Characterization and evaluation of Indian potato germplasm for goodkeeping attributes in sub-tropical northwestern plains

Intra-gastric balloon (IGB) therapy is the most established endoscopic treatment of obesity, but there is a paucity of literature on long-term efficacy. This study aims to evaluate the short- and long-term weight loss efficacy of IGB. Double-blinded RCT with 6-month IGB vs with sham endoscopy, in body mass index (BMI) 27-35 patients. Anthropometric, fasting glucose, and lipid profile measurement as early outcomes (up to 2years) and 10-year follow-up. Primary outcomes were total body weight loss (kg) and BMI. Secondary outcomes were new-onset diabetes mellitus, other new comorbidities, and willingness for further intervention. Initial RCT recruited 99 patients (50 IGB vs 49 sibutramine group). Forty-nine patients (26 IGB vs 23 control group) participated in a 10-year review (follow-up rate of 51.6%). Total body weight loss at 6 (9.75 vs 7.48kg, p = 0.03), 12 (6.52 vs 4.42kg, p = 0.05), 18 (5.42 vs 3.57, p = 0.32), and 24months (4.07 vs 2.93kg, p = 0.56) favored the IGB group. Total weight loss (TWL) at 10years (0.03 vs - 2.32kg, p = 0.05) and %TWL (- 0.16 ± 12.8% vs - 2.84 ± 5.6%, p = 0.39) were not significantly different between groups. Follow-up BMI (30.97 ± 1.6 vs 30.38 ± 1.8kg/m2, p = 1.00) was similar. At 10years, new-onset diabetes mellitus, sleep apnoea, metabolic syndrome, and arthralgia were not significant (p > 0.05). Twenty-three (81%) IGB group vs 13 (56%) control expressed a willingness for further intervention (p < 0.01). IGB delivers weight loss to 2years and is superior to control. However, new comorbidity development is not significantly different at 10years. Patient that received IGB therapy were subsequently more willing for further bariatric metabolic intervention.

A prospective pilot study of the efficacy and safety of Elipse intragastric balloon: A single-center, single-surgeon experience

Introduction: Evidence for the benefits of preoperative weight loss on total weight loss after bariatric surgery (BS) is controversial. We aimed to determine the impact of preoperative total body weight loss (PrTBWL%) on postoperative total body weight loss (PoTBWL%). Methods: Data from 711 patients who underwent BS (LSG: 69.1%, LRYGB: 19.2%, revisions: 11.7%) between March 2016 and January 2022 were prospectively collected. All patients participated in a structured behavior modification, exercise, and low-calorie diet plan with a goal of 10% PrTBWL. Patients were grouped into < 7% or ≥ 7% PrTBWL. Results: The mean age was 43.97 years, mean BMI was 44.6 kg/m2, 86.35% were women and 52.46% were Hispanics. Patients with < 7% PrTBWL had lower PoTBWL% at 1-year (28.78% vs 34.95%, p =.0008), 2-year (26.11% vs 32.98%, p =.0008), 3-year (23.73% vs 30.46%, p =.0008), 4-year (21.55% vs 31.23%, p =.0012) and 5-year follow-up (18.08% vs 33.1%, p =.0008). Time from initial visit to BS was longer in < 7% PrTBWL group (210 vs 164 days, p =.0424). There was an independent linear effect of PrTBWL% on PoTBWL% (p <.0001, r=.4403) on multiple regression analysis. PrTBWL% was inversely correlated with operative time, but not with hospital stay. The 30-day morbidity and mortality was zero. Patients with preoperative BMI < 35 kg/m2 after preoperative weight loss were not denied surgery by their insurance. Conclusion: A significant linear association between PrTBWL% and up to 5-year PoTBWL%, irrespective of the type of BS, was observed. Preoperative weight loss does not contribute to insurance denials.

