Metabolic syndrome, obesity, and gastrointestinal

Metabolic syndrome is a cluster of metabolic abnormalities and is defined as the presence of three or more of the following factors: increased waist circumference, elevated triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and high fasting glucose. Obesity, which is accompanied by metabolic dysregulation often manifested in the metabolic syndrome, is an established risk factor for many cancers. Adipose tissue, particularly visceral fat, is an important metabolic tissue as it secretes systemic factors that alter the immunologic, metabolic, and endocrine milieu and also promotes insulin resistance. Within the growth-promoting, proinflammatory environment of the obese state, cross-talk between macrophages, adipocytes, and epithelial cells occurs via obesity-associated hormones, adipocytokines, and other mediators that may enhance cancer risk and progression. This paper synthesizes the evidence on key molecular mechanisms underlying the obesity-cancer link

Metabolic Syndrome, Obesity, and Gastrointestinal Cancer

Metabolic syndrome is a cluster of metabolic abnormalities and is defined as the presence of three or more of the following factors: increased waist circumference, elevated triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and high fasting glucose. Obesity, which is accompanied by metabolic dysregulation often manifested in the metabolic syndrome, is an established risk factor for many cancers. Adipose tissue, particularly visceral fat, is an important metabolic tissue as it secretes systemic factors that alter the immunologic, metabolic, and endocrine milieu and also promotes insulin resistance. Within the growth-promoting, proinflammatory environment of the obese state, cross-talk between macrophages, adipocytes, and epithelial cells occurs via obesity-associated hormones, adipocytokines, and other mediators that may enhance cancer risk and progression. This paper synthesizes the evidence on key molecular mechanisms underlying the obesity-cancer link

Effects of Gastric Irrigation on Bacterial Counts before Endoscopic Submucosal Dissection: A Randomized Case Control Prospective Study

<div><p>Objective</p><p>The antiseptic effect of gastric irrigation before endoscopic submucosal dissection (ESD) has not yet been reported. The aim of the randomized prospective study is to evaluate the antiseptic effects of gastric irrigation of saline solution before ESD by evaluating bacterial count.</p><p>Methods</p><p>This prospective randomized controlled trial included 50 patients diagnosed with early gastric cancer who were randomly divided into 2 groups (25 patients in each group) by using the opaque envelope method: the clean group (irrigation with 2 L saline solution before ESD) and the regular group (no irrigation). The gastric juice was collected and cultured before ESD. The entire stomach was irrigated using a water jet attached to an endoscope. After ESD with resection and removal of the tumor specimen, a postoperative culture of the gastric juice was obtained using the same method as the preoperative culture.</p><p>Results</p><p>The mean log bacterial count of the post-gastric irrigation gastric juice was 5.08±0.75 in the regular group and 1.86±0.86 in the clean group. The difference in the bacterial counts was significant between the groups (<i>P</i> = 0.0004). The difference in the white blood cells (WBC) count on POD 1 was significant (<i>P</i> = 0.044). WBC count on POD 2 did not significantly differ between the groups (<i>P</i> = 0.3). The difference in the body temperature (BT) on POD 1 was significant (<i>P</i> = 0.017), On POD 2 the BT was not significant between the groups (<i>P</i> = 0.5). On POD 1, 88% of the patients in the regular group and 16% of the patients in the clean group had mild to moderate spontaneous pain (<i>P</i> = 0.0026). On POD 2 the proportion with mild to moderate spontaneous pain was 36% and 24% in the regular group and the clean group, respectively (<i>P</i> = 0.1).</p><p>Conclusion</p><p>Pre-ESD gastric irrigation with saline solution is effective and feasible for suppressing infection during the ESD procedure with favorable clinical outcomes.</p><p>Trial registration information</p><p>The university hospital medical information network (UMIN) #000008691.</p></div

WBC counts between the group on PODs 1 and 2.

<p>The difference in the WBC counts on POD 1 was significant between the groups (<i>P = </i>0.044). However, on POD 2, the difference in the WBC counts on POD 2 was not significant (<i>P = </i>0.3). The WBC counts in the regular group on POD 1 were higher compared to clean group.</p

The proportion of VAS scores 1 to 2 between the groups on PODs 1 and 2.

<p>On POD 1, the proportion of patients in the regular group with mild to moderate spontaneous pain (VAS score 1 to 2) was higher than that of the clean group (<i>P = </i>0.0026). However, on POD 2, the proportions of patients with VAS scores 1 to 2 in both groups were similar and were not significant (<i>P = </i>0.1).</p

Time-dependent changes in body temperature of both groups.

<p>The difference in patient’s BT on POD 1 was significant between the groups (<i>P = </i>0.017). However, on POD 2, the BT did not significantly differ between the groups (<i>P = </i>0.5). The BT in the regular group on POD 1 was higher compared to clean group.</p

Allocation flow chart.

<p>Allocation flow chart.</p

Basal parameters of enrolled patients.

*<p>Unparied <i>t</i>-test,</p>**<p>χ² test.</p

Comparison of logarithmic bacterial counts.

<p>The bacterial counts before ESD were not significantly different between the groups (<i>P = </i>0.4). However, the difference in bacterial counts after ESD was significant between the groups (<i>P = </i>0.0004).</p