Total Body Weight Research Articles

National introduction of one-anastomosis gastric bypass in the UK National Bariatric Surgery Registry – a cohort study

Aim: There is a paucity of evidence regarding the national introduction of newer bariatric metabolic surgery procedures. This study assessed the impact of introducing one-anastomosis gastric bypass (OAGB) in bariatric surgical practice in the UK on 30-day postoperative morbidity and early postoperative weight loss. Methods: Patients who underwent primary BMS in the UK National Bariatric Surgical Registry (2010-2019) were identified. Patient characteristics, 30-day postoperative morbidity, and 12-month total body weight loss (TBWL) were also assessed. Multivariate regression was performed for associations between 30-day postoperative morbidity and 12-month TBWL, with SG as a reference. Learning effects were assessed by factoring in the institutional OAGB caseload (0-24/25-49/50+ cases). Results: A total of 59,226 patients underwent primary BMS during the study period (RYGB, 38,434; SG, 24,702; AGB, 12,627; OAGB, 3,408; and Others, 276). The 30-day postoperative morbidity was lower for OAGB 1.8% (51/2,802) compared to RYGB 4.2% (1,391/32,853) and SG 3.4% (725/21,333) but higher than AGB 1.2% (123/9,915), while on multivariate regression, OAGB was associated with reduced morbidity once the institution caseload exceeded 50 operations (OR 0.35 (95% CI, 0.22-0.56; P<0.001) and no statistical difference to SG at lesser caseloads. Overall, 12-month greater than 25% TBWL was seen in 69.4% (27736/39971) (RYGB: 82.9% (17617/21246)), SG: 65.4% (7383/11283)), AGB: 23.9% (1382/5572)) and OAGB: 82.9% (1328/1601)). On multivariate regression, OAGB was associated with the highest 12-month TBWL once the institution caseload exceeded 50 operations (OR 3.47 (95% CI 2.75-4.39; P<0.001). Conclusion: OAGB has been safely implemented in UK national bariatric surgery practice. It has lower reported postoperative morbidity and comparable weight loss to RYGB or SG, despite being offered to patients with more severe and complex obesity.

Performance Evaluation of Lambs Fed Tifton 85 Grass Hay and Concentrate Through LIPE® Marker

The research was carried out with the aim of evaluate increasing levels of concentrate supplementation on intake and performance of lambs fed Tifton 85 grass hay adopting LIPE® marker technique. Twenty-four weaned and castrated Santa Inês crossbreed lambs with initial body weight (BW) of 20.99 ± 3.62 kg were distributed in four treatments with Tifton 85 hay exclusive or associated with concentrate levels (0.0, 6.6, 13.3 and 20.0 g kg-1 BW d-1), in a completely randomized design with six animals per treatment. The experimental period lasted 98 days, with the first 14 days for animal adaptation to the new environmental conditions, handling and feeding. The diets were fed ad libitum twice a day. Lambs were weighted at each 14 days. Dry matter intake (DMI) was estimated by the technique of Isolated, Purified and Enriched Lignin (LIPE®) while neutral detergent fiber intake (NDFI) and crude protein intake (CPI) were obtained from the content of their fractions present in the diets. There was an increase in DMI and CPI and a similar response in NDFI with the increasing levels of concentrate. The daily liveweight gain per animal showed a linear response when the levels of concentrate were increased and the highest values wereobserved when 20.0 g kg-1 BW d-1 of concentrate was fed. The increasing levels of concentrate supplementation allowed greater daily and total body weight gains per lamb and there is a consistent relationship between nutrient intakes and performance in the treatments and the LIPE® marker proved to be an efficient technique to evaluate the DMI by lambs.

Study of Hepatosomatic Index, Gonadosomatic Index and Fecundity of Tengra Fish (Mystus gulio)

The tengra fish (Mystus gulio) is an important commercial species found in the coastal regions of West Bengal, India and Bangladesh. M. gulio is an important species within its ecosystem and has significance in local fisheries. Its adaptability to both freshwater and brackish environments makes it a resilient species. This study investigated the hepatosomatic index (HSI), gonadosomatic index (GSI), and fecundity of M. gulio to better understand its reproductive biology. Specimens were collected monthly from the Meghna River estuary between February and June 2023. The GSI was found to be highest in August (9.95±0.15%), indicating the peak spawning season. The HSI showed an inverse relationship with GSI, being lowest in March. Fecundity ranged from 88,495 to 264,104 eggs, with a mean of 171,581±17,855. Fecundity was positively correlated with total length, body weight, and gonad weight. Statistical analysis revealed significant differences in GSI and HSI between sexes and age groups (virgin vs 1+ year). Regression models showed that fecundity was highly dependent on gonad weight (r2=0.809) compared to length (r2=0.047) and weight (r2=0.216). M. gulio is an important brackish water fish with good taste and nutritional value. While it is optimally exploited from the East Coast of India, its culture potential is being explored through polyculture experiments and research on seed production and farming techniques. These findings provide valuable insights into the reproductive dynamics of M. gulio and can inform management strategies for sustainable fisheries. However, further research is needed to fully understand the reproductive biology of this catfish across its range to inform sustainable management strategies.

