Bariatric surgery has been widely performed for the treatment of obesity and type 2 diabetes. Efforts have been made to investigate the mechanisms underlying the metabolic effects achieved by ...bariatric surgery and to identify candidates who will benefit from this surgery. Metabolomics, which includes comprehensive profiling of metabolites in biological samples, has been utilized for various disease entities to discover pathophysiological metabolic pathways and biomarkers predicting disease progression or prognosis. Over the last decade, metabolomic studies on patients undergoing bariatric surgery have identified significant biomarkers related to metabolic effects. This review describes the significance, progress, and challenges for the future of metabolomics in the area of bariatric surgery.
Graphical abstract
Although proximal gastrectomy (PG) provides superior nutritional outcomes over total gastrectomy (TG) in upper-third early gastric cancer (EGC), surgeons are reluctant to perform PG due to the high ...rate of postoperative reflux. This meta-analysis aimed to comprehensively compare operative outcomes, nutritional outcomes, and quality of life-related complications between TG and PG performed with esophagogastrostomy (EG), jejunal interposition, or double-tract reconstruction (DTR) to reduce reflux after PG. After searching PubMed, Embase, Medline, and Web of Science databases, 25 studies comparing PG with TG in upper-third EGC published up to October 2020 were identified. PG with DTR was similar to TG regarding operative outcomes. Patients who underwent PG with DTR had less weight reduction (weighted mean difference WMD 4.29; 95% confidence interval 0.51-8.07), reduced hemoglobin loss (WMD 5.74; 2.56-8.93), and reduced vitamin B
supplementation requirement (odds ratio OR 0.06; 0.00-0.89) compared to patients who underwent TG. PG with EG caused more reflux (OR 5.18; 2.03-13.24) and anastomotic stenosis (OR 3.94; 2.40-6.46) than TG. However, PG with DTR was similar to TG regarding quality of life-related complications including reflux, anastomotic stenosis, and leakage. Hence, PG with DTR can be recommended for patients with upper-third EGC considering its superior postoperative nutritional outcomes.
Background
Large neutral amino acids (LNAAs) and gut microbial metabolites have been linked to insulin secretion and resistance. We investigated whether baseline LNAAs and kynurenine pathway ...metabolites and changes in tryptophan-derived gut microbial metabolites (TDGMs), such as indole compounds, were associated with improvements in insulin secretion and resistance after sleeve gastrectomy.
Methods
In this prospective single-arm longitudinal study, 23 patients with type 2 diabetes underwent sleeve gastrectomy. Twelve diabetes-related amino acid metabolites were quantified before surgery, and the following three indices were assessed as outcome measures: insulinogenic index, homeostasis model assessment–insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI). We also measured changes in TDGMs, including four indole compounds, 3 months after bariatric surgery. A linear regression model and receiver operating characteristic curves were assessed.
Results
The mean age and body mass index of study participants were 41.8 years (standard deviation (SD), 13.1 years) and 38.9 kg/m
2
(SD, 5.2 kg/m
2
), respectively. Several baseline amino acid metabolites were significantly associated with a change in insulin secretion or resistance 3 months after bariatric surgery. Phenylalanine and LNAAs showed superior performance for predicting improvements in insulin secretion and resistance. Among the TDGMs, Δindole-3-propionic acid was significantly associated with the Δinsulinogenic index, and Δindole-3-acetic acid was significantly associated with the ΔHOMA-IR and ΔQUICKI.
Conclusions
Our findings underscore the importance of baseline amino acid profiles, especially those of LNAAs and phenylalanine, and alterations in TDGMs for improving insulin secretion and resistance in the early postoperative period after sleeve gastrectomy.
Background
Although type 2 diabetes (T2D) remission after gastric cancer surgery has been reported, little is known about the predictors of postoperative T2D remission.
Methods
This study used data ...from a nationwide cohort provided by the National Health Insurance Service in Korea. We developed a diabetes prediction (DP) score, which predicted postoperative T2D remissions using a logistic regression model based on preoperative variables. We applied machine-learning algorithms random forest, XGboost, and least absolute shrinkage and selection operator (LASSO) regression and compared their predictive performances with those of the DP score.
