The pathological condition of obesity is accompanied by a dysfunctional adipose tissue. We postulate that subcutaneous, preperitoneal and visceral obese abdominal white adipose tissue depots could ...have stromal vascular fractions (SVF) with distinct composition and adipose stem cells (ASC) that would differentially account for the pathogenesis of obesity.
In order to evaluate the distribution of SVF subpopulations, samples of subcutaneous, preperitoneal and visceral adipose tissues from morbidly obese women (n = 12, BMI: 46.2±5.1 kg/m2) were collected during bariatric surgery, enzymatically digested and analyzed by flow cytometry (n = 12). ASC from all depots were evaluated for morphology, surface expression, ability to accumulate lipid after induction and cytokine secretion (n = 3).
A high content of preadipocytes was found in the SVF of subcutaneous depot (p = 0.0178). ASC from the three depots had similar fibroblastoid morphology with a homogeneous expression of CD34, CD146, CD105, CD73 and CD90. ASC from the visceral depot secreted the highest levels of IL-6, MCP-1 and G-CSF (p = 0.0278). Interestingly, preperitoneal ASC under lipid accumulation stimulus showed the lowest levels of all the secreted cytokines, except for adiponectin that was enhanced (p = 0.0278).
ASC from preperitoneal adipose tissue revealed the less pro-inflammatory properties, although it is an internal adipose depot. Conversely, ASC from visceral adipose tissue are the most pro-inflammatory. Therefore, ASC from subcutaneous, visceral and preperitoneal adipose depots could differentially contribute to the chronic inflammatory scenario of obesity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Lymphatic vessels in human adipose tissue Redondo, Patricia de Albuquerque Garcia; Gubert, Fernanda; Zaverucha-do-Valle, Camila ...
Cell & tissue research/Cell and tissue research,
03/2020, Letnik:
379, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Despite being considered present in most vascularised tissues, lymphatic vessels have not been properly shown in human adipose tissue (AT). Our goal in this study is to investigate an unanswered ...question in AT biology, regarding lymphatic network presence in tissue parenchyma. Using human subcutaneous (S-) and visceral (V-) AT samples with whole mount staining for lymphatic specific markers and three-dimensional imaging, we showed lymphatic capillaries and larger lymphatic vessels in the human VAT. Conversely, in the human SAT, microcirculatory lymphatic vascular structures were rarely detected and no initial lymphatics were found.
Hepatopancreatoduodenectomy is one of the most complex abdominal operations mainly indicated in advanced biliary carcinoma.
To present 10-year experience performing this operation in advanced ...malignant tumors.
This is a retrospective descriptive study. From 2004 to 2014, 35 hepatopancreatoduodenectomies were performed in three different institutions. The most common indication was advanced biliary carcinoma in 24 patients (68.5%).
Eighteen patients had gallbladder cancer, eight Klatskin tumors, five neuroendocrine tumors with liver metastasis, one colorectal metastasis invading the pancreatic head, one intraductal papillary mucinous neoplasm with liver metastasis, one gastric cancer recurrence with liver involvement and one ocular melanoma with pancreatic head and right liver lobe metastasis. All patients were submitted to pancreatoduodenectomy with a liver resection as follows: eight right trisectionectomies, five right lobectomies, four left lobectomies, 18 central lobectomies (IVb, V and VIII). The overall mortality was 34.2% (12/35) and the overall morbidity rate was 97.4%.
Very high mortality is seen when major liver resection is performed with pancreatoduodenectomy, including right lobectomy and trisectionectomy. Liver failure in combination with a pancreatic leak is invariably lethal. Efforts to ensure a remnant liver over 40-50% of the total liver volume are the key to obtain patient survival.
ABSTRACT Background: Due to the high failure rate observed in the clinical treatment of morbid obesity an increase in bariatric surgery indications, as an alternative for the control of obesity and ...comorbidities, is noticeable. Aim: To evaluate the performance of type 2 diabetes mellitus, high blood pressure and dyslipidemia in patients submitted to Roux-en-Y gastric bypass in late follow-up. Methods: Retrospective analysis of 59 patients included in the bariatric surgery program. Anthropometric (height and body weight) and laboratory (LDLc, HDLc, VLDLc, triglyceride -TG - and glucose) data were collected on pre- and postoperative stages, through medical records. Results: Among the patients, 86% were female aged 43±11, of whom 52% had attended high school. The average postoperative time was 7±3 years. During the postoperative period, there were decreases of weight and body mass index, respectively (133±06 kg vs 91±04 kg p<0.05 e 49±74 kg/m2 vs 33±79 kg/m2, p<0.05). In comparison to the preoperative stage, lower concentrations of glucose (101.00±26.99 vs 89,11±15.19, p=0.014), total cholesterol rates (179.00±37,95 vs 167.48±28,50, p=0.016), LDLc (104.30±33.12 vs 91.46±24.58, p=0.016), VLDLc (25.40±11,12 vs 15.68±7.40, p<0.01), and TG (143.35±86.35 vs 82.45±37.39, p<0.01) and higher concentrations of HDLc (43.53±8.23 vs 57.90±15.60, p<0.01) were identified in the postoperative stage. 40% of hypertensive patients were still undergoing high blood pressure treatment during the postoperative stage. There was remission of type 2 diabetes mellitus and dyslipidemia on 81% and 94% of the cases, respectively. Conclusion: Roux-en-Y gastric bypass has proven itself to be an effective long term procedure, promoting weight loss, remission of DM2 and dyslipidemia.