Length – Weight Relationship of Rohu (Labeo rohita) Advanced Fingerlings under Sodic Soil Condition

The present study was conducted at the Instructional Fish Farm, College of Fisheries, Acharya Narendra Deva University of Agriculture and Technology, Ayodhya, Uttar Pradesh, in earthen ponds (8m×8m×1m). The experiment for 90 days, using Labeo rohita advanced fingerlings (avg. wt. 30.0 ± 0.5g) under sodic soil conditions. Five treatments were taken in triplicate, with 50 fingerlings per pond. T1 served as the control with traditional feed only (MOC+RB in 1:1 ratio, 5% of total fish body weight). T2 and T3 were fertilized with cattle dung (20 and t ha−1 yr−1) respectively. T4 and T5 received poultry droppings (10 and 7.5 t ha−1 yr−1) respectively. Results showed negative allometric growth (b<3), indicating fish becoming slimmer with length increase. Final weight gain was highest in T4 (110.9±0.9 gm) and T2 (108.7±0.88 gm), and lowest in T1 (70.7±0.49 gm).

The Relationship Between Weight Indices and Blood Levels of Immunosuppressive Drugs in Renal Transplant Recipients

Background: Calcineurin inhibitors and mammalian target of rapamycin (mTOR) inhibitors are essential for maintaining transplanted organs. However, determining the appropriate dosage and predicting blood concentrations of these drugs based solely on net body weight may be inadequate. Previous studies have presented contradictory results regarding the impact of obesity on drug concentrations and transplant success. Objectives: This study aims to evaluate various weight indices to identify the most reliable indicator of weight that correlates with the blood levels of drugs used in organ transplantation. Methods: This retrospective descriptive study included patients from nephrology clinics affiliated with Isfahan University of Medical Sciences who were taking calcineurin and/or mTOR inhibitor drugs. Data extracted from medical records included demographic and clinical information, such as height, weight, and various weight indices (total/ideal/adjusted body weight, lean body mass (LBM), Body Mass Index, and predicted normal weight), as well as blood levels of immunosuppressive drugs at each patient's visit. The dosages of each drug (mg/kg) were analyzed to determine which weight indices best correlated with the obtained blood concentrations, using the Generalized Estimating Equation (GEE) model with logistic regression, an independent correlation matrix, and a binary distribution for data analysis. Results: The study analyzed the medical records of 71 patients. Trough (C0) concentrations of drugs were evaluated in relation to each weight index, and odds ratios (OR) were calculated for statistical comparison. All weight indices increased the likelihood of achieving appropriate concentrations for cyclosporine, tacrolimus, and sirolimus. Drug dosing based on LBM (OR: 1.028), ideal body weight (OR: 1.075), and total body weight (OR: 1.041) showed the strongest correlations with achieving proper blood levels for cyclosporine, tacrolimus, and sirolimus, respectively. Conclusions: Integrating various weight indices for calculating individualized doses (mg/kg) of each immunosuppressive drug increases the likelihood of achieving appropriate blood concentrations. However, the optimal weight index varies for each drug. Further studies, particularly those incorporating therapeutic drug monitoring (TDM) plans in transplant centers, are warranted to validate and generalize these findings, providing a potential avenue for improving immunosuppressive therapy and enhancing transplant outcomes.

Influence of 17α-Methyltestosterone on Morphological Deformities and Pigmentation Development in Juvenile Japanese Eels, Anguilla japonica.

17α-methyltestosterone (MT) is a synthetic steroid used to induce masculinization when administered during the larval stage of fish. However, the side effects of MT on eel are still poorly understood and, in this study, we examined the various effects of MT on juvenile eel A. japonica (100.63 ± 8.56 mm total length (TL)). To further investigate growth and sex differentiation, juvenile eels (n = 1000) were exposed to 25 µg/g MT for 6 months. We analyzed growth-related factors, sex steroid hormones, skin pigmentation, and color-related gene expression. Through this study, we found a 90% sex conversion of juvenile eels to males using MT treatment. In the MT-treated eel group (285.97 ± 26.21 mm TL) where sexual maturity was induced, spermatogonia stages were observed in the gonads. In contrast, the control group (395.97 ± 27.72 mm TL) exhibited an 80% immaturity rate, with only 20% of the subjects that were rapidly developing displaying early oogonia. ELISA analysis results showed that the level of growth hormone, which is known to be secreted from spermatogonia, did not change as a result of MT treatment. We confirmed that MT delayed growth and caused morphological changes, particularly a shortened snout length and pigmentation of the fin. The total length, body weight, and snout length were considerably lower in the experimental group than in the control group. In addition, in histological analysis we also observed that some of the MT-treated group (5 out of 10 fish) showed liver atrophy and inflammation, and physiological analysis showed that the cortisol concentration increased in the MT-treated eels. Interestingly, we found that some pigment color-related genes, such as melanocortin 1 receptor (MC1R), tyrosinase (Tyr), and dopachrome tautomerase (DCT), were significantly overexpressed in the fins of MT-treated eels. These results suggest that the treatment of A. japonica larvae with MT induced masculinization but also causes growth side effects from the use of synthetic hormones.

