Gastrointestinal quality of life following bariatric surgery in Asian patients.

BACKGROUND/AIMS: Bariatric surgery is the only proven method that produces sustained weight loss. We aimed to investigate the Gastrointestinal Quality of Life Index (GIQLI) differences between obese patients following laparoscopic mini-gastric bypass (LMGB), laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) in this study. METHODOLOGY: From December 2005 to December 2007, we enrolled 152 patients who received bariatric surgery, including 41 men and 111 women, mean age 32.6±9.4 years and mean BMI 37.4±7.9kg/m2 (range 32.0-64.9). Clinical characteristics and quality of life were analyzed. RESULTS: One year after bariatric surgery, the mean general score of GIQLI improved significantly (p=0.000). All patients had improvement in three domains of the questionnaire (social function, physical status and emotional status) but not in gastrointestinal symptoms. The preoperative general score was 105.9±15.4 points in LMGB group, 110.9±14.8 points in LAGB group and 99.0±19.8 points in LSG group, respectively. Despite a significant difference between three groups regarding preoperative GIQLI scores (p=0.001), the 1-year results failed to show any significant difference in a comparison of postoperative GIQLI scores (p=0.082). CONCLUSIONS: In conclusion, our study has demonstrated significant improvement in quality of life 1-year after laparoscopic bariatric surgery. The improvement of GIQLI scores in three domains of social function, physical status and emotional status can be offered to obese patients before surgery.

Predictors of anemia after bariatric surgery using multivariate adaptive regression splines.

BACKGROUND/AIMS: Anemia is the most common nutritional deficiency after bariatric surgery. The predictors of anemia have not been clearly identified. This issue is useful for selecting an appropriate surgery procedure for morbid obesity. METHODOLOGY: From December 2000 to October 2007, a retrospective study of 442 obese patients after bariatric surgery with two years' follow-up data was conducted. Anemia was defined by hemoglobin (Hb) under 13mg/dL in male and 11.5mg/dL in female. We analyzed the clinical information and laboratory data during the initial evaluation of patients referred to bariatric surgery for predictors of anemia development after surgery. All data were analyzed by using multivariate adaptive regression splines (MARS) method. RESULTS: Of the patients, the mean age was 30.8±8.6 years; mean BMI was 40.7±7.8kg/m2 and preoperative mean hemoglobin (Hb) was 13.7±1.5g/ dL. The prevalence of anemia increased from preoperatively 5.4% to 38.0% two years after surgery. Mean Hb was significantly lower in patients receiving gastric bypass than in restrictive type surgery (11.9mg/dL vs. 13.1mg/dL, p=0.040) two years after surgery. Besides, the preoperative optimal value of hemoglobin to predict future anemia in MARS model is 15.6mg/dL. CONCLUSIONS: The prevalence of anemia increased to 38.0% two years after bariatric surgery. We obtained an optimal preoperative value of hemoglobin 15.6mg/dL to predict postoperative anemia, which was important in preoperative assessment for bariatric surgery. Patients undergone gastric bypass surgery developed more severe anemia than gastric banding or sleeve gastrectomy.

Evaluation of quality of life and impact of personality in Chinese obese patients following laparoscopic sleeve gastrectomy.