RESUMO Racional: Em função do alto grau de falência que se observa no tratamento clínico da obesidade mórbida, observa-se um aumento da procura pela cirurgia bariátrica como alternativa para o controle da obesidade e comorbidades. Objetivo: Avaliar a evolução do diabete melito tipo 2, da hipertensão arterial sistêmica e da dislipidemia em pacientes submetidos à gastroplastia redutora em Y-de-Roux no período de pós-operatório tardio. Métodos: Análise retrospectiva de 59 pacientes inseridos em programa de cirurgia bariátrica. Foram coletados dados antropométricos (altura e peso corporal) e laboratoriais (LDLc, HDLc, VLDLc, triglicerídeo -TG - e glicose) nos períodos pré e pós-operatório por meio de prontuários médicos. Resultados: Entre os pacientes, 86% eram mulheres com idade de 43±11 anos e 52% tinham cursado o ensino médio. O tempo médio de pós-operatório foi de 7±3 anos. Houve redução no peso e no índice de massa corporal no pós-operatório, respectivamente (133±06 kg vs 91±04 kg p<0,05 e 49±74 kg/m2 vs 33±79 kg/m2, p<0,05). Observou-se concentrações inferiores no pós-operatório, comparado com o pré-operatório, da glicose (101,00±26,99 vs 89,11±15,19, p=0,014), colesterol total (179,00±37,95 vs 167,48±28,50, p=0,016), LDLc (104,30±33,12 vs 91,46±24,58, p=0,016), VLDLc (25,40±11,12 vs 15,68±7,40, p<0,01), e TG (143,35±86,35 vs 82,45±37,39, p<0,01) e maiores de HDLc (43,53±8,23 vs 57,90±15,60, p<0,01 ). No pós-operatório 40% dos pacientes hipertensos ainda estavam em tratamento para hipertensão arterial sistêmica. Houve remissão do diabete melito tipo 2 e da dislipidemia em 81% e 94% dos casos, respectivamente. Conclusão: A gastroplastia redutora em Y-de-Roux mostrou ser procedimento eficaz em longo prazo, com resultados persistentes na perda de peso, remissão do DM2 e da dislipidemia.
Macrophage infiltration into adipose tissue (AT) is a hallmark of the chronic inflammatory response in obesity and is supported by an intense monocyte migration towards AT. Although it has been ...detected an increased proportion of circulating CD16+ monocyte subsets in obese subjects, the mechanisms underlying this effect and the contribution of these cells to the inflamed profile of obese AT are still poorly understood. We investigated whether factors secreted by human obese omental AT could polarize monocytes to CD16+ enriched phenotype, and how these changes could modify their migratory capacity towards adipose tissue itself. We show that explants of human obese omental AT, obtained during bariatric surgery, released higher levels of MIP1-α, TNFα, leptin and also VEGF, together with increasing amounts of microparticles (MP), when compared to explants of lean subcutaneous AT. A higher content of circulating MP derived from preadipocytes and leukocytes was also detected in plasma of obese subjects. Conditioned media or MP released from obese omental AT increased CD16 and CCR5 expression on CD14+CD16− monocytes and augmented their migratory capacity towards the conditioned media from obese omental AT, itself. This effect was inhibited when MIP1-α was neutralized. Additionally, we demonstrate that MP derived from obese omental AT carry and transfer TLR8 to monocytes, thus triggering an increase in CD16 expression in those cells. Our data shows a positive feedback loop between blood monocytes and obese omental AT, which releases chemotactic mediators and TLR8-enriched MP, thus inducing an up-regulation of CD16+ monocytes, favoring leukocyte infiltration in the obese omental AT.
•Microparticles released by obese omental adipose tissue up-regulate CD16 and CCR5 expression on monocytes.•Microparticles derived from obese omental adipose tissue transfer TLR8 to monocytes.•MIP1-α secreted by obese omental adipose tissue acts as a chemotactic agent driving the migration of CD16+ monocytes.