PSLBI-24 Optimizing crop byproduct inclusion in beef cattle diets: Utilization of wheat straw to improve operational economics and oilseed screenings as protein supplements

Abstract Inclusion of crop residues and byproducts in beef cattle diets has become a significant practice in beef cattle production as producers are faced with conventional feed shortages, increased prices, and disrupted supply chains. Wheat straw is a widely available crop byproduct in the western Canadian prairies whose inclusion in beef cattle diets has been prevented by its low nutritional content, necessitating supplementation strategies to enhance its nutritional value. The present study explored the effect of incorporating wheat straw in backgrounding cattle diets with canola or flax screening supplementation to improve the nutritional profile of the diet and determine the sustainability of such inclusion through cattle performance measurements. The experiment was a completely randomized design. Steers [n = 300; initial body weight (BW): 297 ± 18 kg] were randomly assigned to 5 treatment diets, each diet having 4 pen replicates (15 steers/pen); control (CTL), low straw canola (LSC), low straw flax (LSF), high straw canola (HSC) and high straw flax (HSF). The CTL diet was a conventional Western Canadian backgrounding diet (60% barley silage:40% dry rolled barley grain-based concentrate). Low straw diets had a 25% wheat straw inclusion and high straw diets had 50% wheat straw inclusion on a dry matter (DM) basis. Respective screenings were included at 12.50% inclusion of diet DM. The steers were fed for a total of 84 d divided into four periods of 21 d. Statistical analyses were performed using the MIXED procedure of SAS 9.4 with diet treatment included as a fixed effect and pen within diet as a random effect. Treatment means were compared using the LSMEANS statement adjusted for the Tukey-Kramer method. Final BW, total BW gain, average daily gain (ADG) and gain:feed were greater (P < 0.001) for the CTL steers (Table 1). Dry matter intake (DMI) was greatest for CTL steers and decreased with increasing straw inclusion in the diet (P < 0.001). The type of screenings (canola or flax) did not affect (P > 0.05) steers final BW, total BW gain, ADG and gain:feed. Increasing the inclusion of wheat straw in backgrounding diets decreased growth performance parameters. The high level of neutral digestible fiber in wheat straw limited DMI and reduced growth performance compared with CTL steers. The addition of screenings to the diet provided protein content to offset the low nutritional value of the wheat straw; however, the different types of screenings did not result in a cattle performance advantage over the other. Although these findings demonstrate the challenges of including low nutritional crop byproducts, further research is needed to analyze the effects different diets have on operational economics, rumen fermentation parameters and greenhouse gas emissions to further outline any advantages or disadvantages.

Novel Peripherally Selective Cannabinoid Receptor 1 Neutral Antagonist Improves Metabolic Dysfunction-Associated Steatotic Liver Disease in Mice.

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing globally. MASLD is characterized by clinically significant liver steatosis, and a subset of patients progress to more severe metabolic-disorder-associated steatohepatitis (MASH) with liver inflammation and fibrosis. Cannabinoid receptor 1 (CB1) antagonism is a proven therapeutic strategy for the treatment of the phenotypes that underlie MASLD, though work on early centrally penetrant compounds largely ceased following adverse psychiatric indications in humans. We present here preclinical testing of a CB1 neutral antagonist, N-[1-[8-(2-Chlorophenyl)-9-(4-chlorophenyl)-9H-purin-6-yl]-4-phenylpiperidin-4l]methanesulfonamide (RTI-348), with minimal brain exposure when administered to mice. In a diet-induced model of MASLD-induced MASH, administration of RTI-348 decreased the total body and liver weight gain. Animals treated with RTI-348 showed reduced steatosis. Furthermore, they produced lower plasma alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH), biomarkers associated with liver damage. Mice maintained on the MASH diet had elevated expression of genes associated with profibrogenesis, immune response, and extracellular matrix remodeling, and treatment with RTI-348 mitigated these diet-induced changes in gene expression. Using an intracranial electrical self-stimulation model, we also demonstrated that RTI-348 does not produce an anhedonia response, as seen with the first-generation CB1 inverse agonist rimonabant. Altogether, the results herein point to RTI-348 as a promising neutral antagonist for MASH.

