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The studies on the composition of the human microbiomes in healthy individuals, its variability in the course of inflammation, infection, antibiotic therapy, diets and different pathological conditions have revealed their intra and inter-kingdom relationships. The lung microbiome comprises of major species members of the phylum Bacteroidetes, Firmicutes, Actinobacteria, Fusobacteria and Proteobacteria, which are distributed in ecological niches along nasal cavity, nasopharynx, oropharynx, trachea and in the lungs. Commensal and pathogenic species are maintained in equilibrium as they have strong relationships. Bacterial overgrowth after dysbiosis and/or imbalanced of CD4+ helper T cells, CD8+ cytotoxic T cells and regulatory T cells (Treg) populations can promote lung inflammatory reactions and distress, and consequently acute and chronic respiratory diseases. This review is aimed to summarize the latest advances in resident lung microbiome and its participation in most common pulmonary infections and pneumonia, community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP), immunodeficiency associated pneumonia, SARS-CoV-2-associated pneumonia, acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD). We briefly describe physiological and immunological mechanisms that selectively create advantages or disadvantages for relative growth of pathogenic bacterial species in the respiratory tract. At the end, we propose some directions and analytical methods that may facilitate the identification of key genera and species of resident and transient microbes involved in the respiratory diseases' initiation and progression.
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INTRODUCTION: Short bowel syndrome (SBS) has traditionally been regarded as a rapidly fatal medical catastrophe. The advent of pharmacological options directly targeting disease pathophysiology justified this review. AREAS COVERED: Since the 1970s, home parenteral nutrition has reduced mortality, converting SBS into a chronic and disabling compensated and occasionally curable illness. Off-label antidiarrheal drugs and related products, though having minimal scientific evidence of efficacy, represent the standard-of-care and are here reviewed. Trophic intestinal hormones, including GLP-2 and its analogs, have great promise for alleviating malabsorption, the most important symptom within a nonsurgical, routine outpatient framework. Current indications involve adults with massive intestinal losses (fecal wet weight >1500 g/day). Surgical options such as intestinal lengthening or transplantation are also addressed although these options are considerably more aggressive and have stricter indications. EXPERT OPINION: GLP-2 analogs are the first candidates from a pioneering pharmacotherapic family within the SBS framework, namely disease-modifying, absorption-restoring agents. This family of drugs, potentially applicable in all contexts of severe intestinal loss, could become the therapeutic benchmark of the near future.
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Antidiarreicos/uso terapêutico , Peptídeo 2 Semelhante ao Glucagon/uso terapêutico , Intestinos/fisiopatologia , Nutrição Parenteral no Domicílio/métodos , Síndrome do Intestino Curto/terapia , Adulto , Animais , Humanos , Uso Off-Label , Síndrome do Intestino Curto/tratamento farmacológico , Síndrome do Intestino Curto/cirurgiaRESUMO
Exhaled breath contains thousand metabolites and volatile organic compounds (VOCs) that originated from both respiratory tract and internal organ systems and their microbiomes. Commensal and pathogenic bacteria and virus of microbiomes are capable of producing VOCs of different chemical classes, and some of them may serve as biomarkers for installation and progression of various common human diseases. Here we describe qualitative and quantitative methods for measuring VOC fingerprints generated by cellular and microbial metabolic and pathologic pathways. We describe different chemical classes of VOCs and their role in the host cell-microbial interactions and their impact on infection disease pathology. We also update on recent progress on VOC signatures emitted by isolated bacterial species and microbiomes, and VOCs identified in exhaled breath of patients with respiratory tract and gastrointestinal diseases, and inflammatory syndromes, including the acute respiratory distress syndrome and sepsis. The VOC curated databases and instrumentations have been developed through statistically robust breathomic research in large patient populations. Scientists have now the opportunity to find potential biomarkers for both triage and diagnosis of particular human disease.
