMA-IR, and insulin levels. However, the SOCS3 transcript level showed a positive correlation with BMI, waist-to-height ratio, waist circumference, hip circumference, hs-CRP, HOMA-IR, insulin, fasting blood glucose, and total cholesterol. Interestingly, HOMA-IR is the predictor of the transcript level of SOCS1 (ß = - 0.448, P-value = 0.003) and SOCS3 (ß = 0.465, P-value = 0.002) in SAT of all participants. CONCLUSIONS: Our findings point to alterations of SOCS1 and SOCS3 transcript levels, but not promoter methylation levels in subcutaneous adipose tissues from women with obesity. Moreover, mRNA expression of SOCS1 and SOCS3 in SAT was associated with known obesity indices, insulin resistance, and hs-CRP, suggesting the contribution of SOCS1 and SOCS3 in the pathogenesis of obesity-related metabolic abnormalities. However, further studies are required to establish this concept.

Predicting rectal tumor response to neoadjuvant chemoradiotherapy using plasma levels of carcinoembryonic antigen (CEA): Results from a tertiary center in Iran.

Objectives: Nonsurgical treatment of colorectal cancer, the third most prevalent cancer worldwide, through chemoradiotherapy (CRT) has been suggested to induce complete remission. Carcinoembryonic antigen (CEA) has been used as a candidate marker to predict treatment response. In this study, we aimed to assess the applicability of plasma levels of CEAs in predicting the response to CRT, particularly complete pathological response. Methods: We designed a retrospective, cross-sectional study in which tumor stage and plasma levels of CEAs before and after neoadjuvant CRT were extracted from the medical records of patients with rectal tumors who underwent neoadjuvant chemoradiotherapy before surgery at Sina Hospital, Tehran, Iran from 2010 to 2015. Results: Pre-CRT plasma levels of CEA positively correlated with tumor stage, and chemoradiotherapy significantly decreased plasma levels of CEA. Whereas lower pre-CRT plasma levels of CEA and tumor stage were significantly associated with complete response to CRT, post-CRT plasma levels of CEA showed no association with complete response. In addition, in ROC curve analysis, a CEA cut-off value of 2.6 ng/mL predicted complete response to CRT (specificity = 82.6%, sensitivity = 40.5%). Conclusion: Although several factors other than plasma levels of CEA and tumor stage are important in determining the response to CRT, preliminary plasma levels of CEA and tumor stage can be used as factors for determining complete response to neoadjuvant chemoradiotherapy in rectal cancer.

One anastomosis gastric bypass surgery in Type2 diabetes patients with body mass index < 35 kg/m2: A multi-center retrospective cohort study.

Introduction: Bariatric surgeries have shown efficacy in weight reduction, glycemic control and improvement of type-2 diabetes (T2DM) in patients with obesity. We aimed to assess the efficacy of one anastomosis gastric bypass surgery (OAGB) in T2DM patients with body mass index (BMI) < 35 kg/m2 within a year after surgery. Methods: In this multicenter retrospective cohort study, 14 T2DM patients with BMI <35 kg/m2 (females, %: 71.4% (10 of 14), and age, mean (standard deviation): 51.2 (12.3) years) who had underwent OAGB surgery by the same surgeon, were followed at intervals of one, three, six, and 12 months after surgery. The remission rates of T2DM were calculated and the metabolic indices were compared using paired t-test and Wilcoxon rank test. Results: No adverse outcomes were detected 12 months after surgery. Within six months, seven (50%) patients underwent remission (one (7.1%) within one, three (21.4%) within three, and three (21.4%) within six months). Post-operative weight (p < 0.001) and fasting blood glucose (p < 0.01) in all time periods were significantly lower compared to pre-operative values. Hemoglobin A1C (HbA1C) was significantly lower at three- and six-month intervals (p < 0.05) but not at twelve months (p = 0.2). Thyroid-stimulating hormone and triglyceride levels were lower at six months compared to pre-surgical levels (p < 0.05) but cholesterol levels were not different in any of time points (p > 0.05). Conclusion: OAGB surgery is associated with weight reduction, glycemic control and a 50% remission rate within six months in patients with diabetes and BMI <35 kg/m2.

Seizure along with gastroenteritis: An atypical manifestation of appendicitis- A case report.