423 Comparative post-weaning performance characteristics of four breeds of rabbit in hot humid climate of Nigeria

Abstract Rabbits are one of the most popular livestock breeds raised for their meat, fur, and companionship. Rabbit meat is fast gaining prominence as a healthier meat compared with beef, mutton, pork and chevon, which are mostly consumed in Nigeria. This study investigated breed differences in mortality, survival rates and post-weaning growth rate of rabbits reared under inimical environmental conditions. The animals were fed commercially compounded feed with 18% crude protein and 2300Kcal metabolizable energy with intermittent feeding of Panicum sp and Tridax sp. The study area, located at latitude 6.5867° N and longitude 3.9700° E, had an average daily temperature of 35°C and relative humidity of 64%, which negatively impacted the adaptation, survival rates and growth performance of the rabbits. A total of 48 weaner rabbits 8 wk of age, comprising 12 each (9 does and 3 bucks) of Checkered, Chestnut, Dutch and Hyla breeds were reared for 10 wk post-weaning. Mortality was recorded across the breeds and the body weights (BW) of the rabbits were also recorded on a weekly basis for the entire 10-wk period. The study evaluated survival rates across breeds and sex and BW gain. Statistical analyses were conducted using the Minitab software for Chi Squared test of independence for counts and descriptive statistics and general linear model analysis of variance for bodyweight gain. The statistical model describing the analysis was Yijk = µ + αi + (α:β)ij + eijk where αi is the ith fixed effect of breed and βj is the jth fixed effect of sex. The model accounted for 67.03% variation in total weight gain. Further mean separation was done using the Tukey’s multiple comparison procedure. Mortality rates across breeds on the average was 56.25%, with Checkered, Chestnut, Dutch and Hyla respectively recording 66.67%, 41.67%, 50.00% and 66.67% mortality, respectively. Mortality rate across sexes was 63.89% for does and 33.33% for bucks; however, mortality rates were independent (P > 0.05) of both breed and sex with a Chi-Squared value of 2.285 and 3.41, respectively, despite the numerical differences in mortality rates across breeds and sexes. Average total BW gain during the study period across the breeds and within breeds is as presented in Table 1. The nesting of sex within breed revealed that the only significant (P > 0.05) difference was noticed between the Hyla buck and Chestnut doe, while other means were not statistically different (P > 0.05). The Chestnut breed with the least BW gain adapted well in the environment with greatest survival rate, while the Hyla breed had the greatest BW gain and least survival rate throughout the study. This study indicated a negative relationship between survival rates and BW gain, that lighter breeds of rabbit tend to have greater survival rates than the heavier breeds.

Pharmacokinetics of Piperacillin-Tazobactam in Critically Ill Patients with Open Abdomen and Vacuum-Assisted Wound Closure: Dosing Considerations Using Monte Carlo Simulation.

Open abdomen with vacuum-assisted wound closure therapy (OA/VAC) is frequently used in critically ill patients although the impact of OA/VAC on antibiotics pharmacokinetics (PK) remains unknown. We thus aimed to characterize the PK of piperacillin-tazobactam (PTZ) in critically ill patients with OA/VAC and assess the optimal dosing regimens based on pharmacodynamics (PD) target attainment. Over a 15-month study period, 45 patients with OA/VAC treated with PTZ administered continuously and adapted to 24 h creatinine clearance (CLCR) underwent measurements of free concentrations in their plasma, urine, VAC exudate, and peritoneal fluid. Population PK modeling was performed considering the effect of covariates, and Monte Carlo simulations were employed to determine the probability of target attainment (PTA) for the PK/PD targets (100% fT > 16 mg/L) in the plasma and at the peritoneal site at steady state. Piperacillin concentrations were described using a two-compartment model, with age and total body weight as significant covariates for central volume of distribution (V1) and estimated renal function for clearance (CL). Tazobactam concentrations were described using a two-compartment model with estimated renal function as a significant covariate. The central volume of distributions V1 of piperacillin and tazobactam were 21.2 and 23.2 L, respectively. The VAC-induced peritoneal clearance was negligible compared to renal clearance. Most patients achieved the desirable PK/PD target when using a CLCR-pondered PTZ dosing regimen from 12 g/1.5 g/day to 20 g/2.5 g/day. Despite a wide inter-individual variability, the influence of OA/VAC on piperacillin and tazobactam PK parameters is not straightforward. The use of a CLCR-pondered PTZ dosing regimen from 12 g/1.5 g/day to 20 g/2.5 g/day is needed to reach a PTA > 85%.