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Doenças Transmissíveis , Compostos Orgânicos Voláteis , Biomarcadores , Biópsia , Testes Respiratórios , Humanos , Sistema RespiratórioRESUMO
We evaluated whether the excluded stomach (ES) after Roux-en-Y gastric bypass (RYGB) can represent a premalignant environment. Twenty obese women were prospectively submitted to double-balloon enteroscopy (DBE) with gastric juice and biopsy collection, before and 3 months after RYGB. We then evaluated morphological and molecular changes by combining endoscopic and histopathological analyses with an integrated untargeted metabolomics and transcriptomics multiplatform. Preoperatively, 16 women already presented with gastric histopathological alterations and an increased pH (≥4.0). These gastric abnormalities worsened after RYGB. A 90-fold increase in the concentration of bile acids was found in ES fluid, which also contained other metabolites commonly found in the intestinal environment, urine, and faeces. In addition, 135 genes were differentially expressed in ES tissue. Combined analysis of metabolic and gene expression data suggested that RYGB promoted activation of biological processes involved in local inflammation, bacteria overgrowth, and cell proliferation sustained by genes involved in carcinogenesis. Accumulated fluid in the ES appears to behave as a potential premalignant environment due to worsening inflammation and changing gene expression patterns that are favorable to the development of cancer. Considering that ES may remain for the rest of the patient's life, long-term ES monitoring is therefore recommended for patients undergoing RYGB.
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Obesidade/patologia , Estômago/patologia , Adolescente , Adulto , Feminino , Derivação Gástrica/métodos , Suco Gástrico/fisiologia , Expressão Gênica/fisiologia , Humanos , Inflamação/patologia , Inflamação/cirurgia , Metabolômica/métodos , Pessoa de Meia-Idade , Obesidade/cirurgia , Estômago/cirurgia , Transcriptoma/fisiologia , Redução de Peso/fisiologia , Adulto JovemRESUMO
The gastrointestinal (GI) tract is the residence of trillions of microorganisms that include bacteria, archaea, fungi and viruses. The collective genomes of whole microbial communities (microbiota) integrate the gut microbiome. Up to 100 genera and 1000 distinct bacterial species were identified in digestive tube niches. Gut microbiomes exert permanent pivotal functions by promoting food digestion, xenobiotic metabolism and regulation of innate and adaptive immunological processes. Proteins, peptides and metabolites released locally and at distant sites trigger many cell signalling and pathways. This intense crosstalk maintains the host-microbial homeostasis. Diet, age, diet, stress and diseases cause increases or decreases in relative abundance and diversity bacterial specie of GI and other body sites. Studies in animal models and humans have shown that a persistent imbalance of gut's microbial community, named dysbiosis, relates to inflammatory bowel diseases (IBD), irritable bowel syndrome (IBS), diabetes, obesity, cancer, cardiovascular and central nervous system disorders. Notably specific bacterial communities are promising clinical target to treat inflammatory and infectious diseases. In this context, intestinal microbiota transplantation (IMT) is one optional treatment for IBD, in particular to patients with recurrent Clostridium difficile-induced pseudo-membrane colitis. Here we discuss on recent discoveries linking whole gut microbiome dysbiosis to metabolic and inflammatory diseases and potential prophylactic and therapeutic applications of faecal and phage therapy, probiotic and prebiotic diets.
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Disbiose/microbiologia , Microbioma Gastrointestinal , Animais , Humanos , Sistema Imunitário , Inflamação , Intestinos/microbiologiaRESUMO
In the original article the photo of Dr. Faintuch was inadvertently omitted. We apologize for this oversight.
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Determinação da Pressão Arterial , Hipertensão , Bactérias , Pressão Sanguínea , Encéfalo , Feminino , Humanos , Lactente , GravidezRESUMO
Maintenance of healthy human metabolism depends on a symbiotic consortium among bacteria, archaea, viruses, fungi, and host eukaryotic cells throughout the human gastrointestinal tract. Microbial communities provide the enzymatic machinery and the metabolic pathways that contribute to food digestion, xenobiotic metabolism, and production of a variety of bioactive molecules. These include vitamins, amino acids, short-chain fatty acids (SCFAs), and metabolites, which are essential for the interconnected pathways of glycolysis, the tricarboxylic acid/Krebs cycle, oxidative phosphorylation (OXPHOS), and amino acid and fatty acid metabolism. Recent studies have been elucidating how nutrients that fuel the metabolic processes impact on the ways immune cells, in particular, macrophages, respond to different stimuli under physiological and pathological conditions and become activated and acquire a specialized function. The two major inflammatory phenotypes of macrophages are controlled through differential consumption of glucose, glutamine, and oxygen. M1 phenotype is triggered by polarization signal from bacterial lipopolysaccharide (LPS) and Th1 proinflammatory cytokines such as interferon-γ, TNF-α, and IL-1ß, or both, whereas M2 phenotype is triggered by Th2 cytokines such as interleukin-4 and interleukin-13 as well as anti-inflammatory cytokines, IL-10 and TGFß, or glucocorticoids. Glucose utilization and production of chemical mediators including ATP, reactive oxygen species (ROS), nitric oxide (NO), and NADPH support effector activities of M1 macrophages. Dysbiosis is an imbalance of commensal and pathogenic bacteria and the production of microbial antigens and metabolites. It is now known that the gut microbiota-derived products induce low-grade inflammatory activation of tissue-resident macrophages and contribute to metabolic and degenerative diseases, including diabetes, obesity, metabolic syndrome, and cancer. Here, we update the potential interplay of host gut microbiome dysbiosis and metabolic diseases. We also summarize on advances on fecal therapy, probiotics, prebiotics, symbiotics, and nutrients and small molecule inhibitors of metabolic pathway enzymes as prophylactic and therapeutic agents for metabolic diseases.