OBJETIVO: Determinar a prevalência da síndrome de dumping em uma série de casos submetidos ao bypass gástrico, baseado em critérios clínicos, e caracterizar seus principais aspectos. MÉTODOS: Foi ...realizada uma análise dos sintomas descritos como dumping em 34 pacientes obesos mórbidos submetidos ao bypass gástrico com reconstrução em Y de Roux, por meio do preenchimento de um questionário que incluiu um sistema de escore para o diagnóstico clínico da síndrome de dumping, descrito por Sigstad. RESULTADOS: A ocorrência de dumping com base em critérios subjetivos foi de 44%. Aplicando o escore para diagnóstico clínico, a ocorrência foi de 76%. Os sintomas mais freqüentes foram "vontade de deitar" (88%), cansaço (69%) e sono (69%). Apenas 28% dos pacientes com dumping se sentiram incapacitados para a realização das atividades cotidianas. Não foi observada diferença entre o percentual de perda de peso dos pacientes dumpers e não-dumpers. CONCLUSÃO: O escore de Sigstad se mostrou uma ferramenta útil para o diagnóstico de dumping, embora uma visão crítica deva ser adotada quando utilizado em pacientes submetidos ao bypass gástrico. A síndrome de dumping foi frequente nesta população, embora geralmente subestimada, não sendo incapacitante para a realização das atividades cotidianas dos pacientes, assim como não se mostrou um fator relevante no auxílio à perda de peso.
Type 2 diabetes mellitus is an epidemic health problem. Approximately, 90% of diabetic patients are overweight or are obese. The current increase in the prevalence of obesity has been associated with ...an increase in the prevalence of type 2 diabetes. Bariatric surgery is the most effective treatment for morbid obese patients in terms of controlling weight and co-morbidities. Sustained normal plasma concentration of glucose has been reported in most diabetic morbid obese patients, which has been managed surgically. Available data show a significant alteration in the production of some gastrointestinal hormones, which might explain the improvement of glucose metabolism following these procedures. Diabetic patient improvements following some bariatric surgeries seems to be an independent factor unrelated to the amount of weight loss. The authors reviewed data published on the effects of bariatric surgery in diabetic patient improvements and the possible mechanisms responsible for this control.
Introduction: The continuous increase in obesity and its possible association with food insecurity among families in situations of a greater social vulnerability have suggested this factor as a ...subjacent contributor to the appearance of the disease. Nonetheless, the number of obese individuals indicated for bariatric surgery is increasing. Objective: To evaluate the food insecurity situation, social, economic and anthropometric indicators in obese patients for bariatric surgery. Methods: This study was conducted through questionnaires and search of registers in medical records - consisting of 20 patients in pre-operative period, inserted in a Bariatric Surgery Program of a University Hospital. Results: The patients evaluated were in majority women with per capita income of up to one minimum wage. The average age for both sexes was of 43.75 (+ or - 10.5) years. The food insecurity was present in 80% of the households of the patients interviewed, of who 55% were classified with mild food insecurity and 25% with moderate insecurity according to the Brazilian Food Insecurity Scale. The average of the body mass index was 45.59 (+ or - 7.25) kg/m.sup.2 and the waist circumference of 116.07 cm (+ or - 13.09). It can also be verified that 85% of the patients had comorbidities and 70% presented a family history of first degree of obesity. Conclusion: The present study reinforces that the demand for the surgical treatment of obesity occurs predominantly among female and low per capita income individuals, corroborating with the greater proportion of patients in a situation of food insecurity. Key words: Bariatric surgery. Food and nutrition security. Obesity. Introducao: O crescente aumento da obesidade e sua possivel associacao com a inseguranca alimentar entre familias em situacao de maior vulnerabilidade social tem sugerido esse fator como colaborador subjacente ao surgimento da doenca. Nao obstante a esses fatos, e cada vez maior o numero de individuos obesos graves indicados a cirurgia bariatrica. Objetivo: Avaliar a situacao de inseguranca alimentar, indicadores sociais, economicos e antropometricos em pacientes obesos candidatos a cirurgia bariatrica. Metodos: Estudo conduzido por meio de questionarios e busca de registros em prontuarios, constituido por 20 pacientes em periodo pre-operatorio, inseridos em um Programa de Cirurgia Bariatrica de um Hospital Universitario. Resultados: Os pacientes avaliados eram, em sua maioria, mulheres com renda per capita de ate um salario minimo. A media de idade para ambos os sexos foi de 43,75 (+ or - 10,5) anos. A inseguranca alimentar esteve presente em 80% dos domicilios dos pacientes entrevistados, dos quais 55% foram classificados com inseguranca leve e 25% com inseguranca moderada segundo a Escala Brasileira de Inseguranca Alimentar. A media do indice de massa corporal foi de 45,59 (+ or - 7,25) kg/m.sup.2 e do perimetro de cintura de 116,07 cm (+ or - 13,09). Pode-se verificar tambem, que 85% dos pacientes possuiam comorbidades e 70% apresentavam historico familiar de primeiro grau de obesidade. Conclusao: O presente estudo reforca que a procura pelo tratamento cirurgico da obesidade ocorre predominantemente entre individuos do sexo feminino e de baixa renda per capita, corroborando com a maior proporcao de pacientes em situacao de inseguranca alimentar. Palavras-chave: Cirurgia bariatrica. Obesidade. Seguranca alimentar e nutricional.
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