Effectiveness of Structured teaching program on Knowledge and Practice of Blood and Blood components Transfusion among Staff Nurses

Background: Blood is a collection of cells that have been specialized to perform a set oftasks within an organism. It is described as the fluid connective tissue that carriesoxygen and nutrients to the body. It is straw in colour, the average volume of blood inthe human body is 5 litres generally, the PH of blood is 7.4, which is slightly alkaline. The blood comprises 8% of our total body weight. It is composed of plasma, about 55% and 45% cells, respectively. Blood transfusion is when apatient receives a blood product through an intravenous line or the introduction of newmatching blood into the bloodstream or/and of any specific blood components. Objectives: The study aimed to assess the knowledge and practice of a structured teaching programme on blood and blood components among staff nurses. Methods: 50 Staff nurses were selected by a non-probabilityconvenient sampling technique. Quasi-experimental design with one grouppre-test and post-test design was used. The tools used to collect the data consisted of a structuredknowledge questionnaireand structured practice scale on blood and blood component transfusion. The reliability was checked using test-retest method showed that the tools were highly reliable. Results: The good knowledge score was increased from pretest (12%) to posttest (32%). Moderate practice score was increased from pretest (50%) to posttest (78%). There was a significant difference (p<0.05) between mean pretest knowledge and practice scores with mean post test knowledge and practice scores. So, the structured teaching program was effective in improving the knowledge and practice of staff nurses regarding blood and blood components. The Chi-square test showed that there was a significant association with knowledge and gender, practice and marital status, education. The other variables are not showing association. Conclusion: The findings revealed thatstaff nurses’ knowledge and practice regarding bloodand blood components transfusion wasimproved after the teaching program.

Influence of Obesity on the Efficacy and Toxicity of Patients Undergoing Autologous Hematopoietic Cell Transplantation for Lymphoma

Hematopoietic cell transplantation requires higher doses of chemotherapy, and practices of adjusting the weight because of concerns of organ toxicity are common. This retrospective analysis of 239 adult recipients of autologous hematopoietic cell transplantation for lymphoma assessed the effect of obesity on transplantation outcomes. BackgroundPrior data evaluating the impact of obesity in autologous hematopoietic cell transplantation (AHCT) for lymphomas have provided differing results when assessing overall (OS) and progression-free survival (PFS). Impact on survival outcomes have been described, but direct comparison of discrete toxicities is lacking. Patients and methods: We retrospectively compared outcomes with patients divided between 3 groups: nonobese patients (n = 129), obese patients dosed on adjusted body weight (AdjBW) (n = 32), and obese patients dosed on total body weight (TBW) (n = 78). ResultsIn multivariate analysis of OS with the nonobese group as the comparator, outcomes trended worse in obese patients dosed on AdjBW (HR 1.22, 95% CI 0.52-2.85) but were improved in obese patients dosed on TBW (HR 0.19, 95% CI 0.04-0.85, P = .012). PFS of obese patients dosed on AdjBW vs. the nonobese group was comparable (HR 1.19, 95% CI 0.63-2.24), but improved in obese patients dosed on TBW (HR 0.45, 95% CI 0.23-0.89, P = .021). Notably, no differences were noted between groups in gastrointestinal, infectious, renal, or hepatic toxicities. ConclusionIn summary, our data suggest that recipients of AHCT for lymphoma should be dosed on TBW to maximize curative outcomes with no apparent increase in toxicities.

Abstract P118: Effect of renal denervation on the blood pressure and progression of diabetic kidney disease in T2DN rats

Background: As a common complication of diabetes, diabetic kidney disease (DKD) is a chronic progressive disorder that can lead to kidney failure, and it is currently the leading cause of kidney replacement therapy in the USA and worldwide. Although renal denervation (RDNx) has recently been approved by the FDA to treat hypertension, contradictory findings have been reported on the effect of RDNx on the blood pressure and progression of DKD in type 2 diabetic mellitus. Here, we used type 2 diabetic nephropathy (T2DN) rats, a well-established non-obese model that displays similar renal abnormalities and hyperglycemic levels as seen in humans, to evaluate the effect of RNDx on the blood pressure and progression of DKD. Methods: Bilateral RDNx or sham surgeries were performed on male T2DN rats with mild and severe stages of DN (~20 or >35 weeks old). The blood pressure was monitored chronically using radio telemetry throughout the entire experiment. 24-hr urine collection, glucose tolerance test, and GFR measurement were performed at baseline and at the end of the experiments. Blood and urine electrolytes were measured using a blood gas analyzer. The amount of norepinephrine in the kidney was evaluated by ELISA. Results: Bilateral RNDx were successfully performed on T2DN rats with a significant reduction of norepinephrine in the kidneys of the RDNx group (244±13 vs. 8±1 pg/mg for >35 weeks old rats). The mean arterial pressure (MAP) and heart rate remain the same between the Sham and RDNx groups. The glucose tolerance test also indicates no difference between the two groups. While there is a significant decrease in the GFR in Sham group from baseline to week 3, the GFRs between Sham and RDNx groups are not different. Similarly, total body weight, kidney to total body weight ratio, heart to total body weight ratio, and blood and urine electrolytes are also not different between Sham and RDNx groups. Analysis of the younger group (~20 weeks old) is in progress. Conclusion: In summary, our data suggests that RDNx does not affect the blood pressure and progression of DKD in male T2ND rats, at least at the stage of severe kidney injury (>35 weeks old). Funding sources: National Institute of Health R01 DK135644 and R01 DK129227, Department of Veterans Affairs I01 BX004024 (to AS), and APS Postdoctoral fellowship (to BX).