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Disbiose/metabolismo , Disbiose/microbiologia , Doenças Metabólicas/metabolismo , Animais , Microbioma Gastrointestinal/fisiologia , Humanos , Macrófagos/metabolismo , Doenças Metabólicas/microbiologiaRESUMO
BACKGROUND: Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. METHOD: Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged. RESULTS: The flaxseed oil group had improved ultra-sensitive C-reactive protein levels (p = 0.074) and reduced carotid intima-media thickness (CIMT) (p = 0.028); the olive oil group exhibited an improved apolipoprotein (Apo)B/ApoA ratio (p = 0.021), reduced CIMT (p = 0.028), and improved flow-mediated vasodilation (FMV) (p = 0.054); and similarly, the sunflower oil group showed an improved ApoB/ApoA ratio (p = 0.024), reduced CIMT (p = 0.048), and improved FMV (p = 0.001). CONCLUSION: Unsaturated fatty acid supplementation using the three vegetable oils attenuated pro-inflammatory properties and improved prothrombotic conditions. Therefore, introducing or replacing saturated and trans fat with unsaturated fatty acids is beneficial for cardiovascular risk reduction in obese or overweight non-diabetic elderly people. Further studies are needed to determine which unsaturated fat best prevents cardiovascular disease in elderly patients.
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Aterosclerose/dietoterapia , Biomarcadores/sangue , Doenças Cardiovasculares/prevenção & controle , Gorduras Insaturadas na Dieta/uso terapêutico , Ácidos Graxos Insaturados/uso terapêutico , Obesidade/dietoterapia , Sobrepeso/dietoterapia , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/complicações , Espessura Intima-Media Carotídea , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/complicações , Obesidade/fisiopatologia , Sobrepeso/sangue , Sobrepeso/complicações , Sobrepeso/fisiopatologia , Óleos de Plantas/administração & dosagem , Fatores de RiscoRESUMO
BACKGROUND: Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. METHOD: Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged...
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Aterosclerose , Endotélio Vascular , Espessura Intima-Media Carotídea , Idoso , Inflamação , Obesidade , Rigidez Vascular , Ácidos Graxos InsaturadosRESUMO
OBJECTIVES:: Conventional imaging methods are excellent for the morphological characterization of the consequences of osteonecrosis; however, only specialized techniques have been considered useful for obtaining functional information. To explore the affinity of radiotracers for severely devascularized bone, a new mouse model of isolated femur implanted in a subcutaneous abdominal pocket was devised. To maintain animal mobility and longevity, the femur was harvested from syngeneic donors. Two technetium-99m-labeled tracers targeting angiogenesis and bone matrix were selected. METHODS:: Medronic acid and a homodimer peptide conjugated with RGDfK were radiolabeled with technetium-99m, and biodistribution was evaluated in Swiss mice. The grafted and control femurs were evaluated after 15, 30 and 60 days, including computed tomography (CT) and histological analysis. RESULTS:: Radiolabeling achieved high (>95%) radiochemical purity. The biodistribution confirmed good blood clearance 1 hour after administration. For 99mTc-hydrazinonicotinic acid (HYNIC)-E-[c(RGDfK)2, remarkable renal excretion was observed compared to 99mTc-methylene diphosphonate (MDP), but the latter, as expected, revealed higher bone uptake. The results obtained in the control femur were equal at all time points. In the implanted femur, 99mTc-HYNIC-E-[c(RGDfK)2 uptake was highest after 15 days, consistent with early angiogenesis. Regarding 99mTc-MDP in the implant, similar uptake was documented at all time points, consistent with sustained bone viability; however, the uptake was lower than that detected in the control femur, as confirmed by histology. CONCLUSIONS:: 1) Graft viability was successfully diagnosed using radiotracers in severely ischemic bone at all time points. 2) Analogously, indirect information about angiogenesis could be gathered using 999mTc-HYNIC-E-[c(RGDfK)2. 3) These techniques appear promising and warrant further studies to determine their potential clinical applications.