Introduction and importance: Appendicitis is a common cause of acute abdomen in children. Due to its distinct clinical manifestations, often, its diagnosis is not very challenging. At younger age cases with atypical manifestations of appendicitis have been reported in the literature. In this study, we report seizure as another manifestation of appendicitis. Case presentation: A young man presented to our clinic with diarrhea, abdominal pain, fever and history of seizure in past few days. After para-clinical examinations, he was primarily diagnosed as case of viral encephalitis and referred to our center. As his condition worsened, further work-up were done and he was finally diagnosed as perforated appendicitis. Conclusion: Since perforated appendicitis could present with gastroenteritis accompanied by seizure, we believe in patients without a neurological history who present with seizures and loss of consciousness, abdominal problems must be considered.

Short-Term Changes on Body Composition After Sleeve Gastrectomy and One Anastomosis Gastric Bypass.

Introduction: Changes in body composition after different bariatric surgeries have been studied extensively, but most of them have emphasized on Roux-en-Y gastric bypass. Only a few studies have assessed the effects of sleeve gastrectomy (SG). Also, the effect of one anastomosis gastric bypass (OAGB) on body composition is not fully apprehended. Furthermore, there is no agreement on how much fat-free mass (FFM) loss is tolerable in weight loss interventions. Therefore, we decided to assess the reduction in fat mass (FM) and FFM at 1, 3, 6, and 12 months after two types of bariatric surgery in a single center. Methods: In the current retrospective cross-sectional study, the patients' hospital records were analyzed. We included patients who had SG or OAGB and a complete 1-year follow-up record. We recorded demographic data as well as weight, body mass index (BMI), FM, and FFM before and at 1, 3, 6, and 12 months after surgery in a predesigned checklist. Results: We analyzed 311 patients (43 males and 268 females) in the SG (N = 192, 61.7%) and OAGB (N = 119, 38.3%) groups. Both the SG and OAGB groups demonstrated a statistically significant reduction in weight, BMI, FM, and FFM indices at 12 months after the intervention (P < .001). Moreover, no statistically significant difference was observed between the SG and OAGB groups regarding the mean of all body composition indices at 3, 6, and 12 months after the intervention. Conclusion: We found that SG and OAGB effectively decreased weight and body composition indices, comprising FM and FFM, with no significant difference between each other.

Intestinal volvulus secondary to pneumatosis intestinalis: A case report.

INTRODUCTION AND IMPORTANCE: Pneumatosis intestinalis (PI) is a rare but important medical condition that is defined as a collection of individual gas cysts in the submucosa and subserosa of the intestine. PI can be primary or secondary; however, this condition is secondary to underlying diseases most of the time. CASE PRESENTATION: This article presents a 30-year-old man as a case report complaining of generalized abdominal pain and several episodes of non-bilious bloodless vomiting. The patient was admitted to the surgical service department for further investigation, and his abdominal CT scan revealed PI. CLINICAL DISCUSSION: The patient underwent emergency laparotomy surgery due to progressive abdominal pain and peritonitis. The involved segment of the small intestine was resected, and ileo-ileal anastomosis was performed. The patient was discharged from the hospital after a week, stable, and in good medical condition. CONCLUSION: This article intends to emphasize that although most of the patients with PI are asymptomatic or show unspecific symptoms, surgeons must take into account rare but lethal complications of PI such as intestinal volvulus. Early recognition of such complications is so crucial and can be life-saving.

Prophylactic Administration of Diphenhydramine/Acetaminophen and Ondansetron Reduced Postoperative Nausea and Vomiting and Pain Following Laparoscopic Sleeve Gastrectomy: a Randomized Controlled Trial.

PURPOSE: Postoperative nausea and vomiting (PONV) and pain following bariatric surgery are problematic and affect the outcome of patients. Intraoperative multimodal antiemetic prophylaxis is essential to improve postoperative outcomes. This study investigated the effect of adding diphenhydramine to acetaminophen and ondansetron in reducing postoperative nausea and vomiting and pain following laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: Eighty-two patients scheduled for LSG were assigned to receive a single preinduction dose of diphenhydramine 0.4 mg/kg VI (D group) in addition to acetaminophen 1g and ondansetron 4 mg IV at the end of surgery and just acetaminophen 1 g and ondansetron 4 mg IV (C group) in a randomized, double-blind trial. PONV was assessed in recovery and 24 hours after surgery in the ward. Postoperative pain, analgesic requirements, and patients' level of sedation were also assessed. RESULTS: The PONV rates in the recovery of the D group and the C group were 30% and 56% (P = .001). It also had a more significant reduction in the D group than in the C group in the first 24 h after surgery (40% vs. 66%). The severity of pain score and level of sedation and analgesic requirements was significantly reduced in this period in the D group. CONCLUSION: Prophylactic diphenhydramine 0.4 mg/kg at the induction of general anesthesia in combination with acetaminophen 1 g and ondansetron 4 mg at the end of surgery reduced the incidence of PONV and postoperative severity of pain in laparoscopic sleeve gastrectomy.