Serum chemistry, thyroxine concentration, and blood cell morphology of wild, young Blackchin Guitarfish Glaucostegus cemiculus sampled on the eastern Mediterranean coastline.

The Blackchin Guitarfish Glaucostegus cemiculus is endemic to the Mediterranean Sea and is critically endangered, but relevant routine laboratory data are unavailable. Our objectives were to determine the packed cell volume (PCV), comprehensive serum chemistry analytes, and serum total thyroxine (sTT4) concentration; compare serum albumin and serum globulin concentrations as measured by two different methods; and describe the blood cell morphology of healthy, free-ranging Blackchin Guitarfish. Wild Blackchin Guitarfish were captured using a seine net. Blood samples for serum chemistry and hematological analyses were obtained and measured using routine laboratory methods. The fish were tagged and released. This study included 43 Blackchin Guitarfish (17 males and 26 females) that were younger than 6 months as estimated based on total length and body weight. The median PCV (n = 23) was 22% (minimum-maximum [min-max] = 15-25%). Median sTT4 (n = 10) measured by chemiluminescence immunoassay was 7.86 nmol/L (min-max = 7.52-9.57 nmol/L). The study included a comprehensive, 25-analyte serum chemistry analysis (e.g., serum iron and unbound and total iron-binding capacity) and a morphological description of all blood cells. Serum electrophoresis (SEP; n = 13) yielded a consistent serum albumin-migrating protein fraction and four globulin fractions. Serum electrophoretograms corroborating these results are presented. In Blackchin Guitarfish, the serum albumin-migrating fraction measured by SEP combined with serum total protein concentration yields a much higher albumin concentration compared to that measured by bromocresol green spectrophotometry. The true identity of this albumin-migrating fraction remains to be identified. The analytes' calculated 2.5-97.5% interpercentile intervals should be considered as reference intervals applying to Blackchin Guitarfish of similar age but should be applied cautiously to adult fish.

A randomized, double-blind, placebo-controlled trial of weight loss using liraglutide 3.0 mg for weight recurrence after Roux-en-Y gastric bypass

BackgroundBariatric surgery, such as Roux-en-Y gastric bypass (RYGB) remains the gold standard for treating obesity. Most people regain weight from postsurgery nadir. ObjectivesLiraglutide 3.0 mg is approved for weight management. This study will examine the effects on liraglutide 3.0 mg on weight regain post-RYGB. SettingUniversity Hospital, United States. MethodsA 56-week, double-blind, placebo-controlled study was conducted in 132 subjects, who achieved ≥25% total body weight loss (TBWL) status-post-RYGB and regained ≥10% TBWL after reaching nadir weight (NW). Subjects 18–120 months post-RYGB were randomized to receive liraglutide 3.0 mg/d (n = 89) or placebo (n = 43) with lifestyle counseling regularly for 56 weeks. The co-primary endpoints were the proportion of subjects losing at least 5%, 10%, and 15% TBWL and achieving weight lower than their NW. Results53.4% of the placebo group and 65% of the liraglutide group completed the trial due to Severe acute respiratory syndrome coronavirus 2 pandemic. The change in %TBWL from baseline to 56-weeks was −8.8 (8.5, −29.2 to 9.7) and 1.1 (3.5, −7.9 to 5.99) in the liraglutide and placebo groups, respectively. 76% and 17% of subjects achieved ≥5% TBWL at 56 weeks in the liraglutide and placebo groups, respectively; 51% and 26.0% of the liraglutide group achieved ≥10% and ≥15% TBWL, respectively. None of the placebo group lost ≥10% TBWL. Twenty-one percent of subjects receiving liraglutide surpassed postoperative NW. No subjects on placebo met this goal. Nonserious adverse events occurred in 41.6% of subjects on liraglutide. Serious adverse events (SAE) occurred less often on liraglutide. ConclusionsLiraglutide was significantly more effective than placebo in treating weight regain that occurs post-RYGB without increased SAE.

Weight loss after Roux-en-Y gastric bypass and single anastomosis duodenoileostomy following failed sleeve gastrectomy.