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Interface Osso-Implante/fisiologia , Modelos Animais de Doenças , Compostos de Organotecnécio , Osteonecrose/fisiopatologia , Peptídeos Cíclicos , Compostos Radiofarmacêuticos , Animais , Transplante Ósseo , Difosfonatos , Feminino , Fêmur/patologia , Fêmur/fisiopatologia , Marcação por Isótopo/métodos , Camundongos , Neovascularização Fisiológica/fisiologia , Osteonecrose/patologia , Reprodutibilidade dos Testes , Fatores de Tempo , Sobrevivência de Tecidos/fisiologia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: Conventional imaging methods are excellent for the morphological characterization of the consequences of osteonecrosis; however, only specialized techniques have been considered useful for obtaining functional information. To explore the affinity of radiotracers for severely devascularized bone, a new mouse model of isolated femur implanted in a subcutaneous abdominal pocket was devised. To maintain animal mobility and longevity, the femur was harvested from syngeneic donors. Two technetium-99m-labeled tracers targeting angiogenesis and bone matrix were selected. METHODS: Medronic acid and a homodimer peptide conjugated with RGDfK were radiolabeled with technetium-99m, and biodistribution was evaluated in Swiss mice. The grafted and control femurs were evaluated after 15, 30 and 60 days, including computed tomography (CT) and histological analysis. RESULTS: Radiolabeling achieved high (>95%) radiochemical purity. The biodistribution confirmed good blood clearance 1 hour after administration. For 99mTc-hydrazinonicotinic acid (HYNIC)-E-[c(RGDfK)2, remarkable renal excretion was observed compared to 99mTc-methylene diphosphonate (MDP), but the latter, as expected, revealed higher bone uptake. The results obtained in the control femur were equal at all time points. In the implanted femur, 99mTc-HYNIC-E-[c(RGDfK)2 uptake was highest after 15 days, consistent with early angiogenesis. Regarding 99mTc-MDP in the implant, similar uptake was documented at all time points, consistent with sustained bone viability; however, the uptake was lower than that detected in the control femur, as confirmed by histology. CONCLUSIONS: 1) Graft viability was successfully diagnosed using radiotracers in severely ischemic bone at all time points. 2) Analogously, indirect information about angiogenesis could be gathered using 999mTc-HYNIC-E-[c(RGDfK)2. 3) These techniques appear promising and warrant further studies to determine their potential clinical applications.
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Animais , Feminino , Camundongos , Interface Osso-Implante/fisiologia , Compostos de Organotecnécio , Osteonecrose/fisiopatologia , Peptídeos Cíclicos , Compostos Radiofarmacêuticos , Transplante Ósseo , Difosfonatos , Modelos Animais de Doenças , Fêmur/patologia , Fêmur/fisiopatologia , Marcação por Isótopo/métodos , Neovascularização Fisiológica/fisiologia , Osteonecrose/patologia , Reprodutibilidade dos Testes , Fatores de Tempo , Sobrevivência de Tecidos/fisiologia , Tomografia Computadorizada por Raios XRESUMO
Androgens and estrogens play a key role regarding sexual life and reproduction. Along with hypotestosteronemia, obese men exhibit a 2-fold increase in estradiol concentration, adversely infl uencing these parameters. Estrogens and adipokines also infl uence bone metabolism, exerting a direct effect on vitamin D, calcium homeostasis and bone health. Bariatric procedures normalize some sex hormones, and may reverse several obesity-related conditions. Estrogens levels may remain elevated postoperatively, and despite its protective effect on the skeleton, bariatric patients are more prone to fractures when compared to the general population. Multiple nutritional defi cits are common after bariatric interventions, and hypozincemia is the most likely to negatively infl uence reproductive parameters. Zinc is an essential element for normal spermatogenesis, and severe hypozincemia is associated with infertility in both sexes. Vitamin D also acts as a regulator of several enzymes involved in steroid hormone production, and its defi ciency could impair reproductive function. Few studies have addressed changes in sex hormones and in reproductive function in the male bariatric population, as they represent a minority of surgical candidates. Although obesity rates and burden are similar for both sexes, society is more lenient with the obese male. Moreover, 73 % of overweight/obese men are satisfi ed with their health, causing body weight and obesity-related health problems to increase when they opt for bariatric surgery. In the present article, we discuss shifts of sex hormones before and after bariatric surgery, surgery impact on semen quality, skeletal health and nutrients, and new research directions regarding links between vitamin D, zinc, androgens and reproduction.
