Jianzhong Di

Visceral fat area as a new predictor of short-term diabetes remission after Roux-en-Y gastric bypass surgery in Chinese patients with a body mass index less than 35 kg/m2.

BACKGROUND Metabolic surgery has been proposed for inadequately controlled type 2 diabetes mellitus (T2DM) in association with obesity. However, prediction of successful T2DM remission after surgery has not been clearly studied in Chinese patients. The objective of this study was to predict the outcome in those with T2DM after metabolic surgery to help in patient selection. METHODS A retrospective review of prospectively collected data of 68 ethnic Chinese with mean body mass index (BMI) of 31.5 and T2DM were examined for the metabolic outcomes at 1 year after Roux-en-Y gastric bypass (RYGB). Visceral and abdominal subcutaneous fat areas were assessed using magnetic resonance imaging before and 1 year after RYGB. Remission was defined as a glycated hemoglobin (HbA1 c)<6.5% and no medications at 1 year. Binary logistic regression analysis was used to identify predictors. RESULTS At 1 year after surgery, the BMI in the study group decreased from 31.5±3.6 to 24.5±2.5 kg/m2. Remission was achieved in 50 patients (73.5%) at 1 year. Compared with patients in the nonremission group, patients in the remission group had a shorter duration of diabetes, lower preoperative HbA1 c level, higher fasting C-peptide level, and more visceral fat area (VFA). Preoperative BMI and waist circumference did not differ between the 2 groups. CONCLUSION The metabolic improvement in T2DM after RYGB in the mildly obese is greater with a shorter duration of diabetes, higher fasting C-peptide. Those who have more visceral adiposity may obtain greater benefit from RYGB.

Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis.

Background Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting. Objective To explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery. Methods We comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale. Results 32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery. Limitations The main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up. Conclusions Bariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed.

Quantitative analysis of RASSF1A promoter methylation in hepatocellular carcinoma and its prognostic implications

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide and is caused by the accumulation of genetic and epigenetic alterations in regulatory genes. In this study, we used methylight to detect the methylation status of the RASSF1A promoter in 87 paired HCC samples and analysed the relationship between methylation status and clinicopathological parameters, including prognosis after surgery. We found that the methylation level of the RASSF1A promoter in HCC tissues was significantly higher than that in the corresponding non-tumorous tissues (p<0.0001). Furthermore, the methylation level of the RASSF1A gene promoter in HCC samples was higher in patients with a tumor size ≥ 6cm (p=0.0149) and in patients younger than 50 years old (p=0.0175). However, hypermethylation of the RASSF1A promoter in HCC tissues did not affect the overall survival of patients (p=0.611). Thus, RASSF1A promoter hypermethylation may not be a useful biomarker for the prognosis of HCC.

Association of hypomethylation of LINE-1 repetitive element in blood leukocyte DNA with an increased risk of hepatocellular carcinoma

Global DNA hypomethylation has been associated with increased risk for cancers of the colorectum, bladder, breast, head and neck, and testicular germ cells. The aim of this study was to examine whether global hypomethylation in blood leukocyte DNA is associated with the risk of hepatocellular carcinoma (HCC). A total of 315 HCC cases and 356 age-, sex- and HBsAg status-matched controls were included. Global methylation in blood leukocyte DNA was estimated by analyzing long interspersed element-1 (LINE-1) repeats using bisulfite-polymerase chain reaction (PCR) and pyrosequencing. We observed that the median methylation level in HCC cases (percentage of 5-methylcytosine (5mC)=77.7%) was significantly lower than that in controls (79.5% 5mC) (P=0.004, Wilcoxon rank-sum test). The odds ratios (ORs) of HCC for individuals in the third, second, and first (lowest) quartiles of LINE-1 methylation were 1.1 (95% confidence interval (CI) 0.7–1.8), 1.4 (95% CI 0.8–2.2), and 2.6 (95% CI 1.7–4.1) (P for trend <0.001), respectively, compared to individuals in the fourth (highest) quartile. A 1.9-fold (95% CI 1.4–2.6) increased risk of HCC was observed among individuals with LINE-1 methylation below the median compared to individuals with higher (>median) LINE-1 methylation. Our results demonstrate for the first time that individuals with global hypomethylation measured in LINE-1 repeats in blood leukocyte DNA have an increased risk for HCC. Our data provide the evidence that global hypomethylation detected in the easily obtainable DNA source of blood leukocytes may help identify individuals at risk of HCC.