Introduction: In patients with severe obesity, albuminuria can be improved by both conventional medical therapy and bariatric surgery. The purpose of this study was to compare the impact of weight loss achieved through conventional medical therapy or laparoscopic sleeve gastrectomy (LSG) on albuminuria in Japanese subjects with severe obesity and identify the factors involved. Methods: We retrospectively evaluated the clinical characteristics including the urinary albumin/creatinine ratio (UACR) of 340 consecutive subjects with a body mass index ≥35 who received LSG (n = 242) or medical therapy (n = 98) between 2010 and 2018 and were followed for at least 12 months. Results: The baseline of the UACR was not different between the 2 groups. At the 12-month follow-up, total weight loss (TWL) and decreases in glycosylated hemoglobin (HbA1c) and log_e UACR were greater in the LSG group than in the medical therapy group (body weight; −35.7 kg vs. −8.0 kg, p < 0.001, HbA1c; −1.4% vs. −0.7%, p < 0.001, log_e UACR; −0.3 vs. 0.9, p < 0.001). The rate of complete remission of diabetes was significantly higher in the LSG group than in the medical therapy group. At 12 and 36 months (n = 111 in the medical therapy group, n = 56 in the LSG group at 36 months), log_e UACR increased in the medical therapy group, while it remained unchanged or decreased in the LSG group. In subjects with microalbuminuria and macroalbuminuria, changes in the log_e UACR correlated with percent total body weight loss (%TWL) in both groups at 12 months. Percent TWL contributed independently to the change in the log_e UACR, irrespective of whether LSG was performed. In receiver-operating characteristic analysis, a weight loss of 7.8% predicted a decrease in the UACR (∆UACR <0 at 12 months). Conclusion: Our analysis suggests that albuminuria may increase over time if only medical therapy is continued. To improve albuminuria, weight loss may be more important than whether LSG is performed.

IntroductionWeight loss prior to bariatric-metabolic surgery (BMS) is recommended in most bariatric centers. However, there is limited high-quality evidence to support mandatory preoperative weight loss. In this study, we will evaluate whether weight gain prior to primary BMS is related to lower postoperative weight loss.MethodsA retrospective analysis of prospectively collected data was performed. Preoperative weight loss (weight loss from start of program to day of surgery), postoperative weight loss (weight loss from day of surgery to follow-up), and total weight loss (weight loss from start of program to follow-up) were calculated. Five groups were defined based on patients’ preoperative weight change: preoperative weight loss of >5 kg (group I), 3–5 kg (group II), 1–3 kg (group III), preoperative stable weight (group IV), and preoperative weight gain >1 kg (group V). Linear mixed models were used to compare the postoperative weight loss between group V and the other four groups (I–IV).ResultsA total of 1928 patients were included. Mean age was 44 years, 78.6% were female, and preoperative BMI was 43.7 kg/m2. Analysis showed significantly higher postoperative weight loss in group V, compared to all other groups at 12, 24, and 36 months follow-up. Up to three years follow-up, highest total weight loss was observed in group I.ConclusionWeight gain before surgery should not be a reason to withhold a bariatric-metabolic operation. However, patients with higher preoperative weight loss have higher total weight loss. Therefore, preoperative weight loss should be encouraged prior to bariatric surgery.Graphical

Predictors of Complications in Anorexia Nervosa and Atypical Anorexia Nervosa: Degree of Underweight or Extent and Recency of Weight Loss?

Introduction: Enlargement of the remnant gastric pouch or gastro-jejunal (GJ) stoma is associated with weight regain after Roux-en-Y Gastric Bypass (RYGB) surgery. Although evidence exists regarding outcomes of GJ outlet reduction in terms of weight loss, the efficacy of gastric pouch revision is still unclear. There are no published results using endoscopic trans-oral outlet reduction (TORe) in combination with gastroplasty of the entire gastric pouch from the gastro-esophageal (GE) junction to the GJ stoma (TORe-G) utilizing an endoscopic full thickness suturing device (Overstitch, Apollo Endosurgery, Austin Tx). We thus report the first description of using (TORe-G) to treat patients with failed RYGB. Methods: Patients who underwent a combined GJ stoma reduction and gastroplasty for inadequate weight loss [5% EWL from nadir) post-RYGB along with evidence of GJ diameter of ≥ 2 cm and dilation of gastric pouch were included. The procedure involved ablation of the peristomal mucosa and gastric pouch using argon plasma coagulation (APC) and placement of interrupted plications using 2-0 prolene sutures for a targeted GJ diameter of ˜5-8 mm and reducing gastric pouch volume to ˜30 mL. Results: A total of 20 subjects (90% females) with median age of 55 years (IQR 42.2-61) and median duration since RYGB of 10 years (IQR 6.2-12) were evaluated. Median follow up was 4.5 months (range 1-9 months). Median (IQR) baseline weight was 225 (198.2-287.2) lbs and BMI was 37.9 (32.7-44.8) kg/m2. Significant weight loss was seen in 100% of study patients post-revision (p < 0.001) (Figure 1). Median (IQR) %EWL seen at 1, 3, and 6 and 9 months was 21.3% (11.3-30), 39.35% (14.9-53.6), 52.8% (14.3-70.9), and 62.8% (57.2-68.3), respectively. Total weight loss [median (IQR)] was 10 lbs (7.5-25), 19 lbs (15-28), 17 lbs (10-37), and 24.5 lbs (15.5-48.5), respectively. Total percent weight loss [median (IQR)] was 5.1% (3.7-9.1), 8.6% (7.05-10.8), 8.5% (5.7-15.5) and 13% (10.6-17), respectively. None of the covariates including age, interval time since RYGB, and percent weight regained since RYGB predicted weight loss post revision. No major adverse events were observed.Figure 1Conclusion: We demonstrate for the first time the efficacy and safety of TORe-G to re-establish weight loss in patients with failed RYGB using a full thickness endoscopic suturing device. TORe-G resulted in robust weight loss, and may lead to superior restriction compared with TORe alone. Further comparative studies are needed.