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BACKGROUND: Workplace stress has been associated with obesity. Diminished body weight has also been anticipated in some contexts. OBJECTIVE: In a cohort of healthcare personnel, morning cortisol was compared to nutritional and metabolic variables, aiming to identify the correlates of such marker. METHODS: Population n=185, 33.8 ± 9.8 years, 88.1% females, body mass index (BMI) 25.6 ± 4.4 kg/m2, included nurses and other nosocomial professionals, the majority with high social-economic status (75.2%). Participants were stratified according to BMI, fasting blood glucose (FBG) and metabolic syndrome (MS). Fasting plasma cortisol and the Framingham Coronary Risk Score was calculated. RESULTS: Mean cortisol was acceptable (19.4 ± 7.9 µg/dL) although with elevation in 21.6%. No correlation with FBG or MS occurred, and nonobese persons (BMI <25) exhibited the highest values (P=0.049). Comparison of the lowest and highest cortisol quartiles confirmed reduced BMI and waist circumference in the former, with unchanged Framingham Coronary Risk Score. CONCLUSION: Cortisol correlated with reduced BMI. Despite low BMI and waist circumference, Framingham Coronary Risk Score was not benefitted, suggesting that exposure to cardiovascular risk continues, besides psychological strain. Initiatives to enhance organizational and staff health are advisable in the hospital environment.
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Hidrocortisona/sangue , Síndrome Metabólica/psicologia , Obesidade/sangue , Obesidade/psicologia , Recursos Humanos em Hospital/psicologia , Estresse Fisiológico , Adulto , Biomarcadores/sangue , Glicemia/análise , Índice de Massa Corporal , Jejum , Feminino , Humanos , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Doenças Profissionais/sangue , Doenças Profissionais/psicologia , Recursos Humanos em Hospital/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
Background Workplace stress has been associated with obesity. Diminished body weight has also been anticipated in some contexts. Objective In a cohort of healthcare personnel, morning cortisol was compared to nutritional and metabolic variables, aiming to identify the correlates of such marker. Methods Population n=185, 33.8 ± 9.8 years, 88.1% females, body mass index (BMI) 25.6 ± 4.4 kg/m2, included nurses and other nosocomial professionals, the majority with high social-economic status (75.2%). Participants were stratified according to BMI, fasting blood glucose (FBG) and metabolic syndrome (MS). Fasting plasma cortisol and the Framingham Coronary Risk Score was calculated. Results Mean cortisol was acceptable (19.4 ± 7.9 µg/dL) although with elevation in 21.6%. No correlation with FBG or MS occurred, and nonobese persons (BMI <25) exhibited the highest values (P=0.049). Comparison of the lowest and highest cortisol quartiles confirmed reduced BMI and waist circumference in the former, with unchanged Framingham Coronary Risk Score. Conclusion Cortisol correlated with reduced BMI. Despite low BMI and waist circumference, Framingham Coronary Risk Score was not benefitted, suggesting that exposure to cardiovascular risk continues, besides psychological strain. Initiatives to enhance organizational and staff health are advisable in the hospital environment. .
