Omental Fat Research Articles

Maternal under-nutrition during pregnancy alters the molecular response to over-nutrition in multiple organs and tissues in nonhuman primate juvenile offspring.

Previous studies in rodents suggest that mismatch between fetal and postnatal nutrition predisposes individuals to metabolic diseases. We hypothesized that in nonhuman primates (NHP), fetal programming of maternal undernutrition (MUN) persists postnatally with a dietary mismatch altering metabolic molecular systems that precede standard clinical measures. We used unbiased molecular approaches to examine response to a high fat, high-carbohydrate diet plus sugar drink (HFCS) challenge in NHP juvenile offspring of MUN pregnancies compared with controls (CON). Pregnant baboons were fed ad libitum (CON) or 30% calorie reduction from 0.16 gestation through lactation; weaned offspring were fed chow ad libitum. MUN offspring were growth restricted at birth. Liver, omental fat, and skeletal muscle gene expression, and liver glycogen, muscle mitochondria, and fat cell size were quantified. Before challenge, MUN offspring had lower body mass index (BMI) and liver glycogen, and consumed more sugar drink than CON. After HFCS challenge, MUN and CON BMIs were similar. Molecular analyses showed HFCS response differences between CON and MUN for muscle and liver, including hepatic splicing and unfolded protein response. Altered liver signaling pathways and glycogen content between MUN and CON at baseline indicate in utero programming persists in MUN juveniles. MUN catchup growth during consumption of HFCS suggests increased risk of obesity, diabetes, and cardiovascular disease. Greater sugar drink consumption in MUN demonstrates altered appetitive drive due to programming. Differences in blood leptin, liver glycogen, and tissue-specific molecular response to HFCS suggest MUN significantly impacts juvenile offspring ability to manage an energy rich diet.

Use of real-time ultrasound measurements of fat thickness and longissimus thoracis muscle characteristics for predicting body fat depots in crossbred hair ewes

This study aimed to predict body fat depots using ultrasound measurements (USM) of fat thickness and longissimus thoracis muscle characteristics in crossbred hair ewes. A total of 24 animals with a mean body weight (BW) of 37 ± 4kg and a body condition score of 2.39 ± 0.49 were used. USM was recorded 24h before slaughter and included: subcutaneous fat thickness (SFT), area (LTMA), amplitude (LTA), and depth (LTD) of the l. thoracis muscle and kidney fat thickness (µKFT). After slaughter, the internal fat (IF) was separated, classified, and weighed as mesenteric (MF), omental (OF), or pelvic fat (PF). The left half was then separated into subcutaneous and intermuscular fat (CF), and the muscle and bone tissues were weighed separately and adjusted to take account of the whole animal. Total body fat (TBF) was determined to be the IF plus the CF weights. LTA and LTMA correlated poorly to moderately with fat depots (0.37 ≤ r ≤ 0.74, P < 0.05). Other than CF, µKFT showed poor to moderate correlation with the other depots of body fat (0.44 ≤ r ≤ 0.75, P < 0.05). The regression model used to predict MF had r2 of 0.87 (RSD=0.14kg) and included BW and LTMA (P<0,05). OF and PF were predicted with r2 of 0.55 and 0.44, respectively, including µKFT (RSD = 0.20 and 0.17kg). IF was predicted by empty BW, LTMA, and µKFT with r2 as 0.81 (RSD=0.30kg). For TBF, EBW and LTMA explained 72% of its variation (RSD= 0.59kg). USM of fat thickness and l. thoracis muscle characteristics can improve the accuracy of predicting body energy reserves in crossbred hair ewes.

A rare case of peritoneal tuberculosis mimicking peritoneal carcinomatosis: the ongoing challenge

Tuberculosis (TB) is a serious infection that can involve any organ system and present in various forms. About one-third of the world’s population are carriers of latent TB. Although most cases are from a pulmonary origin, there is a rising prevalence of abdominal TB. Patients with pulmonary or extrapulmonary TB are treated similarly through the use of pharmacological therapy. Nonspecific clinical manifestations of TB have made it difficult for clinicians to diagnose. Peritoneal tuberculosis (PTB) is a serious concern as its symptoms overlap with that of many other chronic conditions, especially in those who are immunocompromised. The lack of highly sensitive and specific testing methods has made early intervention difficult, therefore a high index of suspicion is crucial in the progression of the disease. Here, we present a case of a 71-year-old female with a history of abdominal pain, fever, and weakness. Initial investigation with computed tomography (CT) imaging revealed omental fat stranding that pointed towards peritoneal carcinomatosis (PC) from possible recurrence of her ovarian cancer. Further investigation with a peritoneal biopsy was remarkable for caseating granulomas with fat necrosis confirming extrapulmonary TB. This report highlights a rare case of PTB mimicking PC in an elderly patient who is immunocompromised from the use of long-term corticosteroids who continued to decline after pharmacological treatment of the disease.