BACKGROUND/AIMS: The effectiveness of laparoscopic sleeve gastrectomy (LSG) in measuring the quality of life (QOL) and personality in obese patients has not been previously investigated. This study aims to investigate different clinical outcome variables, the relationships between quality of life and different personality one-year after LSG in obese patients. METHODOLOGY: Sixty-one consecutive obese patients (49 females) who underwent LSG were evaluated for clinical characteristics after weight reduction. Chinese Personality Assessment Inventory and Gastrointestinal Quality-of-Life Index (GIQLI) were analyzed. RESULTS: One year after LSG, mean body weight (BW), mean body mass index (BMI) and excess weight loss (EWL) were 66.5±13.6kg, 24.4±4.4kg/m2 and 88.1±32.5%, respectively. Metabolic syndrome decreased from 45.1% to 9.8%. The significant variables were systolic blood pressure, fasting glucose, triglyceride, uric acid, aspartate aminotransferase, alanine aminotransferase, insulin, high sensitivity C-reactive protein, HbA1c, C-peptide and HOMA. All patients demonstrated improvement in two domains of the questionnaire (physical status and emotion status), but not in gastrointestinal symptoms. Although the 'Agreeableness' dimension of Chinese personality had a lower presenting BMI (23.9kg/m2) and better excess weight loss (88.0%), this group showed less improvement in gastrointestinal symptoms and had poorer physical status. CONCLUSIONS: LSG provided meaningful weight loss and improvement in quality of life. Chinese personality was the predictor of weight loss and GIQLI.

Prediction of successful weight reduction after laparoscopic adjustable gastric banding.

BACKGROUND/AIM: Compared with conventional pharmacological therapies, bariatric surgery has been shown to cause greater and- sustained weight loss. It was aimed to evaluate weight loss in obese patients after laparoscopic adjustable gastric banding surgery using information typically available during the initial evaluation studied before bariatric surgery and genes. METHODOLOGY: 74 patients undergoing laparoscopic adjustable gastric banding (LAGB) were enrolled. Artificial Neural Network technology was used to predict weight loss. RESULTS: We studied 74 patients consisting of 22 men and 52 women 2 years after operation. Mean age was 31.7 +/- 9.1 years. 27 (36.5%) patients had successful weight reduction (excess weight loss >50%) while 47 (63.5%) did not. ANN provided predicted factors on gender, insulin, albumin and two genes: re4684846_r, rs660339_r which were associated with success. CONCLUSION: Artificial neural network is a better modeling technique and the predictive accuracy is higher on the basis of multiple variables related to laboratory tests. Our finding gave demonstrated result that obese patients of successful weight reduction after laparoscopic adjustable gastric banding surgery were women, having little lower insulin and albumin, and carrying GG genotype on rs4684846 and with at least one T allele on rs660339. In these cases, weight loss will give better results.

Obesity and the decision tree: predictors of sustained weight loss after bariatric surgery.

BACKGROUND/AIMS: Bariatric surgery is the only long-lasting effective treatment to reduce body weight in morbid obesity. Previous literature in using data mining techniques to predict weight loss in obese patients who have undergone bariatric surgery is limited. This study used initial evaluations before bariatric surgery and data mining techniques to predict weight outcomes in morbidly obese patients seeking surgical treatment. METHODOLOGY: 251 morbidly obese patients undergoing laparoscopic mini-gastric bypass (LMGB) or adjustable gastric banding (LAGB) with complete clinical data at baseline and at two years were enrolled for analysis. Decision Tree, Logistic Regression and Discriminant analysis technologies were used to predict weight loss. Overall classification capability of the designed diagnostic models was evaluated by the misclassification costs. RESULTS: Two hundred fifty-one patients consisting of 68 men and 183 women was studied; with mean age 33 years. Mean +/- SD weight loss at 2 year was 74.5 +/- 16.4 kg. During two years of follow up, two-hundred and five (81.7%) patients had successful weight reduction while 46 (18.3%) were failed to reduce body weight. Operation methods, alanine transaminase (ALT), aspartate transaminase (AST), white blood cell counts (WBC), insulin and hemoglobin A1c (HbA1c) levels were the predictive factors for successful weight reduction. CONCLUSION: Decision tree model was a better classification models than traditional logistic regression and discriminant analysis in view of predictive accuracies.

The application of artificial neural networks and decision tree model in predicting post-operative complication for gastric cancer patients.