Effect of Roux-en-Y gastric bypass on the remission of type 2 diabetes: a 3-year study in Chinese patients with a BMI <30 kg/m2

BACKGROUND Roux-en-Y gastric bypass (RYGB) is an effective treatment for patients with type 2 diabetes (T2D) and morbid obesity. However, T2D remission after surgery has not been adequately studied in Chinese patients with a body mass index (BMI)<30 kg/m2. OBJECTIVES The objective of this study was to evaluate the 3-year effect of RYGB among patients with T2D with a BMI<30 kg/m2 and elucidate the predictors of T2D remission. SETTING Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China. METHODS Sixty-six Chinese patients with T2D and a BMI 25-30 kg/m2 were retrospectively examined for metabolic outcomes 3 years after RYGB. Remission was defined as glycated hemoglobin (HbA1C)<6.5% and no medications. Binary logistic regression analysis was used to identify preoperative parameters independently predictive of diabetes remission at 1 and 3 years postoperatively [variables: sex, age, BMI, T2D duration, plasma glucose 2 hours after meal, HbA1C, fasting C-peptide, visceral fat area, free triiodothyronine, and thyroid-stimulating hormone. There was no significant difference in fasting insulin or glucose between the remission and no remission groups. RESULTS Patients were a mean 50.4±11.4 years of age at baseline, and 57.6% were female. Mean T2D duration was 8.9±5.2 years, baseline HbA1C level was 8.3±1.9%, and baseline BMI was 28.2±1.2 kg/m2 (range: 25.5-30.0). BMI was 22.5±1.8 kg/m2 (range: 19.1-28.0) at 1 year and 23.0±1.76 kg/m2 (range: 19.7-28.0) at 3 years. Remission was achieved in 49 patients (74.2%) at 1 year and 38 patients (57.6%) at 3 years. There was a significant reduction in medication for diabetes, hypertension, and hyperlipidemia (P<.01). Compared with patients in the no remission group, patients in the remission group had higher fasting C-peptide levels (P<.01) and free triiodothyronine levels (P = .01) at 1 year. Multiple logistic regression analysis confirmed that fasting C-peptide (odds ratio = 3.795, P = .007) and free triiodothyronine (odds ratio = 4.661, P = .019) levels were predictors of T2D remission at 1 year. No significant difference was found between the 2 groups at 3 years. CONCLUSIONS RYGB resulted in significant clinical and biochemical improvements in Chinese patients with BMI 25-30 kg/m2 and T2D. Appropriate patient selection (better β-cell function) may produce better outcomes.

Robotic Versus Laparoscopic Bariatric Surgery: a Systematic Review and Meta-Analysis

We aim to summarize the available literature on patients treated with robotic bariatric surgery (RBS) or laparoscopic bariatric surgery (LBS) and compare the clinical outcomes between RBS and LBS. A systematic literature was conducted in accordance with the PRISMA guidelines. Thirty-four observational studies met our inclusion criteria, and 27 studies of 27,997 patients were included in the meta-analysis. There were no significant differences between RBS and LBS regarding overall postoperative complications, major complications, the length of hospital stay, reoperation, conversion, and mortality. Nevertheless, RBS was burdened by longer operative times and higher hospital costs when compared with LBS. On the contrary, the incidence of anastomotic leak was lower in RBS than in LBS. Further studies with a longer follow-up are recommended.

Effect of Roux-en-Y gastric bypass on thyroid function in euthyroid patients with obesity and type 2 diabetes