EP553 - Omental Infarction mimicking acute cholecystitis - A Case Report

Abstract Introduction Spontaneous torsion and infarction of the omentum is a rare presentation with a variety of clinical presentations. We report a middle-aged male patient who presented with signs and symptoms mimicking acute cholecystitis. Case Presentation A 47-year-old man presented with an 18-hour history of right upper quadrant (RUQ) pain. Pain was constant, worse on movement and inspiration. On examination, he was exceptionally tender in the RUQ with positive Murphy’s sign. Initial investigations showed a mild inflammatory response, and the working diagnosis was acute cholecystitis. An abdominal ultrasound scan demonstrated a thin-walled gallbladder, free from gallstones and no evidence of acute cholecystitis. Given the patients ongoing severe pain and examination findings, a CT scan of abdomen and pelvis with contrast was performed. This demonstrated an oval shaped area of localized omental fat stranding in the RUQ, suggestive of omental infarction. The patient was managed conservatively with analgesia and discharged once symptoms were adequately controlled. Discussion Torted, infarcted omentum is a rare cause of acute abdominal pain. It is more frequently observed in 40–50-year-olds with male predominance. Most commonly it mimics symptoms and signs of acute appendicitis. However, this is a rare case mimicking acute cholecystitis. In this case, the necrotic segment was adherent with the anterior abdominal wall, causing significant pain and tenderness. When the clinically presentation of acute cholecystitis is not reflected by abdominal ultrasound, cross sectional imaging should be obtained to ensure definitive diagnosis is established in timely manner.

Association between body condition score and abdominal fat assessed by ultrasound in Jersey cows.

Body condition score (BCS) is a subjective tool and the deposition of subcutaneous fat differs from the deposition of abdominal fat. The aim of this study was to evaluate by multivariate regression models and ultrasonography the amount of fat accumulated in different areas of the abdominal cavity in Jersey non-pregnant non-lactating cows and its association with their BCS. From a commercial farm, 21 non-pregnant non-lactating Jersey cows were selected at random. Cows were placed in a headlock line, and BCS was evaluated (scale 1-5 with a 0.25 unit increment) by the same assessor. Ultrasonographic evaluation was performed using a Sonosite machine in duplicate, considering key anatomical points of the body to predict total abdominal fat (AT), retroperitoneal fat (RT), omental fat (OT) and mesenteric fat (MT). A regression analysis for each abdominal fat depot and the BCS was run using SAS. Models from the lowest to the largest r2 are reported. The r2 for the models were MT r2=0.023; RT r2=0.1047; OT r2=0.323 and AT r2=0.369. Correlation between BCS and abdominal fat depots was positive, lower for mesenteric and retroperitoneal fat, but higher for omental and total abdominal fat. Cows were divided on the basis of the median of BCS distribution to high (≥3.5) and low (≤3.25). Those with high BCS had significantly larger amounts of fat in different anatomical areas of abdominal cavity than cows with low BCS. BCS has a low-to-moderate association with abdominal fat depots, but a high variability exists within each BCS punctuation, which supports the notion that fat accumulation patterns and metabolic turnover between abdominal and subcutaneous fat differ from each other.

