Is It Safe to Combine a Fundoplication to Sleeve Gastrectomy? Review of Literature

Complicacions; Fundoplicatura; MànigaComplicaciones; Funduplicatura; MangaComplications; Fundoplication; SleeveBackground and Objectives: The rising numbers of laparoscopic sleeve gastrectomy (LSG) procedures now being performed worldwide will likely be followed by an increasing number of patients experiencing gastro-esophageal reflux disease (GERD). The purpose of the current review was to analyze in terms of safety different techniques of fundoplication used to treat GERD associated with LSG. Methods: An online search was performed in PubMed/MEDLINE in December 2020 to identify articles reporting LSG and fundoplication. The following term combination was used: (sleeve, fundoplication), (sleeve, Nissen), (sleeve, Rossetti), (sleeve, Toupet) and (sleeve, Dor). The extracted information included details of the methods (e.g., retrospective case series), demographic characteristics (e.g., age, gender), clinical characteristics, number of patients, rate of conversion, and postoperative outcomes. Results: A total of 154 studies were identified and after an assessment of title according to our exclusion criteria, 116 articles were removed. Of the 38 studies analyzed for full content review, a total of seven primary studies (487 patients) were identified with all inclusion criteria. Analyzing the different types of fundoplication used, we have identified: 236 cases of Nissen-Sleeve, 220 cases with modified Rossetti fundoplication, 31 cases of Dor fundoplication, and no case of Toupet fundoplication. The overall postoperative complication rate was 9.4%, with the most common reported complication being gastric perforation, 15 cases—3.1%. The second most common complication was bleeding identified in nine cases (1.8%) followed by gastric stenosis in six cases (1.2%). The mortality was nil. Conclusions: Different types of fundoplication associated with LSG appear to be a safe surgical technique with an acceptable early postoperative complication rate. Any type of fundoplication associated with LSG to decrease GERD should be evaluated cautiously while prospective clinical randomized trials are needed.This research received no external funding

Development and validation of an interpretable machine learning-based calculator for predicting 5-year weight trajectories after bariatric surgery: a multinational retrospective cohort SOPHIA study

Background Weight loss trajectories after bariatric surgery vary widely between individuals, and predicting weight loss before the operation remains challenging. We aimed to develop a model using machine learning to provide individual preoperative prediction of 5-year weight loss trajectories after surgery. Methods In this multinational retrospective observational study we enrolled adult participants (aged $\ge$18 years) from ten prospective cohorts (including ABOS [NCT01129297], BAREVAL [NCT02310178], the Swedish Obese Subjects study, and a large cohort from the Dutch Obesity Clinic [Nederlandse Obesitas Kliniek]) and two randomised trials (SleevePass [NCT00793143] and SM-BOSS [NCT00356213]) in Europe, the Americas, and Asia, with a 5 year followup after Roux-en-Y gastric bypass, sleeve gastrectomy, or gastric band. Patients with a previous history of bariatric surgery or large delays between scheduled and actual visits were excluded. The training cohort comprised patients from two centres in France (ABOS and BAREVAL). The primary outcome was BMI at 5 years. A model was developed using least absolute shrinkage and selection operator to select variables and the classification and regression trees algorithm to build interpretable regression trees. The performances of the model were assessed through the median absolute deviation (MAD) and root mean squared error (RMSE) of BMI. Findings10 231 patients from 12 centres in ten countries were included in the analysis, corresponding to 30 602 patient-years. Among participants in all 12 cohorts, 7701 (75$\bullet$3%) were female, 2530 (24$\bullet$7%) were male. Among 434 baseline attributes available in the training cohort, seven variables were selected: height, weight, intervention type, age, diabetes status, diabetes duration, and smoking status. At 5 years, across external testing cohorts the overall mean MAD BMI was 2$\bullet$8 kg/m${}^2$ (95% CI 2$\bullet$6-3$\bullet$0) and mean RMSE BMI was 4$\bullet$7 kg/m${}^2$ (4$\bullet$4-5$\bullet$0), and the mean difference between predicted and observed BMI was-0$\bullet$3 kg/m${}^2$ (SD 4$\bullet$7). This model is incorporated in an easy to use and interpretable web-based prediction tool to help inform clinical decision before surgery. InterpretationWe developed a machine learning-based model, which is internationally validated, for predicting individual 5-year weight loss trajectories after three common bariatric interventions.Comment: The Lancet Digital Health, 202

O -GlcNAc and Neurodegeneration: Biochemical Mechanisms and Potential Roles in Alzheimer\u27s Disease and Beyond

