Do Gut Hormones Contribute to Weight Loss and Glycaemic Outcomes after Bariatric Surgery?

Bariatric surgery is an effective intervention for management of obesity through treating dysregulated appetite and achieving long-term weight loss maintenance. Moreover, significant changes in glucose homeostasis are observed after bariatric surgery including, in some cases, type 2 diabetes remission from the early postoperative period and postprandial hypoglycaemia. Levels of a number of gut hormones are dramatically increased from the early period after Roux-en-Y gastric bypass and sleeve gastrectomy-the two most commonly performed bariatric procedures-and they have been suggested as important mediators of the observed changes in eating behaviour and glucose homeostasis postoperatively. In this review, we summarise the current evidence from human studies on the alterations of gut hormones after bariatric surgery and their impact on clinical outcomes postoperatively. Studies which assess the role of gut hormones after bariatric surgery on food intake, hunger, satiety and glucose homeostasis through octreotide use (a non-specific inhibitor of gut hormone secretion) as well as with exendin 9-39 (a specific glucagon-like peptide-1 receptor antagonist) are reviewed. The potential use of gut hormones as biomarkers of successful outcomes of bariatric surgery is also evaluated

New therapies for obesity

Obesity is a chronic disease associated with serious complications and increased mortality. Weight loss through lifestyle changes results in modest weight loss long-term possibly due to compensatory biological adaptations (increased appetite and reduced energy expenditure) promoting weight gain. Bariatric surgery was until recently the only intervention that consistently resulted in ≥ 15% weight loss and maintenance. Our better understanding of the endocrine regulation of appetite has led to the development of new medications over the last decade for treatment of obesity with main target the reduction of appetite. The efficacy of semaglutide 2.4 mg/week - the latest glucagon like peptide-1 (GLP-1) receptor analogue - on weight loss for people with obesity suggests that we are entering a new era in obesity pharmacotherapy where ≥15% weight loss is feasible. Moreover, the weight loss achieved with the dual agonist tirzepatide (GLP-1/glucose-dependent insulinotropic polypeptide) for people with type 2 diabetes and most recently also obesity, indicate that combining the GLP-1 with other gut hormones may lead to additional weight loss compared to GLP-1 receptor analogues alone and in the future, multi-agonist molecules may offer the potential to bridge further the efficacy gap between bariatric surgery and the currently available pharmacotherapies. This article provides a review of the currently available interventions for weight loss and weight maintenance with a focus on pharmacological therapies for obesity approved over the last decade, as well as the emerging development of new obesity pharmacotherapies.</p

The quiet Sun's magnetic flux estimated from CaIIH bright inter-granular G-band structures

We determine the number density and area contribution of small-scale inter-granular calcium-II bright G-band structures in images of the quiet Sun as tracers of kilo-Gauss magnetic flux-concentrations. In a 149" x 117" G-band image of the disk center at the activity minimum, 7593 small inter-granular structures ['IGS']were segmented with the `multiple-level tracking' pattern recognition algorithm ['MLT_4']. The scatter-plot of the continuum versus the G-band brightness shows the known magnetic and non-magnetic branches. These branches are largely disentangled by applying an intrinsic Ca-II excess criterion. The thus obtained 2995 structures contain 1152 G-band bright points ['BP'] and 1843 G-band faint points ['FP']. They show a tendency of increasing size with decreasing G-band excess, as expected from the `hot wall' picture. Their Ca-H and G-band brightness are slightly related, resembling the known relation of Ca-II and magnetic field strength. The magnetic flux density of each individual BP and FP is estimated from their G-band brightness according to MHD-model calculations. The entity of BP and FP covers the total field-of-view ['FOV'] with a number density of 0.32/Mm^2 and a total area contribution of 2.0%. Their individual calibrations yield a mean flux density of 20 Mx/cm^2 in the entire FOV and 13 Mx/cm^2 for inter-network regions

Complicated Gallstones after Laparoscopic Sleeve Gastrectomy

Background. The natural history of gallstone formation after laparoscopic sleeve gastrectomy (LSG), the incidence of symptomatic gallstones, and timing of cholecystectomy are not well established. Methods. A retrospective review of prospectively collected database of 150 patients that underwent LSG was reviewed. Results. Preoperatively, gallbladder disease was identified in 32 of the patients (23.2%). Postoperatively, eight of 138 patients (5.8%) became symptomatic. Namely, three of 23 patients (13%) who had evident cholelithiasis preoperatively developed complicated cholelithiasis. From the cohort of patients without preoperative cholelithiasis, five of 106 patients (4.7%) experienced complicated gallstones after LSG. Total cumulative incidence of complicated gallstones was 4.7% (95% CI: 1.3–8.1%). The gallbladder disease-free survival rate was 92.2% at 2 years. No patient underwent cholecystectomy earlier than 9 months or later than 23 months indicating the post-LSG effect. Conclusion. A significant proportion of bariatric patients compared to the general population became symptomatic and soon developed complications after LSG, thus early cholecystectomy is warranted. Routine concomitant cholecystectomy could be considered because the proportion of patients who developed complications especially those with potentially significant morbidities is high and the time to develop complications is short and because of the real technical difficulties during subsequent cholecystectomy