990 A Rare Case of Adenomyoma in Gastric Pylorus of a Young Adult Female: A Case Report

Abstract Introduction Gastric adenomyoma is a rare benign tumour which occurs 85% in antrum and 15% in pylorus. Although adenomyomas are benign, diagnosis is difficult as they are commonly found alongside with adenocarcinomas. Case report A 20-year-old previously healthy female presented with epigastric pain, gastric outflow obstruction features and weight loss for 3 months. Initial USS was followed by a CECT which, showed intramural mass lesion with necrotic centre arising from the inferior wall of the pre pyloric area of the stomach with acute inflammatory changes of the adjacent omental fat, giving differential diagnosis of GIST or gastrinoma at pyloric region. Subsequent upper GI endoscopy revealed a protruding pyloric mass without mucosal lesions. Unfortunately, the unavailability of EUS and biopsy posed a diagnostic hurdle. Intraoperatively, a mass intricately adhered to the transverse colon and omentum was discovered, leading to a surgical intervention involving distal gastrectomy, gastrojejunostomy, and jejunojejunostomy. Unexpectedly, histological analysis unveiled adenomyoma at the prepyloric area, characterized by Brunner’s glands, dilated glands, and heterotrophic small intestinal tissue. Discussion This rare manifestation of adenomyoma in the gastric pylorus, particularly in a young adult, highlights the challenges in accurate preoperative diagnosis. The favourable postoperative outcome prompts reflection on the potential role of advanced diagnostic tools, emphasizing the significance of EUS and biopsy in steering clear of extensive surgeries. Conclusions This case report underscores the crucial role of personalized diagnostic methods, especially in cases like ours where a rare adenomyoma mimicking other tumours.

Three-Month Excessive Body Weight Loss < 37.7% as a Predictor of Mid-term Suboptimal Outcomes Postlaparoscopic Sleeve Gastrectomy: Risk Factors and the Impact of Neutrophil-to-Lymphocyte Ratio on Adipocyte Function.

This study aimed to evaluate the impact of achieving < 37.7% excess body-weight loss (EBWL) within 3months of postlaparoscopic sleeve gastrectomy (LSG) on clinical outcomes and its correlation with adipocyte function. Patients (n = 176) who underwent LSG between January 2019 and January 2023 were included. Weight loss and status of health markers were monitored postoperatively. The cohort was stratified based on EBWL < 37.7% at 3months or not. Variables including neutrophil-to-lymphocyte ratio (NLR), insulin resistance, and comorbidities were analyzed. Omental visceral and subcutaneous adipose tissue samples were used to analyze the differences in adipocyte function by western blot. Patients with EBWL < 37.7% at 3months post-LSG (suboptimal group) comprised less likelihood of achieving ≥ 50% EBWL than those who achieved ≥ 37.7% EBWL (optimal group) at 6months (42.55% vs. 95.52% in optimal group, p < 0.001), 12months (85.11% vs. 99.25% in optimal group, p < 0.001) and 24months (77.14% vs. 94.74% in optimal group, p = 0.009) post-LSG. High BMI (OR = 1.222, 95% CI 1.138-1.312, p < 0.001), NLR ≥ 2.36 (OR = 2.915, 95% CI 1.257-6.670, p = 0.013), and female sex (OR = 3.243, 95% CI 1.306-8.051, p = 0.011) significantly predicted EBWL < 37.7% at 3months post-LSG. Patients with NLR ≥ 2.36 had significantly lower adipose triglyceride lipase in omental fat (p = 0.025). EBWL < 37.7% at 3months post-LSG is a strong predictor of subsequent suboptimal weight loss. High BMI, NLR ≥ 2.36, and female sex are risk factors in predicting EBWL < 37.7% at 3months post-LSG. These findings may offer a reference to apply adjuvant weight loss medications to patients who are predisposed to suboptimal outcomes.

Xenoestrogen concentration in women with endometriosis or leiomyomas: A case-control study.

Xenoestrogens are synthetic or naturally occurring chemicals capable of altering the endocrine system of humans and animals owing to their molecular similarity to endogenous hormones. There is limited data regarding their effects on women´s health. Chronic exposure to xenoestrogens can promote the development of estrogen-related diseases. To examine xenoestrogen concentration (TEXB-α) differences between women with leiomyomas or endometriosis and control women, and to study the relationship between the clinical and sociodemographic characteristics of these patients and their xenoestrogen levels. Prospective case-control study. We selected 221 women who underwent surgery at Quironsalud Madrid University Hospital between 2017 and 2021. The cases included 117 patients: 74 women who underwent surgery for uterine leiomyomas, 21 with endometriosis, and 22 with both pathologies. The control group comprised 104 healthy women who underwent surgical procedures for other reasons. TEXB-α was determined in the omental fat of all patients. Using a questionnaire and reviewing the patients' medical records, we collected sociodemographic data and other relevant variables. A significant majority of study participants (68.8%) had detectable levels of xenoestrogens. We found no association between TEXB-α levels in omental fat and the presence of myomas or endometriosis. In the case group, women living or working in Madrid Community exhibited, on average, 3.12 Eeq pM/g higher levels of TEXB-α compared to those working in other areas (p = 0.030). Women who referred to the use of estrogen-containing hormonal contraceptives had, on average, 3.02 Eeq pM/g higher levels of TEXB-α than those who had never used them (p = 0.022). This study found no association between omental xenoestrogen levels and leiomyomas or endometriosis. However, their presence in most participants and their association with highly polluted areas emphasizes the importance of limiting environmental exposure to these substances. We also identified an association between hormonal contraceptive use and xenoestrogen concentration.