Alzheimer disease (AD) is a growing problem for aging populations worldwide. Despite significant efforts, no therapeutics are available that stop or slow progression of AD, which has driven interest in the basic causes of AD and the search for new therapeutic strategies. Longitudinal studies have clarified that defects in glucose metabolism occur in patients exhibiting Mild Cognitive Impairment (MCI) and glucose hypometabolism is an early pathological change within AD brain. Further, type 2 diabetes mellitus (T2DM) is a strong risk factor for the development of AD. These findings have stimulated interest in the possibility that disrupted glucose regulated signaling within the brain could contribute to the progression of AD. One such process of interest is the addition of O-linked N-acetylglucosamine (O-GlcNAc) residues onto nuclear and cytoplasmic proteins within mammals. O-GlcNAc is notably abundant within brain and is present on hundreds of proteins including several, such as tau and the amyloid precursor protein, which are involved in the pathophysiology AD. The cellular levels of O-GlcNAc are coupled to nutrient availability through the action of just two enzymes. O-GlcNAc transferase (OGT) is the glycosyltransferase that acts to install O-GlcNAc onto proteins and O-GlcNAcase (OGA) is the glycoside hydrolase that acts to remove O-GlcNAc from proteins. Uridine 5′-diphosphate-N-acetylglucosamine (UDP-GlcNAc) is the donor sugar substrate for OGT and its levels vary with cellular glucose availability because it is generated from glucose through the hexosamine biosynthetic pathway (HBSP). Within the brains of AD patients O-GlcNAc levels have been found to be decreased and aggregates of tau appear to lack O-GlcNAc entirely. Accordingly, glucose hypometabolism within the brain may result in disruption of the normal functions of O-GlcNAc within the brain and thereby contribute to downstream neurodegeneration. While this hypothesis remains largely speculative, recent studies using different mouse models of AD have demonstrated the protective benefit of pharmacologically increased brain O-GlcNAc levels. In this review we summarize the state of knowledge in the area of O-GlcNAc as it pertains to AD while also addressing some of the basic biochemical roles of O-GlcNAc and how these might contribute to protecting against AD and other neurodegenerative diseases

Évaluation des procédures de chirurgie bariatrique

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

La prise en charge chirurgicale des tumeurs endocrine du pancréas (série rétrospective de 50 cas)

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

La chirurgie bariatrique (La gastroplastie horizontale calibrée ajustable sous laparoscopie (anneau périgastrique))

MONTPELLIER-BU Pharmacie (341722105) / SudocSudocFranceF

Le Médecin traitant et la chirurgie de l'obésité (Enquête auprès d'un panel de médecins généralistes de l'Hérault)

Le médecin traitant a un rôle central dans la lutte contre l'obésité. Après échec du traitement médical, la chirurgie bariatrique est maintenant considérée comme le seul traitement efficace. Objectif: Cerner les rapports de généralistes héraultais avec la chirurgie de l'obésité. Méthode: Etude descriptive transversale auprès de 78 praticiens associée à une approche qualitative par entretiens semi-dirigés individuels pour 26 d'entre eux. Résultats: Avis sur les recommandations HAS: 50% des interrogés les avaient déjà lues, majoritairement suite à une FMC. Elles sont adaptées pour 96% d'entre eux. 10% en ignoraient leur existence. Sentiment d'imp-lication (indication); 81% des médecins avaient déjà adressé un patient à une évaluation. 80% souhaiteraient être concertés avant l'interVention mais seulement 26% l'ont été. 23% ne se sentaient pas impliqués. Attentes (suivi); Se reconnaissant comme premier interlocuteur, ils désireraient une meilleure intégration par les équipes et par le patient afin d'éviter des ruptures dans le parcours ou pire un lâcher-prise auprès des spécialistes. Des conseils pratiques (surveillance, alimentation, supplémentations) ainsi que le projet thérapeutique seraient utiles. Recevoir l'ensemble des conclusions spécialisées et avoir les coordonnées centralisées d'un réseau faciliteraient l'échange. Un dossier commun tenu par le patient lui-même pourrait être une solution. Difficultés: Détenir les bonnes indications, encadrer la pratique, faire face à une pression fréquente du patient reste complexe. Après intervention, les difficultés résultent plus des modifications profondes engendrées (physiques, et surtout psychiques) que de la prescription ou adaptation des thérapeutiques.MONTPELLIER-BU Médecine UPM (341722108) / SudocSudocFranceF