BACKGROUND The impact of bariatric surgery on thyroid hormone levels is poorly understood. OBJECTIVES To investigate changes in serum-free thyroxine (FT4) and thyroid-stimulating hormone (TSH) after Roux-en-Y gastric bypass (RYGB) in euthyroid patients with obesity and type 2 diabetes. SETTING University Hospital, China. METHODS Eighty-one euthyroid Chinese patients with obesity and type 2 diabetes who underwent RYGB, and 20 healthy volunteers were enrolled in this retrospective study. Participants were evaluated for changes in anthropometric parameters, metabolic indexes, FT4, and TSH at baseline and 6 months after surgery. Multiple linear regression analysis was used to identify factors that could predict changes in FT4 and TSH. RESULTS Mean FT4 levels decreased from 16.26-14.59 pmol/L (P<.01), while TSH levels decreased significantly (2.19±1.09 mIU/L versus 1.97±1.12 mIU/L, P = .027) 6 months postsurgery. Multiple linear regression analysis showed that the waist/hip ratio (β =-7.406, P = .031) and duration of diabetes (β =-.087, P = .009) were independent factors contributing to this decrease in FT4 levels. Moreover, changes in TSH levels were significantly and positively correlated with 2-hour postprandial blood glucose at patient baseline (β = .064, P< .01). CONCLUSIONS The present study is the first to show that both serum levels of FT4 and TSH decrease after RYGB in euthyroid patients with obesity and type 2 diabetes. Our results suggest that not only can RYGB improve metabolic abnormalities, but it may also alter the feedback regulation of the thyroid system.

Decreased serum CA19-9 is associated with improvement of insulin resistance and metabolic control in patients with obesity and type 2 diabetes after Roux-en-Y gastric bypass.

Patients with type 2 diabetes are known to show elevated serum levels of carbohydrate antigen 19‐9 (CA19‐9). The aim of the present study was to investigate the possible relationships of CA19‐9 with metabolic control, insulin resistance (IR), and pancreatic β‐cell function in patients with obesity and type 2 diabetes who underwent Roux‐En‐Y gastric bypass (RYGB).

Silencing of TCTN1 inhibits proliferation, induces cell cycle arrest and apoptosis in human thyroid cancer

Tectonic family member 1 (TCTN1) is one of the tectonic family members, and a regulator of the hedgehog signaling pathway, which has been studied in various cancer types, including prostate and pancreatic cancer. However, its function in thyroid cancer has not been well documented. Therefore, the present study investigated the function of TCTN1 in thyroid cancer using a loss-of-function assay. Lentivirus-mediated RNA interference was applied to downregulate TCTN1 in the thyroid cancer cell lines, CAL62 and 8305C. A series of functional properties, including cell viability, colony formation, cell cycle and apoptosis were determined using MTT, colony formation assay and flow cytometry analyses, respectively. The results demonstrated that lentivirus-medicated RNAi could specifically suppress the expression of TCTN1 at the mRNA and protein levels in CAL62, and 8305C cells. Knockdown of TCTN1 inhibited cell growth and proliferation via inducing S phase arrest, and apoptosis. Mechanistically, the S phase arrest was accompanied by the upregulation of cyclin dependent kinase 2, cyclin A2 and downregulation of cyclin B1. Knockdown of TCTN1 induced apoptosis through increasing the expression of Bcl2-associated agonist of cell death, cleaved caspase-3 and poly(ADP-ribose)polymerase, and decreasing apoptosis regulator Bcl-2 expression. The current study highlights the essential role of TCTN1 in promoting thyroid cancer cell proliferation, and its knockdown may serve as a potential therapeutic treatment for thyroid cancer.

Effectiveness and safety of laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus

Gastric bypass may be conducted to aid in glycemic control in adults with type 2 diabetes mellitus (T2DM). The aim of the present study was to investigate the clinical results of diabetes remission and metabolic syndrome in individuals with T2DM after undergoing a gastric bypass. A total of 85 patients (39 men and 46 women) with T2DM underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). Data regarding patient demographics, body mass index (BMI), co-morbidities and details of diabetes mellitus, including disease duration, remission, β-cell function, blood lipid levels and nutritive status were prospectively collected and analyzed. The mean duration from the onset of T2DM was 7.79±4.84 years (range, 1 month to 22 years). The preoperative mean BMI was 31.60±4.10 (range, 28.53–48.10 kg/m2), mean percentage of body fat was 36.35±9.12% (range, 18–56%), and the mean HbA1c was 8.32±2.13% (range, 7–15.9%). Five patients (5.9%) developed complications without mortality. T2DM and β-cell function were significantly improved from by month 6 after surgery (P<0.05). Improvements in central obesity, blood pressure (BP; systolic and diastolic) control, blood lipid levels were observed, without malnutrition or severe anemia. Therefore, the present results indicate that laparoscopic RYGBP is a safe and effective procedure for improving glycemic control, obesity, body fat percentage and BP in patients with T2DM and obesity.