At ultrasound, normal omental fat moving along the abdominal wall during breathing. In this case of subhepatic acute appendicitis the inflammatory conditions result in an omental thickening but the sliding is preserved.

At ultrasound, normal omental fat moving along the abdominal wall during breathing. In this case of subhepatic acute appendicitis the inflammatory conditions result in an omental thickening but the sliding is preserved.

Dapagliflozin added to metformin reduces perirenal fat layer in type 2 diabetic patients with obesity

Sodium-glucose co-transporters type 2 inhibitors (SLGT2i) are highly effective in controlling type 2 diabetes, but reported beneficial cardiovascular effects suggest broader actions on insulin resistance. Weight loss may be initially explained by glycosuria-induced net caloric output and secondary volumetric reduction, but its maintenance could be due to loss of visceral fat mass. Structured ultrasound (US) imaging of abdominal adipose tissue (“eco-obesity”) is a recently described methodology used to measure 5 consecutive layers of abdominal fat, not assessable by DEXA or CT scan: superficial subcutaneous (SS), deep subcutaneous (DS), preperitoneal (PP), omental (Om) and right perirenal (RK). PP, Om and RK are predictors of metabolic syndrome (MS) with defined cut-off points. To assess the effect of SLGT2i on every fat depot we enrolled 29 patients with type 2 Diabetes (HbA1c 6.5–9%) and Obesity (IMC > 30 kg/m2) in an open-label, randomized, phase IV trial (EudraCT: 2019-000979-16): the Omendapa trial. Diabetes was diagnosed < 12 months before randomization and all patients were treatment naïve. 14 patients were treated with metformin alone (cohort A) and 15 were treated with metformin + dapaglifozin (cohort B). Anthropometric measures and laboratory tests for glucose, lipid profile, insulin, HOMA, leptin, ultrasensitive-CRP and microalbuminuria (MAL) were done at baseline, 3rd and 6th months. At 6th month, weight loss was −5.5 ± 5.2 kg (5.7% from initial weight) in cohort A and −8.4 ± 4.4 kg (8.6%) in cohort B. Abdominal circumference showed a −2.7 ± 3.1 cm and −5.4 ± 2.5 cm reduction, respectively (p = 0.011). Both Metformin alone (−19.4 ± 20.1 mm; −21.7%) or combined with Dapaglifozin (−20.5 ± 19.4 mm; −21.8%) induced significant Om fat reduction. 13.3% of cohort A patients and 21.4% of cohort’s B reached Om thickness below the cut-off for MS criteria. RK fat loss was significantly greater in cohort B group compared to cohort A, at both kidneys. Only in the Met + Dapa group, we observed correlations between Om fat with leptin/CRP/MAL and RK fat with HOMA-IR. US is a useful clinical tool to assess ectopic fat depots. Both Metformin and Dapaglifozin induce fat loss in layers involved with MS but combined treatment is particularly effective in perirenal fat layer reduction. Perirenal fat should be considered as a potential target for cardiovascular dapaglifozin beneficial effects.

Performance, carcass characteristics, and meat quality of lambs fed diets containing crude glycerin

The aim of this study was to evaluate the effects of four crude glycerin levels in the diet of feedlot lambs on performance, carcass characteristics, and meat quality. Forty three-month-old crossbred Santa Inês x Dorper lambs weighing 18.2 ± 0.169 kg were used in a completely randomized design, with four diets and 10 replicates per diet. The animals were housed in individual pens. The trial period (42 days) was preceded by 14 days of adaptation to handling and diet. Final body weight (FBW), empty body weight (EBW), average daily weight gain, feed conversion, and feed efficiency did not differ with crude glycerin levels in the diet. Nutrient intake (dry matter (DM), ether extract (EE), crude protein (CP), and neutral detergent fiber (NDF)) did not differ depending on crude glycerin levels. In the evaluation of carcass characteristics, there was a quadratic effect due to crude glycerin levels on hot carcass yield (maximum point- maxP = 9.73%), leg perimeter (maxP = 9.45%), fat thickness (maxP = 7.41%), and leg weight (maxP = 8.69%). Loin weight and conformation showed a linear increase as a function of crude glycerin levels. The other studied variables were not affected by crude glycerin levels in the diet. In the non-carcass components, the full gastrointestinal tract, mesenteric fat, omental, and perirenal fat were not influenced by crude glycerin levels. Regarding meat quality, no effects were observed on the parameters evaluated in the longissimus dorsi. The addition of up to 15% crude glycerin in the lamb's diet does not affect its performance, however, the addition of up to 8% improves carcass characteristics and maintains meat quality.