BACKGROUND/AIMS: Gastric cancer remains a leading cause of death worldwide. Post-operative complication is one important factor which causes mortality of gastric cancer patients after gastrectomy. Better prediction of post-operative complication before gastrectomy can significantly reduce post-operative mortality and morbidity. Therefore, 3 data mining techniques were applied in this study on improving prediction of post-operative complication. METHODOLOGY: A retrospective study was performed on 521 patients from 3 over 2,000 acute-bed medical centers in Taiwan during February 2002 to October 2004. Pre- and post-operative clinical data were collected and analyzed by applying 3 data mining techniques, included Artificial Neural Networks (ANN), Decision Tree (DT) and Logistic Regression (LR). RESULTS: Results of this study indicated that ANN was a better technique than DT and LR in predicting post-operative complication. Nutritious status, pathological characteristics and operational characteristics were important predictors of post-operative complication. CONCLUSIONS: Further study on predicting postoperative complication in gastric cancer patients is still important. However, how to combine different data mining techniques to improve accuracies of prediction will be another important issue for clinicians and researchers.

Prediction of successful weight reduction after bariatric surgery by data mining technologies.

BACKGROUND: Surgery is the only long-lasting effective treatment for morbid obesity. Prediction on successful weight loss after surgery by data mining technologies is lacking. We analyze the available information during the initial evaluation of patients referred to bariatric surgery by data mining methods for predictors of successful weight loss. METHODS: 249 patients undergoing laparoscopic mini-gastric bypass (LMGB) or adjustable gastric banding (LAGB) were enrolled. Logistic Regression and Artificial Neural Network (ANN) technologies were used to predict weight loss. Overall classification capability of the designed diagnostic models was evaluated by the misclassification costs. RESULTS: We studied 249 patients consisting of 72 men and 177 women over 2 years. Mean age was 33 +/- 9 years. 208 (83.5%) patients had successful weight reduction while 41 (16.5%) did not. Logistic Regression revealed that the type of operation had a significant prediction effect (P = 0.000). Patients receiving LMGB had a better weight loss than those receiving LAGB (78.54% +/- 26.87 vs 43.65% +/- 26.08). ANN provided the same predicted factor on the type of operation but it further proposed that HbAlc and triglyceride were associated with success. HbAlc is lower in the successful than failed group (5.81 +/- 1.06 vs 6.05 +/- 1.49; P = NS), and triglyceride in the successful group is higher than in the failed group (171.29 +/- 112.62 vs 144.07 +/- 89.90; P = NS). CONCLUSION: Artificial neural network is a better modeling technique and the overall predictive accuracy is higher on the basis of multiple variables related to laboratory tests. LMGB, high preoperative triglyceride level, and low HbAlc level can predict successful weight reduction at 2 years.

Gallbladder disease among obese patients in Taiwan.

BACKGROUND: Obesity is a risk factor for gallbladder disease. The authors analyze the prevalence and clinicopathology of gallbladder disease among obese patients in Taiwan. METHODS: Prevalence and various clinical factors associated with cholelithiasis were studied in 199 patients who were undergoing bariatric surgery for obesity. Clinical data (gender, age, BMI and associated diseases), laboratory evaluation and immunoglobulin G antibodies against Helicobacter pylori were obtained from the patient records. The histopathologic findings of the gallbladder were also examined retrospectively. The degree of acute inflammation, chronic inflammation, cholesterolosis, cholesterol polyp and gastric metaplasia was determined and scored. RESULTS: Of the patients, 91% (n=181) were females and 9% (n=18) were males, age 34.26 +/- 8.41 years, with mean BMI 35.28 +/- 6.11 kg/m2. The prevalence of cholelithiasis was 10.1%. Increased diastolic blood pressure and HBsAg carrier were the only significant factors associated with cholelithiasis. All obese patients in our study presented with variable degrees of chronic mononuclear cell infiltration in the gallbladder mucosa. Cholesterolosis was present in 100 patients (50.3%), followed by gastric metaplasia (27.1%), cholesterol polyp (16.1%) and acute inflammation (9.5%). Multivariate analysis showed an association between cholelithiasis and acute and chronic inflammation. The predictors of cholesterolosis were BMI, waist circumference and high-sensitivity C-reactive protein. The seroprevalence of H. pylori was 42.2%. Older age, abnormal liver function tests, calcium and HBsAg carrier were significantly different between H. pylori-seropositive and H. pylori-seronegative obese patients. However, we could rarely find H. pylori within the gallbladder mucosa. CONCLUSION: Cholelithiasis in Asian obese patients is significantly associated with increased diastolic blood pressure and hepatitis B surface antigen carriers. Because chronic liver disease seems to be a risk factor for cholelithiasis in both non-obese and obese populations, prophylactic cholecystectomy can be considered in obese patients with HBsAg positivity. We did not find evidence that H. pylori has a role in the pathogenesis of gallbladder disease and gallstone by histologic and serologic examinations. Furthermore, mucosal abnormalities of acute and chronic inflammatory cell infiltration are common in obese patients, which related to cholelithiasis.

