Modificazioni del microbiota nell’adulto vs. adolescente dopo sleeve gastrectomy laparoscopica

Sono stati arruolati dal 1° Ottobre 2014 in modo prospettico 25 pazienti adulti e 20 adolescenti obesi con indicazione alla chirurgia bariatrica o a trattamento multimodale (dieta ed esercizio fisico). Al fine di ottenere uno studio caso-controllo età -correlato, sono stati arruolati, nello stesso periodo,12 adolescenti e 12 adulti sani volontari normopeso (NP) presso l’Unità di Metagenomica del Microbioma umano dell’Ospedale Pediatrico Bambin Gesù (OPBG) e presso il dipartimento di Medicina Clinica del Policlinico Umberto I rispettivamente. Applicando il test di Kruskal-Wallis per le abbondanze relative di phylum per i 4 Gruppi/Gruppo CTRL, abbiamo osservato differenze statisticamente significative nella distribuzione di Actinobacteria, Bacteroidetes and Firmicutes (p < 0.05). Nel confronto di distribuzione Actinobacteria e Bacteroidetes erano statisticamente significativi per le coppie ob_ado/ob_adulti, con livelli di Actinobacteria più elevati per il gruppo ob_ado, mentre i livelli di Bacteroidetes erano predominanti nel gruppo ob_adulti Dei 20 pazienti adulti obesi (ob_adulti) arruolati, 10 sono stati sottoposti a sleeve gastrectomy . Applicando il test di Kruskal-Wallis per le abbondanze relative di specie pre e post sleeve gastrectomy abbiamo osservato differenze statisticamente significative nella distribuzione di Bacteroides fragilis, Coriobacteriaceae, Veillonella parvula. (p < 0.05) Venticinque pazienti obesi adolescenti (ob-ado)sono stati arruolati e 21 sottoposti a sleeve gastrectomy. Tredici hanno raggiunto il follow-up di 6 mesi ed hanno eseguito campionatura di feci, pasto misto e prelievi ematici.Applicando il test di Kruskal-Wallis per le abbondanze relative di phylum per i pazienti ob_ado pre e post sleeve gastrectomy abbiamo osservato differenze statisticamente significative nella distribuzione di Actinobacteria (p < 0.05) Applicando il test di Kruskal-Wallis per le abbondanze relative di genere/ specie pre e post sleeve gastrectomy abbiamo osservato differenze statisticamente significative nella distribuzione di Clostridiales, Erysipelotrichaceae, Abiotrophia, Haemophilus parainfluenzae,Propionibacterium acnes, (p < 0.05) E’ in corso l’analisi delle correlazioni tra le caratteristiche cliniche e antropometriche e le abbondanze di batteri. . Il modello basato sulle OTUs, ci ha consentito di assegnare come markers F. prausnitzii e Actinomyces al gruppo Obesi adolescenti( Ob_ado), mentre Parabacteroides, Rikenellaceae, B. caccae, Barnesiellaceae, e Oscillospira al gruppo di controllo (CTRL_ado). In conclusione questo studio ha dimostrato caratteristiche uniche nella diversità ecologica, nella composizione e nel modello correlato alle OTU del microbiota intestinale in obesi adolescenti e adulti, e tra questi e gli individui normopeso. I “markers” identificati in questo studio potrebbero essere considerati per lo sviluppo di nuovi probiotici, età-correlati, che possono portare a definire nuove strategie, basate sulla modulazione del microbiota, per la prevenzione e il trattamento dell’obesità

Laparoscopic sleeve gastrectomy in adolescents with or without syndromic obesity: two years follow-up