Randomized, controlled trials (RCTs) comparing the effectiveness of metabolic bariatric surgery (MBS) in addition to one or more treatment interventions for obesity (i.e., lifestyle structured interventions-LSI, medical therapy-MT, obesity management medication-OMM or endobariatric procedures-EP) are lacking. This study aims to assess the effectiveness of multiple simultaneous (before or immediately after MBS) interventions for treating obesity. We performed a meta-analysis including all RCTs enrolling patients undergoing different MBS procedures add-on to other anti-obesity strategies (LSI, MT, OMM or ES) versus MBS alone, with a duration of at least 6 months. The primary outcome was BMI at the end-point; secondary end-points included percentage total and excess weight loss (%TWL%, and EBWL%), total weight loss (TWL), fasting plasma glucose (FPG), HbA1c, surgical and non-surgical severe adverse events (SAE), mortality, remission of type 2 diabetes, hypertension, dyslipidemia and health-related quality of life (HR-QoL). A total of 25 RCTs were retrieved. The addition of either OMM (i.e., liraglutide) or EP (i.e., intragastric balloon-IB, endosleeve-ES) to MBS was associated with a significantly lower BMI at the end-point (p = 0.040). The addition of liraglutide only to MBS was associated with a greater %EWL%, but not %TWL and TBWL (p = 0.008). Three trials evaluated end-point HbA1c, showing a significant reduction in favour of liraglutide as an add-on therapy to MBS (p = 0.007). There was no mortality. MBS combined with non-surgical approaches appears more effective than MBS alone in reducing BMI. Further RCTs on combined therapies to MBS for severe obesity are needed to enhance the tailoring of treatment for severe obesity.

The evidence supporting the benefits of early exercise in post-bariatric patients is growing. This study analyzed the effects of early exercise (1-week post-bariatric surgery) on body composition in patients with overweight and obesity 1month after surgery. Thirty patients (age 36.5 ± 12.3 [range, 18-65] years; body mass index [BMI], 36.2 ± 12.3kg/m2, range, 29-48) who underwent laparoscopic sleeve gastrectomy for bariatric surgery were instructed to participate in an exercise training program initiated on day 3 post-surgery and to follow a recommended protein intake of 60g/day. After 1-month post-surgery, patients were stratified into those who adhered to exercise recommendations and those who did not. Pre- and post-differences in total weight loss (TWL), skeletal muscle mass (SMM), fat mass (FM), and visceral fat mass (VFM) were compared. TWL, SMM, and FM loss were similar between non-adherent and adherent subjects (10.2 ± 3.5kg and 11.9 ± 3.6kg; p = 0.2; 2.9 ± 1.0kg and 3.2 ± 1.2; p = 0.2; 6.2 ± 2.1kg and 7.5 ± 3.6kg; p = 0.2, respectively), whereas VFM was markedly reduced in the adherent group (29.9 ± 18.2 cm2 vs 14.6 ± 9.4 cm2; p = 0.01) compared to the non-adherent group. When the group was divided according to adherence to exercise and protein intake or non-adherence to both conditions, there was a significant difference in TWL, FM, and VFM losses (p < 0.05). In contrast, no differences in SMM were found. Early exercise training accelerated visceral fat mass loss during the initial recovery period in patients after bariatric surgery. Additionally, adherence to daily protein intake recommendations can increase total body weight and fat mass loss.