Obesity modulates the cellular and molecular microenvironment in the peritoneal cavity: implication for ovarian cancer risk.

Abdominal obesity increases the risk of developing ovarian cancer but the molecular mechanisms of how obesity supports ovarian cancer development remain unknown. Here we investigated the impact of obesity on the immune cell and gene expression profiles of distinct abdominal tissues, focusing on the peritoneal serous fluid (PSF) and the omental fat band (OFB) as critical determinants for the dissemination of ovarian metastases and early metastatic events within the peritoneal cavity. Female C57BL/6 mice were fed a low-fat (LFD) or a high-fat diet (HFD) for 12 weeks until the body weights in the HFD group were significantly higher and the mice displayed an impaired glucose tolerance. Then the mice were injected with the murine ovarian cancer cells (MOSE-LTICv) while remaining on their diets. After 21 days, the mice were sacrificed, tumor burden was evaluated and tissues were harvested. The immune cell composition of abdominal tissues and changes in gene expression in the PSF and OFB were evaluated by flow cytometry and qPCR RT2-profiler PCR arrays and confirmed by qRT-PCR, respectively. Other peritoneal adipose tissues including parametrial and retroperitoneal white adipose tissues as well as blood were also investigated. While limited effects were observed in the other peritoneal adipose tissues, feeding mice the HFD led to distinct changes in the immune cell composition in the PSF and the OFB: a depletion of B cells but an increase in myeloid-derived suppressor cells (MDSC) and mono/granulocytes, generating pro-inflammatory environments with increased expression of cyto- and chemokines, and genes supporting adhesion, survival, and growth, as well as suppression of apoptosis. This was associated with a higher peritoneal tumor burden compared to mice fed a LFD. Changes in cellular and genetic profiles were often exacerbated by the HFD. There was a large overlap in genes that were modulated by both the HFD and the cancer cells, suggesting that this 'genetic fingerprint' is important for ovarian metastases to the OFB. In accordance with the 'seed and soil' theory, our studies show that obesity contributes to the generation of a pro-inflammatory peritoneal environment that supports the survival of disseminating ovarian cancer cells in the PSF and the OFB and enhances the early metastatic adhesion events in the OFB through an increase in extracellular matrix proteins and modulators such as fibronectin 1 and collagen I expression as well as in genes supporting growth and invasion such as Tenacin C. The identified genes could potentially be used as targets for prevention strategies to lower the ovarian cancer risk in women with obesity.

Effect of Liraglutide in Different Abdominal Fat Layers Measured by Ultrasound: The Importance of Perirenal Fat Reduction

Introduction: Ultrasonography (US) in patients with obesity allows us to measure different layers of abdominal fat (superficial subcutaneous, deep subcutaneous, preperitoneal, omental, and perirenal), not assessable by DEXA or CT scan. Omental and perirenal fat depots are considered predictors of metabolic complications. Liraglutide is particularly effective in reducing weight in patients with insulin-resistance, but its direct impact on each abdominal fat layer is unknown. Methods: We measured, at the L4 level, all 5 abdominal fat depots in 860 patients with obesity (72.8% women, mean age 56.6 ± 1.5 years, BMI 34.4 ± 4.7 kg/m2, body fat 47 ± 2%, abdominal circumference 105.8 ± 3 cm), before and after 6 months of liraglutide treatment. Laboratory tests for glucose, insulin, and lipid profile were routinely done. T-student was used to compare intraindividual differences. Results: Weight loss was 7.5 ± 2.8 kg (7.96% from baseline), with no differences by sex/age/BMI. Greater loss was observed in patients with higher dosages and NAFLD. All US-measured fat layers showed a significant reduction (p < 0.05) at 6th months. Preperitoneal fat showed a −26 ± 5.5% reduction and 46% of the patients went below metabolic syndrome (MS) risk cut-off values. Omental fat was reduced by −17.8 ± 5% (67% of the patients below MS risk) and perirenal fat by −22.4 ± 4.4% (56% of the patients below MS). Both omental and perirenal fat reduction correlated with total and LDL cholesterol. Higher perirenal fat reduction (−28%) was seen among patients with obesity and hypertension. Perirenal fat also correlated with blood pressure reduction. Conclusion: Liraglutide induces greater fat loss in the layers involved with MS. However, the maximal reduction is seen at perirenal fat, which has been recently related with hypertension and could play an important role in modulating kidney’s expansion and intraglomerular pressure. US is a reproducible clinical tool to assess pathologic fat depots in patients living with obesity.