Results
The DP score comprised five parameters: baseline body mass index (< 25 or ≥ 25 kg/m
2
), surgical procedures (subtotal or total gastrectomy), age (< 65 or ≥ 65 years), fasting plasma glucose levels (≤ 130 or > 130 mg/dL), and antidiabetic medications (combination therapy including sulfonylureas, combination therapy not including sulfonylureas, single sulfonylurea, or single non-sulfonylurea). The DP score showed a clinically useful predictive performance for T2D remission at 3 years after surgery training cohort: area under the receiver operating characteristics (AUROC) 0.73, 95% confidence interval (CI), 0.71–0.75; validation cohort: AUROC 0.72, 95% CI 0.69–0.75, which was comparable to that of the machine-learning models (random forest: AUROC 0.71, 95% CI 0.68–0.74; XGboost: AUROC 0.70, 95% CI 0.67–0.73; LASSO regression: AUROC 0.75, 95% CI 0.73–0.78 in the validation cohort). It also predicted the T2D remission at 6 and 9 years after surgery.
Conclusions
The DP score is a useful scoring system for predicting T2D remission after gastric cancer surgery.
We conducted a systematic review and meta-analysis of studies to quantify the association between body mass index (BMI) and the risks of all-cause and cardiovascular mortality in patients with type 2 ...diabetes.
We included studies assessing the impact of BMI on all-cause and cardiovascular mortality in patients with type 2 diabetes. Data were combined using a random-effects dose-response model.
Sixteen cohort studies on all-cause mortality (n = 445,125) and two studies on cardiovascular mortality (n = 92,841) were evaluated in the meta-analysis. A non-linear association was observed between BMI and all-cause mortality among patients with type 2 diabetes. With a BMI nadir of 28-30 kg/m2, the risk of all-cause mortality displayed a U-shaped increase. With a BMI nadir of 29-31 kg/m2, the risk of cardiovascular mortality exhibited a gradual non-linear increase for BMI > 31 kg/m2. Subgroup analyses suggested that study location, diabetes duration, and smoking history may have contributed to heterogeneity among the studies.
An obesity paradox exists for patients with type 2 diabetes with respect to all-cause and cardiovascular mortality. Study location, diabetes duration, and smoking history might contribute to heterogeneity among obesity paradox studies of patients with type 2 diabetes.
Background
Gastric cancer adversely affects nutrition and immunity, while increasing the risk of tuberculosis (TB). This study investigated the incidence and risk factors for TB in gastric cancer ...patients who had undergone gastrectomy or endoscopic submucosal dissection (ESD).
Methods
This retrospective cohort study was conducted using Korean national insurance claims data. We defined three study groups (total gastrectomy, subtotal gastrectomy, and ESD) of patients diagnosed with gastric cancer plus a cancer-free control group. The latent TB infection (LTBI) screening status, TB incidence, and potential confounders in each cohort were analyzed, and the risk of TB was analyzed using a Cox proportional hazard model.
Results
LTBI tests were performed in less than 1% of all patients, and the TB incidence rates were 473.8, 287.4, 199.4, 111.1 events/100,000 person-years in the total gastrectomy, subtotal gastrectomy, ESD, and control cohorts, respectively. Compared to the control cohort, the total gastrectomy cohort showed the highest hazard ratio (HR) for TB incidence (HR: 2.896, 95% CI: 2.559–2.337), while the ESD cohort showed a significantly increased risk (HR: 1.578, 95% CI: 1.957–1.980). Age, body mass index, and lack of exercise were risk factors in all cohorts. Comorbidities were also considered risk factors, depending on the cohort type.
Conclusions
Patients who underwent gastrectomy or ESD had an increased risk of TB, and this risk was correlated with the scope of gastrectomy. Considering the low rate of LTBI diagnostic tests and increased risk of TB in the study cohorts, more specific and practical guidelines for TB management are required for gastric cancer patients.