Contexto O estresse no ambiente de trabalho tem sido associado com obesidade. Peso corporal diminuído também tem sido relatado em algumas circunstâncias. Objetivo Numa casuística de profissionais da saúde, o cortisol matutino foi comparado com variáveis nutricionais e metabólicas, objetivando identificar as correlações de tal marcador. Métodos A população com n=185; 33,8 ± 9,8 anos; 88,1% mulheres, índice de massa corporal (IMC) 25.6 ± 4.4 kg/m2, incluía enfermeiros e outros funcionários nosocomiais, em sua maioria (75,2%) com nível sócio-econômico elevado. Os participantes foram estatrificados de acordo com IMC, glicemia de jejum, e síndrome metabólica. O cortisol de jejum e o escore Framingham de risco cardiovascular foram registrados. Resultados O cortisol médio era aceitável (19.4 ± 7.9 µg/dL), todavia com valores elevados em 21,6%. A glicemia de jejum e a síndrome metabólica não exibiram correlação, sendo que no tocante ao IMC, os não obesos (IMC <25) apresentaram o cortisol mais alto (P=0,049). Comparando-se os quartis superior e inferior do cortisol, confirmou-se o vínculo com o IMC e perímetro abdominal mais baixos, com escore Framingham de risco cardiovascular inalterado. Conclusão O cortisol alterado concentrou-se nos casos de IMC mais reduzido. A despeito do baixo IMC e perímetro abdominal, esta população não se beneficiou de escore de risco cardiovascular menor, sugerindo que, mesmo na ausência de obesidade, este grupo estava exposto a elevado risco cardiovascular, ao lado do estresse. Iniciativas direcionadas para melhor saúde organizacional e da equipe de profissionais, são recomendáveis no ambiente hospitalar. .
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Hidrocortisona/sangue , Síndrome Metabólica/psicologia , Obesidade/sangue , Obesidade/psicologia , Recursos Humanos em Hospital/psicologia , Estresse Fisiológico , Índice de Massa Corporal , Biomarcadores/sangue , Glicemia/análise , Jejum , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Doenças Profissionais/sangue , Doenças Profissionais/psicologia , Estudos Prospectivos , Recursos Humanos em Hospital/estatística & dados numéricos , Fatores de Risco , Fatores SocioeconômicosRESUMO
BACKGROUND: Patients with postbariatric bacterial overgrowth were reinvestigated after a follow-up of 15 years. It was hypothesized that systemic associations analogous to those reported for whole gut microbiome would be revealed. METHODS: Patients (n = 37, 70.3 % females, 42.4 ± 9.9 years old, preoperative BMI 53.5 ± 10.6 kg/m(2), current BMI 32.8 ± 10.8 kg/m(2)), all submitted to RYGB on account of morbid obesity, were followed during 176.8 ± 25.7 months. Blood tests included fasting blood glucose, HbA1c, liver and pancreatic enzymes, and lipid fractions. Bacterial overgrowth was diagnosed by quantitative culture of gastric fluid in both the excluded remnant and the gastric pouch, with the help of double-balloon enteroscopy. Absolute counts of aerobes and anaerobes in both gastric reservoirs were correlated with nutritional and biochemical measurements, aiming to identify clinically meaningful associations. RESULTS: Patients denied diarrhea, abdominal pain, weight loss, or other symptoms related to bacterial overgrowth. Biochemical profile including enzymes was also acceptable, indicating a stable condition. Positive correlation of bacterial count in either segment of the stomach was demonstrated for BMI and gamma-glutamyl transferase, whereas negative correlation occurred regarding fasting blood glucose. CONCLUSIONS: An antidiabetic role along with deleterious consequences for weight loss and liver function are possible in such circumstances. Such phenotype is broadly consistent with reported effects for the whole gut microbiome. Prospective controlled studies including molecular analysis of gastrointestinal fluid, and simultaneous profiling of the entire microbiome, are necessary to shed more light on these findings.
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Derivação Gástrica/métodos , Fígado/metabolismo , Obesidade Mórbida/cirurgia , Estômago/microbiologia , Adulto , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Feminino , Derivação Gástrica/efeitos adversos , Humanos , Masculino , Estudos Prospectivos , Redução de PesoRESUMO
Since the days of Albukasim in medieval Spain, natural orifices have been regarded not only as a rather repugnant source of bodily odors, fluids and excreta, but also as a convenient invitation to explore and treat the inner passages of the organism. However, surgical ingenuity needed to be matched by appropriate tools and devices. Lack of technologically advanced instrumentation was a strong deterrent during almost a millennium until recent decades when a quantum jump materialized. Endoscopic surgery is currently a vibrant and growing subspecialty, which successfully handles millions of patients every year. Additional opportunities lie ahead which might benefit millions more, however, requiring even more sophisticated apparatuses, particularly in the field of robotics, artificial intelligence, and tissue repair (surgical suturing). This is a particularly exciting and worthwhile challenge, namely of larger and safer endoscopic interventions, followed by seamless and scarless recovery. In synthesis, the future is widely open for those who use together intelligence and creativity to develop new prototypes, new accessories and new techniques. Yet there are many challenges in the path of endoscopic surgery. In this new era of robotic endoscopy, one will likely need a virtual simulator to train and assess the performance of younger doctors. More evidence will be essential in multiple evolving fields, particularly to elucidate whether more ambitious and complex pathways, such as intrathoracic and intraperitoneal surgery via natural orifice transluminal endoscopic surgery (NOTES), are superior or not to conventional techniques.