Optimization of the process of preparation of liver pâtés and omental fat of lambs fed with lipid cakes.

The aim of this work was to optimize the process of elaborating liver pâtés and omental lamb fat and to evaluate the quality of the products. Livers and fats were obtained from lambs fed with diets composed of corn and soybean meal that were partially replaced by cupuaçu, tucumã and palm kernel cake. To prepare the pâtés, livers were baked for 20 minutes at 100°C, weighed, seasoned, crushed, packaged and pasteurized. The best formulation of the pâté was with 40% liver, 10% fat, 35% water, and pasteurized for 20 minutes at 65°C. The pâté from the livers of lambs fed with palm kernel cake obtained a higher caloric value of 193.05 kcal/100 g and all pâtés met the recommended microbiological quality. There was a significant effect (p< 0.05) of the diets on the aroma and texture of the liver pâtés of lambs fed corn and soybean meal and palm kernel cake, and these were 6.38 and 3.37, respectively. Thus, the pâtés can be considered an alternative to increase the options for consumption of liver from lambs, and also for adding commercial value to lamb viscera.

Activation of a non-neuronal cholinergic system in visceral white adipose tissue of obese mice and humans

Background and objectivesSince white adipose tissue (WAT) lacks parasympathetic cholinergic innervation, the source of the acetylcholine (ACh) acting on white adipocyte cholinergic receptors is unknown. This study was designed to identify ACh-producing cells in mouse and human visceral WAT and to determine whether a non-neuronal cholinergic system becomes activated in obese inflamed WAT. MethodsMouse epididymal WAT (eWAT) and human omental fat were studied in normal and obese subjects. The expression of the key molecules involved in cholinergic signaling was evaluated by qRT-PCR and western blotting whereas their tissue distribution and cellular localization were investigated by immunohistochemistry, confocal microscopy and in situ hybridization. ACh levels were measured by liquid chromatography/tandem mass spectrometry. The cellular effects of ACh were assessed in cultured human multipotent adipose-derived stem cell (hMADS) adipocytes. ResultsIn mouse eWAT, diet-induced obesity modulated the expression of key cholinergic molecular components and, especially, raised the expression of choline acetyltransferase (ChAT), the ACh-synthesizing enzyme, which was chiefly detected in interstitial macrophages, in macrophages forming crown-like structures (CLSs), and in multinucleated giant cells (MGCs). The stromal vascular fraction of obese mouse eWAT contained significantly higher ACh and choline levels than that of control mice. ChAT was undetectable in omental fat from healthy subjects, whereas it was expressed in a number of interstitial macrophages, CLSs, and MGCs from some obese individuals. In hMADS adipocytes stressed with tumor necrosis factor α, ACh, alone or combined with rivastigmine, significantly blunted monocyte chemoattractant protein 1 and interleukin 6 expression, it partially but significantly, restored adiponectin and GLUT4 expression, and promoted glucose uptake. ConclusionsIn mouse and human visceral WAT, obesity induces activation of a macrophage-dependent non-neuronal cholinergic system that is capable of exerting anti-inflammatory and insulin-sensitizing effects on white adipocytes.