ObjectivesWe assessed thyroid-stimulating hormone (TSH) suppression effects on bone mineral density (BMD) in postmenopausal women who underwent thyroidectomy.Data sourcesPubMed, EMBASE, Cochrane ...Library, Web of Science and SCOPUS were searched from inception to 24 February 2021.Study selectionCase-control studies were included.Data extraction and synthesisTwo authors independently reviewed the studies, extracted the data and performed meta-analysis of eligible studies.Research design and methodsStudies evaluating BMD in postmenopausal women with thyroid cancer who had thyroidectomy and levothyroxine therapy were included. Differences in BMD were presented as standardised mean differences (SMDs). Meta-analyses were conducted using a random-effects model.ResultsAnalysis of 16 case-control studies (426 patients and 701 controls without thyroid cancer) showed that stringent TSH suppression (TSH <0.10 mIU/L) after thyroidectomy had deleterious effects on the BMD of the lumbar spine in postmenopausal women compared with controls (SMD −0.55; 95% CI −0.99 to −0.10; I2=75.8%). There was no significant difference in patients with moderate TSH suppression (TSH 0.10–0.49 mIU/L). TSH suppression in postmenopausal women was not significantly associated with lower femoral neck BMD. Subgroup analysis of the lumbar spine showed that the association between stringent TSH suppression and lower BMD was consistent among studies with >10 years of follow-up (SMD −0.32; 95% CI −0.50 to −0.14). Subgroup analysis of the femoral neck showed that total thyroidectomy was related to detrimental effects on the BMD of the femoral neck (SMD −0.60; 95% CI −0.89 to −0.31; I2=90.4%), but near-total thyroidectomy was not (SMD 0.00; 95% CI −0.30 to 0.30; I2=55.6%).ConclusionsStringent TSH suppression had deleterious effects on the BMD of the lumbar spine after thyroidectomy in postmenopausal women. Further studies are needed to determine whether stringent TSH suppression after thyroidectomy increases the fracture risk.
ObjectivesWith the increasing popularity of searches for medical information on YouTube, the availability of videos concerning carpal tunnel syndrome (CTS) is increasing. This study aimed to evaluate ...the quality and reliability of YouTube videos on CTS.Setting and participantsNo participants were included.Primary and secondary outcome measuresWe searched YouTube on 1 April 2021 using the keywords “carpal tunnel syndrome” and “carpal tunnel release” and evaluated the first 55 retrieved videos. We summarised the video characteristics including Video Power Index (VPI), which was designed to evaluate video popularity based on the number of likes and views. We categorised them based on source and content. Video quality and reliability were evaluated using the Journal of the American Medical Association (JAMA) benchmark criteria, the Global Quality Score (GQS) and the Carpal Tunnel Syndrome-Specific Score (CTS-ss) .ResultsThe mean (range: minimum–maximum) of JAMA scores, GQS and CTS-ss were 2.13 (1–4), 2.69 (1–5), and 5.0 (1–15), respectively. The most common source of video was from allied health workers, and academically sourced videos had the highest JAMA score and GQS. Three scores were significantly correlated with each other. Multiple linear regression analysis showed that a higher JAMA score was associated with a higher likes ratio, and a higher GQS was associated with a longer video running time and greater number of comments. However, a higher VPI was not associated with higher video quality or reliability represented by the three scores.ConclusionsYouTube videos on CTS have low quality and reliability. Video popularity was not significantly correlated with quality or reliability. Our findings suggest that expert groups should provide and promote high-quality video content to YouTube users and patients.
Background
In this modern era, laparoscopic distal gastrectomy (LDG) has largely replaced open distal gastrectomy for the treatment of gastric cancer; however, a quantitative review of reconstruction ...methods applied exclusively using LDG has not yet been published. Thereafter, we compared three reconstruction methods (Billroth I, Billroth II, and Roux-en Y) using the data derived solely from LDG patients.
Methods
A systematic search was conducted using electronic bibliographic databases (Google Scholar, PubMed, and Embase), for articles that compared reconstruction methods in LDG, published within the last decade. A systematic review comparing 12 outcome parameters and sensitivity analyses were performed to increase the statistical power and minimize the inconsistency and heterogeneity of results.
Results
Twenty-three clinical trials involving 5797 patients were included in the meta-analysis. There were no significant differences in the postoperative recovery and intraoperative parameters, except for operation time. B1 demonstrated a significantly shorter operation time when compared with B2 and RY by 21.6 min (
P
< 0.0001) and 44.69 min (
P
< 0.0001), respectively. In terms of postoperative endoscopic symptoms, RY was significantly superior to B1 and B2 for bile reflux (
P
< 0.001) and remnant gastritis (
P
< 0.001). For postoperative complications, B1 showed a significantly lower rate of postoperative morbidity than did RY and B2 (
P
= 0.0006 and
P
= 0.0005, respectively).
Conclusions
Our study is the first meta-analysis comparing anastomoses in LDG and introduces novel criteria for consideration when selecting reconstructions in LDG. Considering the significant differences in postoperative complications and endoscopic symptoms, these two parameters lay reasonable groundwork for guiding the surgeon’s choice of reconstruction.
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