Introduction Childhood obesity is an emerging health problem. Surgical treatment of obese adolescents, particularly those affected by congenital syndrome, represents a controversial issue. The aim of this multicenter study was to retrospectively assess the results of laparoscopic sleeve gastrectomy (LSG) in a cohort of adolescents affected by morbid obesity, with or without congenital syndromes. Materials and methods Forty-one obese (BMI 49 ± 6 kg/m2) adolescents with mean age of 16 ± 3 years (58.5% with previous intragastric balloon failure), and subjected to LSG, were retrospectively evaluated for complications rate, % excess weight loss (%EWL), and inhibition of co-morbidities after 2 years of follow-up. Results All the operations were completed laparoscopically and no intra-operative complications were recorded. No mortality was recorded while peri- or post-operative complications only occurred in two patients (4.9%). The EWL% at 6, 12, and 24 months were 42.3, 58.3, and 59.4, respectively. %EWL was comparable (p = 0.7) between non-syndromic and syndromic obese adolescents at 24 months. Conversely patients with previous intragastric balloon surgery had a significant lower EWL (%) at 24 month (p < 0.01). Moreover, at the same time point, co-morbidity resolution rate was 78.2% while improvement rate was 57.6%. Specifically, remission rate of type 2 diabetes (T2DM), hypertension and obstructive sleep apnea (OSA) were 71, 75 and 61%, respectively. Conclusion LSG is advantageous in the treatment of morbidly obese juveniles concerning safety, weight loss and co-morbidity control and at same time presenting, a possible effective therapeutic option for patients affected by congenital syndrom

Laparoscopic Gastric Sleeve and Micronutrients Supplementation: Our Experience

Background. Laparoscopic gastric sleeve (LGS) has been recently introduced as a stand-alone, restrictive bariatric surgery. Theoretically, LGS attenuates micronutrients deficiencies and associated complications that were typically observed following malabsorptive procedures. The aim of this study was to assess some micronutrients and mineral deficiencies in patients undergoing LGS. Methods. In the period between July 2008 and April 2010, 138 obese patients (110 females and 28 males) with mean BMI 44.4 kg/m2 ± 6.5, mean age 43.9 ± 10.9 years were enrolled and underwent LGS. Patients were followed up with routine laboratory tests and anthropometric measurements and assessed for nutritional status, as regards vitamin B12, folic acid, iron, hemoglobin, calcium, and vitamin D, every three months throughout 12 months. Results. 12 months after sleeve, patients did not show iron deficiency and/or anemia; plasma calcium levels were in the normal range without supplementation from the sixth month after the operation. Vitamin B12 and folic acid were adequately supplemented for all the follow-up period. Vitamin D was in suboptimal levels, despite daily multivitamin supplementation. Conclusion. In this study, we showed that LGS is an effective surgery for the management of morbid obesity. An adequate supplementation is important to avoid micronutrients deficiencies and greater weight loss does not require higher dosage of multivitamins

Gut microbiota markers in obese adolescent and adult patients: Age-dependent differential patterns

Obesity levels, especially in children, have dramatically increased over the last few decades. Recently, several studies highlighted the involvement of gut microbiota in the pathophysiology of obesity. We investigated the composition of gut microbiota in obese adolescents and adults compared to age-matched normal weight (NW) volunteers in order to assemble age- and obesity-related microbiota profiles. The composition of gut microbiota was analyzed by 16S rRNA-based metagenomics. Ecological representations of microbial communities were computed, and univariate, multivariate, and correlation analyses performed on bacterial profiles. The prediction of metagenome functional content from 16S rRNA gene surveys was carried out. Ecological analyses revealed a dissimilarity among the subgroups, and resultant microbiota profiles differed between obese adolescents and adults. Using statistical analyses, we assigned, as microbial markers, Faecalibacterium prausnitzii and Actinomyces to the microbiota of obese adolescents, and Parabacteroides, Rikenellaceae, Bacteroides caccae, Barnesiellaceae, and Oscillospira to the microbiota of NW adolescents. The predicted metabolic profiles resulted different in adolescent groups. Particularly, biosynthesis of primary bile acid and steroid acids, metabolism of fructose, mannose, galactose, butanoate, and pentose phosphate and glycolysis/gluconeogenesis were for the majority associated to obese, while biosynthesis and metabolism of glycan, biosynthesis of secondary bile acid, metabolism of steroid hormone and lipoic acid were associated to NW adolescents. Our study revealed unique features of gut microbiota in terms of ecological patterns, microbial composition and metabolism in obese patients. The assignment of novel obesity bacterial markers may open avenues for the development of patient-tailored treatments dependent on age-related microbiota profiles

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020