Nanomaterials of triazine-based dendrons: convergent synthesis and their physical studies.

[structure: see text] Without employing protection and deprotection processes, two series of triazine-based dendrons were efficiently prepared by a convergent method and fully characterized; their physical properties, including acidic, thermal, electrical, and optical stabilities were also studied.

Hepatic histopathology of morbid obesity: concurrence of other forms of chronic liver disease.

BACKGROUND: Obesity is a chronic inflammatory condition, with related steatohepatitis and liver fibrosis. The authors analyzed the hepatic histopathology in morbidly obese patients and predictors of concurrence of clinical and/ or histopathologic findings of steatohepatitis with other forms of chronic liver disease. METHODS: The histopathologic findings in the liver of 160 patients who were undergoing laparoscopic gastric bypass or gastric banding for morbid obesity, were examined. Clinical data (gender, age, BMI and associated diseases) and laboratory evaluation were obtained from the patient records. The degree of steatosis, ballooning degeneration, lobular inflammation and fibrosis were determined and scored. RESULTS: Among the patients, 62.5% (n=100) were females and 37.5% (n=60) were males, age 27 +/- 12 years, with mean BMI 43 +/- 5.8 kg/m(2). 63, 54, 26, 15 and 2 patients were diagnosed as non-nonalcoholic steatohepatitis (non-NASH), NASH, chronic hepatitis B (CHB), alcoholic steatohepatitis and chronic hepatitis C (CHC), respectively. The prevalence of NASH was 33.8%, of which 5 patients (9.2%) had bridging fibrosis, but no cirrhosis was found in the NASH group. The prevalence of CHB was 16.3%, of which 3 patients (11.6%) had bridging fibrosis and/or cirrhosis. Multivariate analysis showed an association between steatosis and AST, ALT, GGT, C-peptide, insulin, HOMA-IR and adiponectin. The predictors of ballooning degeneration were serum sugar and AST, whereas the predictors of lobular inflammation were AST and ALT. There was a trend toward a correlation between abnormal liver function, insulin resistance, steatosis, liver cell injury and Mallory body in the NASH population. BMI, C-peptide, steatosis, ballooning degeneration and portal inflammation were significantly different between NASH and CHB groups, but only steatosis and ballooning degeneration were independent factors of NASH compared with CHB group after multivariate analysis. Overall, AST, AST/ALT ratio, uric acid and portal inflammation were independently associated with advanced fibrosis, while only Mallory body (P=0.033) and portal inflammation (P=0.015) were significantly different between mild-moderate fibrosis and advanced fibrosis in the NASH patients. CONCLUSION: Hepatic steatosis, features of metabolic syndrome and liver cell injuries were common in morbidly obese patients. Abnormal liver function and portal inflammation were related to hepatic fibrosis. The coexistance of clinical and histologic features of steatohepatitis with another chronic liver disease may reflect the biological significance of the chronic inflammatory condition in the obese population, which requires further investigation.