While sleeve gastrectomy (SG) results in sustained weight loss for the majority of patients, some will experience inadequate weight loss or weight regain requiring revision. The objective of this study was to evaluate differences in weight loss over time between patients undergoing Roux-en-Y gastric bypass (RYGB) or single anastomosis duodenoileostomy (SADI) after SG. We queried a single institution's bariatrics registry to identify patients who underwent RYGB or SADI after previous SG over a three-year period. Demographics, operative characteristics, and post-operative complications were evaluated. Interval total body weight loss (TBWL) and excess body weight loss (EBWL) were calculated from available follow-ups within 2years. We identified 124 patients who underwent conversion to RYGB (n = 61) or SADI (n = 63) following previous SG. There were no differences in sex, age, or medical comorbidities between groups. The median initial BMI was higher in the SADI group (44.9 vs. 41.9 for RYGB, p = 0.03) with greater excess body weight (56.7 vs. 64.3kg, p = 0.04). The SADI group had a shorter median operative duration (157 vs. 182min for RYGB, p < 0.01) and lower readmission rates (0 vs. 14.75%, p < 0.01). There was no difference in post-operative complications or need for rehydration therapy between the groups. Among 122 patients (98.4%) that had follow-up weights available, there were no differences in TBWL between groups. RYGB patients had a higher EBWL at 2, 3, and 6months (p < 0.05 for all comparisons), but there were no differences between RYGB and SADI at 1 or 2 years. Both RYGB and SADI conversions proved effective for further weight loss following failed SG at our academic center. While neither demonstrated clear superiority in long-term (> 1year) weight loss, RYGB's restrictive gastric pouch may explain its early weight loss advantage.

Automatic endoscopic gastroplasty for the treatment of obesity: results from a prospective multicenter study (with video)

EndoZip (Nitinotes Ltd, Cesarea, Israel) is a fully automated, operator-independent robotic endoscopic suturing device developed for gastric volume reduction and treatment of obesity. We aim to assess the efficacy and safety of EndoZip to treat patients with obesity. We conducted a prospective multicenter study and recruited 45 patients with a body mass index of 30 to 40 kg/m2. Our primary outcome was to assess the percentage of total body weight loss (%TBWL) at 12 months. The secondary outcome was to determine the safety and change in quality of life using the Influence of Weight on the Quality of Life questionnaire at 1 year. The mean ± standard deviation age was 44.2 ± 8.8 years, and the mean ± standard deviation body mass index was 34.5 ± 2.9 kg/m2. A majority (90.7%) of patients were female. The procedure was technically successful in all patients (100%). A median of 4 (range, 3-5) full-thickness sutures were placed, and the mean procedure time was 30.8 ± 15.8 minutes. At 12 months, the mean %TBWL was 13.21 (95% confidence interval, 10.11-16.31), and 76.6% of patients achieved≥5% TBWL. We observed significant reduction in waist circumference, glycated hemoglobin, and alanine aminotransferase levels at 12 months (P< .001). We found a significant improvement in quality of life at 12 months (51.28 ± 16.22 vs 35.8 ± 11.9, P< .001). Serious adverse events occurred in 2 patients (4.4%). The average length of stay was 1 day. Our first-in-human study showed that the EndoZip device is safe and effective in treating obesity. The weight loss led to changes in comorbidities and improvement in quality of life. (Clinical trial registration number: NCT04773795.).

Effects of Sulfonylureas and Dipeptidyl Peptidase 4 Inhibitors on Percentage Body Fat Change in Type 2 Diabetes Mellitus Patients on Metformin at 4 and 12 Weeks.

Introduction Anti-diabetic drugs used for the treatment of type 2 diabetes mellitus (T2DM) have a unique effect on the body weight and fat distribution of a patient. This study aimed to find out the change inpercentage body fat and body composition with the addition of sulfonylureas or dipeptidyl peptidase 4 (DPP-4) inhibitors to metformin monotherapy. Methods An observational 12-week follow-up study was conducted with a sample size of 52 patients. All patients enrolled in the study were evaluated forbaseline percentage body fat and body composition parameters including total body weight, total body water, and skeletal muscle mass using the ACCUNIQ BC300, added on to either sulfonylureas or DPP-4 inhibitors over a stable dose of metformin; repeat assessment performed at 4 weeks and 12 weeks, and change in values was noted. Results Of the 52 patients, 28 patients were on sulfonylureas and 24 were on DPP-4 inhibitors. In the sulfonylurea group, there was an increase in percentage body fat from 31.97 ± 8.77% at baseline to 32.65 ± 8.94% at 12 weeks (p = 0.041), while in the DPP-4 inhibitor group, there was a decrease in percentage body fat from 31.87 ± 7.41% at baseline to 31.24 ± 8.5% at 12 weeks (p = 0.102). In the sulfonylurea group, there was a decrease in body weight from 67.25 ± 14.79 kilograms (kg) at baseline to 66.97 ± 14.62 kg at 12 weeks (p = 0.429). In the DPP-4 inhibitor group, there was a decrease in body weight from 66.56 ± 10.82 kg at baseline to 65.76 ± 12.56 kg at 12 weeks (p = 0.079). In the sulfonylureagroup, total body water decreased from32.54 ±6.65 L at baseline to 32.06 ±6.51 L at 12 weeks (p = 0.084), while in the DPP-4 inhibitor group, the total body water decreased from 32.46 ±5.39 L at baseline to 32.18 ±5.48 L at 12 weeks (p = 0.741).Skeletal muscle mass decreased from 24.78 ±5.12 kgto 24.4 ±5.04 kg (p = 0.041) in the sulfonylurea group and from 24.74 ±4.2 kgto 24.53 ±4.25 kg(p = 0.666) in the DPP-4 inhibitor group. Conclusion Our study shows that sulfonylureas are associated with an increase in percentage body fat, while there were no significant changes associated with DPP-4 inhibitors when given in addition to metformin. There are no significant changes in body weight associated with sulfonylureas or DPP-4 inhibitors in addition to metformin. Also, sulfonylureas are associated with a decrease in skeletal muscle mass after 12 weeks.