Lumbar hernia: An unusual abdominal hernia: A case report and review of literature (radiological perspective) in a tertiary center in south-south Nigeria

Lumbar hernias are unusual abdominal wall defects involving the posterolateral abdominal wall: the superior lumbar triangle of Grynfelt, which is the most common site, and the inferior lumbar triangle of Petit. They are located between the muscular layers of the abdominal wall and can be easily ignored because of abdominal obesity. In general, it is difficult to diagnose because of their unclear non-specific symptoms. However, radiographic studies have been valuable in confirming the diagnosis. The introduction of ultrasonography and computed tomography (CT) has greatly improved the diagnosis of lumbar hernia. Following the establishment of the diagnosis, operative management is indicated due to chance of incarceration. Our case study is an 80 years old man who presented to the Radiology department for an emergency abdominal ultrasound scan investigation on account of abdominal pain/abdominal swelling on the lateral aspect of the right flank of about 5 days as explained by his relative. The abdominal ultrasound shows a hyperechoic mass in the right flank that extends through a defect in the transversus abdominis muscle. This mass measures 5.3x4.9cm and shows no flow on Doppler interrogation. Note mild fluid collection seen surrounding the mass. Also note marked subcutaneous oedema. Another imaging modality was employed; non contrast computed tomography and shows a lateral abdominal wall defect in the right lower internal oblique with sac containing bowel loop and omental fat. Other visualized bowel loops are normal in caliber and wall thickness.

Evidence Based Classical Ayurveda Management the Epidydimal Cysts

Epididymal cysts are collection of fluid in a single sac (unilocular) or more than one (multilocular) as a result of dilatation of efferent epididymal tubules due to tubular obstruction with benign in nature and often bilateral in nature. It involves the development of fluid-filled sacs or cysts within the epididymis, a coiled tube located behind each testicle. An epididymal cyst, also known as a spermatocele that affects the male reproductive system. If it is not treated it may develop to an abscess and probably the destruction of the epididymis which can lead to infertility. In Ayurveda it can be under the heading Kaphaja Granthi. A 27-year-old male patient visited the outpatient department of Kayachikitsha with complaints of bilateral scrotal swelling with itching since six months. Patient was diagnosed on the basis of colour doppler of scrotum and it indicates bilateral epididymis head cyst with minimal fluid seen around left spermatic cord with herniation of omental fat on Valsalva. The patient was treated with classical management of Kapahaja Granthi described in texts, Vaman (medicated emesis), Virechana (therapeutic purgation) and followed by administered Arogyavardhini Vati 2 tablet each of 250mg twice a day in empty stomach, Kanchanara Guggulu two tablet each of 500mg twice a day after food with lukewarm water and Varunadi Kashaya 40ml once a day in morning empty stomach. After this treatment there was no scrotal swelling also the colour doppler study reveals normal colour doppler study with no significant abnormality noted. This case indicates the Ayurveda classical management given in texts can be helps to manage the condition like epidydimal cyst.

SAT675 GLP-1RA Therapy And Intussusception: A Case Report Of Bowel Telescoping In Anobese Patient After Successful Weight Loss On Therapy

Abstract Disclosure: S. Alqaisi: None. W.R. Doerfler: None. T. Latif: None. A. Bandi: None. Background: Glucagon-like peptide receptor agonists (GLP-1RA) are incretin-based drugs that are now a mainstay in managing type 2 diabetes and obesity, offering added cardiorenal benefits. GLP-1RAs slow gastric emptying and small bowel motility, leading to side effects like constipation, nausea, and diarrhea. Small bowel obstruction (SBO), though not well described in clinical trials, has been reported in observational studies. SBO due to intussusception is a rare condition in adults where one segment of the bowel telescopes into the adjacent segment, potentially causing intestinal ischemia. Although GLP-1RA therapy has not been previously linked to intussusception, we present a patient who developed intussusception while on GLP-1RA therapy for obesity. Case: A 54-year-old female with a history of prediabetes, generalized anxiety disorder, diverticulosis, and total hysterectomy with bilateral salpingo-oophorectomy who was referred for obesity class-I (BMI-33) management considered constitutional given the negative work-up. After an initial weight loss of 40 Ibs with diet and exercise, her success stalled. She was started on medical therapy, initially on orlistat which caused diarrhea, then switched briefly to phentermine-topiramate, that resulted in palpitations and increased anxiety. Hence, liraglutide was initiated, resulting in a further weight loss of 25 Ibs. Three months later, she admitted with left lower quadrant abdominal pain, nausea, vomiting, and diarrhea. Lab tests were unremarkable, and an abdominal CT scan showed an 8.9 cm segment of small bowel intussusception without obstruction. Her symptoms improved after a large episode of emesis and placement of a nasogastric tube. She underwent diagnostic laparoscopy followed by exploratory laparotomy. The entire small bowel length was examined, with no abnormalities found, indicating a transient intussusception. She was discharged on liraglutide. Later, she underwent a follow-up small bowel follow-through that showed normal small bowel features. Liraglutide therapy was discontinued, and she remains symptoms free. Discussion: This case highlights the importance of providers being aware of potential adverse effects, including the rare but serious complication of SBO in patients receiving GLP-1RA therapy. Significant weight and omental fat loss may have led to intussusception in our patient. Thinning of the mesentery and loss of visceral fat oppose less resistance to abdominal peristalsis, increasing the risk of intussusception. While the exact mechanism of GLP-1RA-induced SBO remains unclear, it is postulated that inhibition of intestinal motility may play a role, particularly in patients with pre-existing gastrointestinal neuropathy. Therefore, clinicians should monitor patients for signs of gastrointestinal distress or obstruction and investigate suspected cases promptly for timely management. Presentation: Saturday, June 17, 2023

