Mechanisms maintaining reduced appetite and normoglycaemia after metabolic surgery. The role of bile acids

Obesity is becoming the healthcare epidemic of this century. Weight loss surgery is the only effective treatment for morbid obesity. Furthermore glycaemic control in type 2 diabetic patients is improved after metabolic surgery. Here I observed that with gastric bypass, type 2 diabetes can be improved and even rapidly put into a state of remission irrespective of weight loss. This is achieved via an improvement of both insulin resistance and insulin production. Reduced insulin resistance within the first week after surgery remains unexplained, but increased insulin production in the first week after surgery may be explained by the enhanced postprandial GLP-1 response. In addition, I demonstrate that bile flow changes lead to increased gut hormone response in animal models. Roux-en-Y gastric bypass in humans causes changes in bile flow leading to increased plasma bile acid concentrations. This phenomenon may explain the improved glycaemic control following gastric bypass. In conclusion I investigated the mechanism of diabetes remission after metabolic surgery and explored the role of gut hormones and bile acids in the changes in glucose homeostasis following metabolic surgery

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Techniques, assessment, and effectiveness of bariatric surgery in combating obesity

Dimitrios K Papamargaritis, Dimitrios J Pournaras, Carel W Le RouxImperial Weight Centre, Imperial College London, London, UKAbstract: Obesity is an epidemic disease, and its prevalence is predicted to rise in the future. Many health and social comorbidities, such as cardiovascular disease, type 2 diabetes mellitus, cancer, nonalcoholic fatty liver disease, arthritis, infertility, eating disorders, unemployment, and low quality of life, have been associated with obesity. Nowadays, bariatric surgery is the only effective treatment for severe obesity. An increasing body of literature demonstrates significant remission of obesity-related comorbidities and an increase in life expectancy after surgical treatment. Unfortunately, serious complications can appear after surgery, and the careful preoperative assessment of patients is necessary to estimate the indications and contraindications of bariatric surgery. Recent studies report the lower complication and mortality rates when bariatric procedures are performed in high-volume centers. The purpose of this review is to describe the techniques of the currently used surgical procedures and the clinical effectiveness of bariatric surgery. Additionally, the possible complications and mortality rates after bariatric surgery are discussed.Keywords: obesity, surgery, assessment, clinical effectiveness, complication

Mechanisms maintaining reduced appetite and normoglycaemia after metabolic surgery : the role of bile acids

Obesity is becoming the healthcare epidemic of this century. Weight loss surgery is the only effective treatment for morbid obesity. Furthermore glycaemic control in type 2 diabetic patients is improved after metabolic surgery. Here I observed that with gastric bypass, type 2 diabetes can be improved and even rapidly put into a state of remission irrespective of weight loss. This is achieved via an improvement of both insulin resistance and insulin production. Reduced insulin resistance within the first week after surgery remains unexplained, but increased insulin production in the first week after surgery may be explained by the enhanced postprandial GLP-1 response. In addition, I demonstrate that bile flow changes lead to increased gut hormone response in animal models. Roux-en-Y gastric bypass in humans causes changes in bile flow leading to increased plasma bile acid concentrations. This phenomenon may explain the improved glycaemic control following gastric bypass. In conclusion I investigated the mechanism of diabetes remission after metabolic surgery and explored the role of gut hormones and bile acids in the changes in glucose homeostasis following metabolic surgery.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Solitary neurofibroma of the sensory branch of the axillary nerve. Report of a case

Solitary neurofibromas of the upper limb are rare, especially when they are located more proximally than the elbow. Α case of a neurofibroma of the upper arm in a 70-year old female patient, arising from a cutaneous branch of the axillary nerve is presented. Problems of accurate pre-operative diagnosis are emphasised, as her main symptom was pain. Treatment consisted of total excision of the tumour without restoration of nerve continuity. Postoperatively, the patient’s symptoms subsided; no significant neurological deficit was recorded as well as any local recurrence three years postoperatively

Hepatitis B Virus Vaccination Coverage in Medical, Nursing, and Paramedical Students: A Cross-Sectional, Multi-Centered Study in Greece

Students of health professions are at high risk of hepatitis B Virus (HBV) infection during their clinical training. The aim of this cross-sectional, multi-centered study was to investigate the HBV vaccination coverage in Greek medical, nursing, and paramedical students, to look into their attitudes towards the importance of vaccines and to reveal reasons associated with not being vaccinated. A self-completed, anonymous questionnaire was distributed to 2119 students of health professions in Greece, during the academic year 2013–2014. The HBV vaccination coverage of students was high (83%), being higher among medical students (88.1%, vs. 81.4% among nursing and 80.1% among paramedical students; p &lt; 0.001). The vast majority of them (95%) have been vaccinated during childhood. In addition, 30% of the unvaccinated students declared fear over HBV safety. Our results indicate that the healthcare students achieved higher reported immunization rates compared to the currently serving healthcare workers, but also to the students of the last decade. The fact that nursing and paramedical students have lower coverage figures underlines the importance of targeted interventions for the different subgroups of healthcare students in terms of educational programs and screening for HBV markers in order to increase HBV vaccination uptake