Storage of crisphead lettuce was carried out at 1 degrees C in an ordinary cold storage room and in an ice bank cooling system. The plants were grown at three plantings at 50, 100, 150 and 200 kg total nitrogen supply per hectare and harvested at two or three different plant ages. The cultivars used were 'Marius' and 'Saladin'. The aim of the experiment was to prolong the storage and to reduce the losses. After 14 days of storage the greatest total weight losses were found at the mid-season planting whereas the least total weight loss was found at the late planting. Ice bank cooling at all plantings reduced the total weight loss in comparison to the cold storage. The effect of nitrogen and cultivar was low. The total weight loss defined as loss due to transpiration and trimming was neither related to the head weight nor the surface area of the heads. A reduced loss with increasing plant age was not a question of increased transpiration due to surface to volume ratio changes, but may be related to other factors. A lower average total weight loss was found in the ice bank cooling system compared to the cold storage. The explanation of this might be the existence of a high relative humidity in the ice bank storage. To reduce the total weight loss harvest must take place at the right plant age. No definite growth stage was defined here, but the plants must have reached marketable quality as the young plants are more susceptible to weight loss during storage. It seems likely that some unknown internal factors in the plant were involved in reduction of the total weight loss.

Bariatric endoscopic antral myotomy: first-in-human proof of concept of a novel therapeutic method to delay gastric emptying and induce weight loss

Prior research suggested presurgical weight loss is associated with greater total weight loss, resulting in amore effective bariatric intervention. We aimed to assess whether preoperative weight loss is a predictor for total weight loss, and which patient factors are associated with successful weight loss. All patients (N = 773) that underwent primary bariatric surgery between June 2017 and August 2019 were included in this single-center retrospective study. Outcome measures were preoperative weight loss (%preopWL) and total weight loss (%TWL) up to 1year postoperatively. Patients were divided into 4 groups based on quartiles of %preopWL. Total weight loss after 1, 6, and 12months for the upper quartile was 16.9%, 33.4%, and 37.8%, and for the lower quartile 11.8%, 28.9%, and 35.2%, respectively (p < 0.001). Seven hundred fourteen patients (92.4%) were available for the 1-year follow-up. Preoperative weight loss was not associated with the incidence of complications. Independent factors predicting increased %preopWL were mandated preoperative weight loss program (MWP) (p < 0.001), older age (p = 0.005), weight measurement in the week before surgery (p = 0.031), and non-diabetic status (p = 0.010). Predictors for superior %TWL were MWP (p = 0.014), younger age (p = 0.001), non-diabetic status (p = 0.005), female gender (p = 0.001), higher Body Mass Index (p = 0.006), and banded gastric bypass (p = 0.001). Higher preoperative weight loss is associated with persisting greater weight loss up to at least 12months post-surgery. In order to optimize preoperative weight loss, we recommend extra preoperative support to younger and diabetic patients. We advise nutritional counseling and additional weight measurement in the week before surgery.

Key Clinical MessageSleeve gastrectomy (SG) is a surgical weight-loss procedure. Splenic abscess is a rare complication of SG. Four cases of splenic abscess after SG have been reported, all managed by surgical intervention. We report the first documented case of multiple splenic abscesses following SG managed conservatively by an integrated medical treatment.

Sub-optimal weight loss following Roux-en-Y gastric bypass (RYGB) represents an important clinical challenge in a significant number of patients. Early identification of such patients would be advantageous, as it could aid in the selective implementation of targeted adjunct interventions during the first post-operative year. Clinical audit data from 1137 patients undergoing RYGB between 2013 and 2016 at the Instituto Sallet in Brazil were prospectively registered in an online database (BOLD) and analyzed. Forty-eight percent of patients achieving less than 5% total weight loss after the first post-operative month achieved a 20% total weight loss at 1year (n = 626; OR = 0.6 CI = 95%). Eighty-three percent of patients losing between 5 and 10% at 1month and 95% of patients losing greater than 10% at 1month had lost at least 20% of total body weight after the first post-operative year. Forty-four percent of patients achieving less than 10% total weight loss after the third post-operative month achieved 20% total weight loss at 1year (n = 494; OR = 0.3 CI = 95%). Total bodyweight reduction after RYGB of < 5% at 1month and < 10% at 3months is associated with suboptimal weight loss at 1year. These results reinforce findings from other studies reporting that patients tend to follow a common weight loss trajectory. Identifying the patients with weight trajectory requiring adjunct therapies early on is crucial so appropriate adjustments can be made to post-operative care.

Sexual Activity After Bariatric Surgery: A Prospective Monocentric Study Using the PISQ-IR Questionnaire