Anesthesia for an infant with congenital mediastinal mass: a case report

BackgroundGiant anterior mediastinal masses in infants are one of the most challenging cases faced in pediatric anesthesia practice. They can pose unique challenges for resection such as cardiovascular collapse on induction of anesthesia and injury to surrounding structures that maybe compressed or displaced. Principles that must be followed and kept in mind during removal of giant mediastinal mass include appropriate diagnostic imaging to define mass extent, airway control during induction, a multidisciplinary team approach including cardiothoracic for sternotomy, cannulation to institute cardiopulmonary bypass, otolaryngology for rigid bronchoscopy, preservation of neurovascular structure, and complete resection whenever possible. Our patient had a mass that weighed twice his whole body weight.Case presentationHere we present a 3-month-old Middle Eastern infant weighing 3.2 kg with a large congenital teratoma who presented to the emergency room with cyanosis and respiratory distress. During his hospital course, he underwent three procedures, two of them under light-to-moderate sedation: a diagnostic computer tomography scan followed by mass content drainage by interventional radiology (Figs. 1, 2). On the third day, he had a thoracotomy with complete tumor resection under general anesthesia with the help of an epidural for pain control (Fig. 3). The resected tumor weighed 2.5 kg, which was equal to twice the patient’s total body weight (Fig. 4). After the surgery, he was extubated in the operating room and discharged home 3 days later.Fig. 1Anterior–posterior chest x-ray showing the anterior mediastinal mass (AMM)Fig. 2Cross-section computed tomography (CT) showing large anterior mediastinal mass (AMM)Fig. 3Gross anatomy of the tumor before resectionFig. 4Gross anatomy of the removed tumorConclusionAnterior mediastinal mass patients can be challenging for the anesthesiologist. They need meticulous thorough perioperative assessment to determine the extent of compression on major intramediastinal structures and to predict the complications. Planning by multidisciplinary team and discussion with the family is important. These types of cases should be preferably operated on by an experienced team in a well-equipped operation room in tertiary care institutes.

No effect of circulating leptin on energy metabolism in normal weight or overweight/obese lactating mothers: The case-control Breastmilk and the Link to Overweight/Obesity and Maternal diet (BLOOM) study

Pregnancy and lactation are associated with metabolic changes, including alterations in energy metabolism, which are closely linked to body mass and composition due to hormonal status. Therefore, the objective of this study was to investigate the energy metabolism in exclusively or predominantly breastfeeding mothers with normal weight (NW) and overweight/obesity (OW/OB) and evaluate its associations with fasting serum leptin. This cross-sectional BLOOM study was conducted among 39 mothers (n=19 NW, n=20 OW/OB) in 15.5±1.2 weeks of lactation. The leptin was analyzed in a blood sample using an enzyme-linked immunosorbent assay, body composition was analyzed by dual-energy X-ray absorptiometry, and resting metabolic rate (RMR) was measured by indirect calorimetry method. The average RMR for all groups was 1747.5±281.9kcal/d, with a statistically significant difference between groups (1932.7±222.6 vs. 1550.5±190.6, p<0.001, respectively in the OW/OB and NW group). The OW/OB mothers had higher oxygen uptake (VO2) and exhaled carbon dioxide (VCO2), but not respiratory quotient (RQ), carbohydrate (CHO%) and lipid oxidation (FAT%). When analyzing correlations stratified by BMI category, we found that serum leptin was correlated with CHO% negatively, and with FAT% positively in the NW but not in OW/OB mothers. Additionally, serum leptin was a significant predictor of RMR, VCO2, VO2, CHO%, and RMR/kg of total body weight. However, after adjusting for confounders, the observed associations were no longer statistically significant (RMR: β=0.113, 95% CI-0.354-0.319; VO2: β=0.141, 95% CI-0.462-0.744; VCO2: β=0.238, 95% CI-0.411-0.888; CHO%: β=-0.146, 95% CI-0.151-0.444; RMR/kg of total body weight: β=-0.294, 95% CI-0.831-0.244). Our results did not support the hypothesis that leptin plays a role in regulating energy homeostasis during lactation.