Magnetic Field Structures in a Facular Region Observed by THEMIS and Hinode

The main objective of this paper is to build and compare vector magnetic maps obtained by two spectral polarimeters, i.e. THEMIS/MTR and Hinode SOT/SP, using two inversion codes (UNNOFIT and MELANIE) based on the Milne-Eddington solar atmosphere model. To this end, we used observations of a facular region within active region NOAA 10996 on 23 May 2008, and found consistent results concerning the field strength, azimuth and inclination distributions. Because SOT/SP is free from the seeing effect and has better spatial resolution, we were able to resolve small magnetic polarities with sizes of 1" to 2", and we could detect strong horizontal magnetic fields, which converge or diverge in negative or positive facular polarities. These findings support models which suggest the existence of small vertical flux tube bundles in faculae. A new method is proposed to get the relative formation heights of the multi-lines observed by MTR assuming the validity of a flux tube model for the faculae. We found that the Fe 1 6302.5 \AA line forms at a greater atmospheric height than the Fe 1 5250.2 \AA line.Comment: 20 pages, 9 figures, 3 tables, accepted for publication in Solar Physic

Standardni jezik i standardne riječi

Background Bariatric surgery reduces cardiovascular events and mortality risk in obese individuals. However, it is unclear whether diabetes modifies this effect. This study examined mortality, cardiovascular, and cancer risk following bariatric surgery in adults with and without pre‐existing diabetes. Methods Using mortality‐linked Hospital Episodes Statistics (2006‐14) from England, the risk of death, myocardial infarction, stroke, unstable angina, heart failure, and cancer following bariatric surgery was examined; the risk of death in people undergoing surgery was also compared with mortality rates of the general population. Results Of the 35 887 people undergoing bariatric surgery, 9175 (25.6%) had pre‐existing diabetes. During a mean follow‐up of 5.3 years, 801 people died, of whom 293 (36.6%) had pre‐existing diabetes. The risk of all‐cause mortality was 26% higher in people with than without diabetes (adjusted hazard ratio [aHR] 1.26, 95% confidence interval [CI] 1.08‐1.46), whereas the risk of cancer was 21% higher (aHR 1.21; 95% CI 1.14‐1.77). The risk of cardiovascular events was higher for patients with than without diabetes (aHRs [95% CIs] 2.08 [1.42‐3.05], 1.80 [1.29‐2.52], 1.61 [1.18‐2.19], and 1.42 [1.14‐1.77] for myocardial infarction, unstable angina, stroke, and heart failure, respectively). Compared with the general population, the age‐standardized mortality rate ratio was 1.70 (1.52‐1.91) and 1.35 (1.23‐1.48) in people with and without pre‐existing diabetes, respectively. Conclusions For patients with pre‐existing diabetes, the risk of death, cardiovascular events, and cancer after bariatric surgery was higher than for those without diabetes, whose mortality risk after surgery remains 35% higher than that of the general population

Effectiveness of integrating a pragmatic pathway for prescribing liraglutide 3.0mg in weight management services (STRIVE study): a multicentre, open-label, parallel-group, randomized controlled trial

Summary. Background: An effective prescribing pathway for liraglutide 3 mg, an approved obesity pharmacotherapy, may improve treatment access. This trial compared a targeted prescribing pathway for liraglutide 3 mg with multiple stopping rules in specialist weight management services (SWMS) to standard SWMS care. Methods: This phase four, two-year, multicentre, open-label, parallel-group, real-world randomized clinical trial (ClinicalTrials.gov: NCT03036800) enrolled adults with BMI ≥35 kg/m2 plus prediabetes, type 2 diabetes, hypertension or sleep apnoea from five SWMS in Ireland and UK. Participants were randomly allocated (2:1, stratified by centre and BMI) to SWMS care plus a targeted prescribing pathway for once daily subcutaneous liraglutide 3 mg (intervention) with stopping rules at 16 (≥5% weight loss, WL), 32 (≥10% WL) and 52 weeks (≥15% WL) or to SWMS care alone (control) through an online randomization service. The primary outcome was WL ≥15% at 52 weeks, assessed by complete cases analysis. All randomized participants were included in safety analysis. Findings From November 28, 2017 to February 28, 2020, 434 participants were screened, and 392 randomized (260 intervention; 132 control), while 294 (201 intervention; 93 control) included in the 52 weeks complete case analysis. More intervention than control participants achieved WL ≥15% at 52 weeks [51/201 (25.4%) vs 6/93 (6.5%); odds ratio 5.18; 95% CI 2.09, 12.88; p &lt; 0.0001]. More adverse events occurred in the intervention (238/260, 91.5%; two deaths) than control (89/132, 67.4%; no deaths) group. Interpretation: A targeted prescribing pathway for liraglutide 3 mg helps more people achieve ≥15% WL at 52 weeks than standard care alone

Extending the domain theory to support application generation

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