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Cirurgia Endoscópica por Orifício Natural/métodos , Cirurgia Endoscópica por Orifício Natural/tendências , Neoplasias Gastrointestinais/cirurgia , Gastrostomia/métodos , Humanos , Cirurgia Endoscópica por Orifício Natural/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Divertículo de Zenker/cirurgiaRESUMO
BACKGROUND: A clinical study was designed that aimed to analyze whether resection of the large bowel in cancer patients might benefit diabetes mellitus. METHODS: This prospective case-control study included retrospective information. Patients (n = 247) included diabetic and euglycemic groups with colorectal cancer operations (n = 60), cancer gastrectomy (n = 72), exclusive chemoradiotherapy for rectal cancer (n = 46), and noncancer clinical controls (n = 69). Follow-up periods were, respectively, 79.2 ± 27.4, 86.8 ± 25.1, 70.0 ± 26.3, and 85.1 ± 18.2 months (NS). Diabetes groups included patients with prediabetes. RESULTS: Diabetes remission, defined as conversion from diabetes to prediabetes or from this condition to normal, was documented in, respectively, 32.4 % (11 of 34), 41.2 % (14 of 34), 7.1 % (1 of 14), and 7.7 % (3 of 39) in the four cohorts (P = 0.004). Within the same period, progression of euglycemic participants to diabetes occurred in 30.8 % (8 of 26), 63.2 % (24 of 38), 25.0 (8 of 32), and 20.0 % (6 of 30) (P = 0.028). Diabetes amelioration was associated with weight loss in gastrectomy patients but not in the other groups. Dietary intake, estimated in the two surgical populations, did not predict outcome. CONCLUSIONS: Diabetes amelioration after colorectal interventions was demonstrated, but progression of euglycemic patients toward prediabetes was not changed in comparison with nonsurgical controls. It is speculated that reshaping of the bowel microbiome or hormone changes after colorectal interventions underlay the improvement in diabetes. Body weight fluctuations could not be incriminated in this investigation.
Assuntos
Glicemia/metabolismo , Colectomia , Neoplasias Colorretais/cirurgia , Diabetes Mellitus/sangue , Idoso , Índice de Massa Corporal , Brasil/epidemiologia , Estudos de Casos e Controles , Neoplasias Colorretais/complicações , Neoplasias Colorretais/mortalidade , Diabetes Mellitus/mortalidade , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Redução de Peso/fisiologiaRESUMO
BACKGROUND: Mucosal alterations after Roux-en-Y gastric bypass for morbid obesity have not been clearly evaluated. This study aims to analyze the mucosal alterations (proliferative status (Ki-67); apoptosis (caspase-3 and BCL-2); hormonal function (gastrin)) in the excluded stomach. METHODS: Double-balloon enteroscopy was performed in 35 patients who underwent Roux-en-Y gastric bypass longer than 36 months. Multiple biopsies of the proximal pouch and the excluded gastric mucosa were collected. Gastric biopsies from 32 non-operated obese patients were utilized as controls. Endoscopic biopsies were cut from tissue blocks fixed in formalin and embedded in paraffin. Sections 4 µm thick were examined for immunoexpression using the streptavidin-biotin-peroxidase method. RESULTS: The two groups were comparable for age, gender, gastritis, intestinal metaplasia, and Helicobacter pylori. The mean number of positive gastrin cells was 55.5 (standard deviation (SD) = 11.7) in the control group and 29.6 (SD = 7.9) in the cases, p = 0.0003. Ki-67 proliferative index in cases (body = 24.7%, antrum = 24.9%) was significantly higher compared to controls (body = 15.0% and antrum = 17.7%), p = 0.002 and 0.01, respectively. Caspase-3 immunoexpression was higher in the controls compared to the excluded stomach (46 vs. 31%), p = 0.02. There was no statistical difference between CD3, CD8, and Bcl-2 immunoexpressions in the control and cases. CONCLUSIONS: Cell proliferation is increased and apoptosis is downregulated in the excluded gastric mucosa compared to the non-operated obese controls. Alterations in cell turnover and in hormonal secretions in these conditions may be of relevance in long-term follow-up.