Reduction en masse of inguinal hernia after self-reduction: a case report.

BACKGROUND: Reduction en mass (REM) is one of the rare complications of inguinal hernia reduction. Although REM can be detected on the basis of specific computed tomography (CT) scan findings, many radiologists are not familiar with its radiological appearance because of the scarcity of this complication, which may cause a delay in diagnosis. CASE PRESENTATION: The patient reported in this article was a 50-year-old Persian man with a history of inguinal hernia, who had been referred with the periumbilical pain that radiated to the right lower quadrant and developed following hernia replacement by the patient himself. REM diagnosis was based on clinical examination and CT scan findings, and surgical treatment was performed by the Lichtenstein repair and mesh implantation. CONCLUSIONS: Although REM usually occurs after reduction with compression in the inguinal hernia, this unique case report highlighted the possibility of REM after self-reduction. Surgeons and radiologists should consider REM in patients with a history of inguinal hernia presenting with intestinal obstruction symptoms, even without any apparent signs of hernia in the physical examination.

Ovarian vein and IVC thrombosis due to normal vaginal delivery; a case report and literature review.

INTRODUCTION AND IMPORTANCE: Ovarian vein thrombosis (OVT) is exceedingly rare, which commonly occurs in postpartum patients and can result in serious complication such as pulmonary emboli. With a presentation often mimicking that of acute abdomen, it can be often misdiagnosed and mistreated. CASE PRESENTATION: A 30-year-old woman referred with right lower quadrant abdominal pain, nausea and anorexia, one week after normal vaginal delivery. Physical examination demonstrated tenderness and rebound tenderness at the right side of the abdomen, with a stable vital sign except 38 °C fever. She had no history of coagulation problems or thrombotic disorders. Patient was admitted on a suspicion of appendicitis and was prescribed antibiotics followed by pelvic and abdominal ultrasonography that indicated an 8 to 10-centimeter hypoechoic tubular structure on the right side, next to the IVC. CT scan with contrast showed clear dilatation and thrombosis of the right ovarian vein with spread to the IVC. Anticoagulant treatment was started with 1000 intravenous units of heparin per hour, along with aPTT control, with a disappearance of the symptoms after 72 h. CONCLUSION: Suspicion of OVT should be high in cases where patients refer with abdominal pain after childbirth, this diagnosis should be taken into account. In the absence of proper and timely diagnosis, it may lead to serious complications or mortality of the mother. CT scan with contrast and at least 3- months anticoagulant therapy (in case of thrombosis spreading to the IVC, this period should be extended) is recommended in diagnosing and treatment of OVT.

Enterocutaneous fistula formation thirty years after a femoral neck fracture fixation with lag screws: A case report.

INTRODUCTION AND IMPORTANCE: As the population grows older, femoral neck fracture is becoming one of the prevalent cases in orthopedics, although this fracture can also happen in younger individuals following high energy traumas. Fixation with cancellous lag screws is one treatment option for femoral neck fractures, especially for young adults and relatively active older patients. CASE PRESENTATION: In this case report, we describe a 52-year-old man referred with the formation of enterocutaneous fistula (ECF) in the surgery place for fixation of a femoral neck fracture 30 years prior to presentation. CLINICAL DISCUSSION: Interpretation of CT scan images as well as findings of the performed laparotomy suggested that fixation procedure with screws was probably the main culprit for penetration of ileum. Subsequently, the removal of screws enabled the fistula to reach the surface of skin, which presented with fecal drainage. To eliminate fistula, we performed right hemicolectomy and ileocolic anastomosis for the case. CONCLUSION: Since management of ECF remains among the most challenging problems for surgeons, this unique case report indicates the possibility for formation of such fistula following a fixation procedure in the hip joint area, even after thirty years and stresses on taking measures in order to prevent fistula formation caused by the prevalent procedures performed on the hip joint.