The Regulation of Endothelin-1 in Pregnancies Complicated by Gestational Diabetes: Uncovering the Vascular Effects of Insulin.

Gestational diabetes mellitus (GDM) is a condition of pregnancy defined by new-onset hyperglycemia. GDM is associated with impaired maternal endothelial and vascular reactivity. Endothelin-1 (ET-1) is a potent vasoconstrictor that contributes to endothelial dysfunction, however, its abundance and actions in GDM are unclear. Maternal plasma was obtained from pregnancies complicated by GDM (n = 24) and gestation-matched controls (n = 42); circulating ET-1 levels were assessed by ELISA. Human omental arteries from healthy pregnancies and those complicated by GDM were dissected from omental fat biopsies and collected at cesarean section. mRNA expression of ET-1 and its receptors, ETA and ETB, in addition to vascular cell adhesion molecule-1 (VCAM1) and intercellular adhesion molecule-1 (ICAM1) were assessed by qPCR (n = 28). Using wire myography, we investigated vascular constriction to ET-1 (10-11-10-4 M) in omental arteries from pregnancies complicated by GDM, compared to gestation-matched controls (n = 7). GDM cases were stratified by clinical management, diet intervention (n = 5), or insulin treatment (n = 6). Additionally, arteries from healthy pregnancies were treated with insulin (1 mU/mL (n = 7) and 10 mU/mL (n = 5)) or vehicle control. Vasoactive response to ET-1 was measured via wire myography. Circulating ET-1 levels and mRNA expression of the ET-1 system in omental arteries were not found to be significantly different between pregnancies complicated by GDM compared to healthy controls. However, we found insulin treatment during pregnancy and in ex vivo models reduced ET-1 vasoconstriction of maternal vasculature in GDM. These data suggest insulin may improve vascular function in GDM, however, further investigation is needed to define the role of ET-1 in pregnancy.

Effect of Spirulina platensis Supplementation on Carcass Characteristics, Fatty Acid Profile, and Meat Quality of Omani Goats.

In a 70-day study, 36 Jabbali and Sahrawi bucks, aged 11 months, were utilized to evaluate the effects of different levels of spirulina dietary supplement (SP) on carcass characteristics, fatty acid profile, and meat quality traits in Omani goat breeds. The goats were put into six groups of six bucks, each at random. The diet consisted of a conventional concentrate feed ration (CFR) without spirulina (CON), and the CFR diet supplemented with spirulina at the levels of 2 g/head daily (T1) and 4 g/head daily (T2). In general, Sahrawi bucks showed a highly significant response to SP feeding compared with Jabbali bucks. The treatment groups, especially T1, showed a significant increase in average daily gain and carcass traits (body length, leg length, and the rack weight) compared with the CON group of Sahrawi bucks. The weights of omental and kidney fat were also significantly higher in T1 compared with CON and T2 groups of Sahrawi goats, while they were significantly higher in T2 compared with CON and T1 groups of Jabbali goats. Carcass profile and meat quality, including ultimate ph and meat color lightness (L*) were increased significantly with dietary spirulina in both LD and SM muscles of Sahrawi goats. Most of the Sfa, Mufa, Pufa, Pufa n-6, Pufa n-3, and n-6/n-3 ratios of the LD showed significant differences in diets supplemented with SP compared with CON for Sahrawi bucks, while some of them were significant in Jabbali bucks. The LD muscle of Sahrawi goats fed diets supplemented with SP of the T1 group significantly decreased in the amounts of pentadecanoic and margaric acids compared with the T2 and CON groups. The study concluded that incorporating SP (2 g and 4 g/head daily) into the diet of Omani goats, especially Sahrawi goats, can increase growth performance, as well as improve fatty acid composition and meat quality.