SICOB Italian clinical practice guidelines for the surgical treatment of obesity and associated diseases using GRADE methodology on bariatric and metabolic surgery.

Obesity is a chronic disease associated with increased morbidity and mortality and reduced quality of life. Pharmacotherapy can be associated with life style changes in increasing and maintaining weight loss and ameliorating obesity-related complications and comorbidities. In patients affected by obesity and uncontrolled obesity-associated complications or high degrees of BMI (> 40 Kg/m), metabolic bariatric surgery can be a valid therapeutic option.

Bariatric Surgery for Patients with Overweight/Obesity. A Comprehensive Grading Methodology and Network Metanalysis of Randomized Controlled Trials on Weight Loss Outcomes and Adverse Events.

This study aims to compare different types of metabolic bariatric surgery (MBS) with lifestyle intervention/medical therapy (LSI/MT) for the treatment of overweight/obesity. The present and network meta-analysis (NMA) includes randomized trials. MBS was associated with a reduction of BMI, body weight, and percent weight loss, when compared to LSI/MT, and also with a significant reduction of HbA1c and a higher remission of diabetes.

In severe obesity, subcutaneous adipose tissue cell-derived cytokines are early markers of impaired glucose tolerance and are modulated by quercetin.

Background: Excessive adiposity provides an inflammatory environment. However, in people with severe obesity, how systemic and local adipose tissue (AT)-derived cytokines contribute to worsening glucose tolerance is not clear.

Methods: Ninty-two severely obese (SO) individuals undergoing bariatric surgery were enrolled and subjected to detailed clinical phenotyping.

Bariatric Surgery Versus Lifestyle Intervention in Class I Obesity: 7-10-Year Results of a Retrospective Study.

Introduction: The American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation of Surgery for Obesity (IFSO) have both stated that bariatric surgery (BS) should not be denied in Class I patients. However, lifestyle intervention (LI), such as diet plus gym programs, is still considered the preferred approach for subjects with a BMI ranging from 30 to 35 kg/m. The aim of this study was to retrospectively compare results of LI and BS in patients in Class I obesity.

Ten years of follow-up of bilio-intestinal bypass: is malabsorption necessary for long-term metabolic results?

Background: Bilio-intestinal bypass (BIBP) is an uncommon bariatric procedure. In 1999, a prospective trial was started at our institution to evaluate the effectiveness of BIBP. Trial was interrupted in 2006 due to high rate of complications.

Is the Sleeve Gastrectomy Always a Better Procedure? Five-Year Results from a Retrospective Matched Case-Control Study.

Introduction: Bariatric surgery is considered the most effective treatment for obesity. A recent worldwide survey demonstrated that Laparoscopic Sleeve Gastrectomy (LSG) is the most commonly performed bariatric procedure, while Laparoscopic Adjustable Gastric Banding (LAGB) has been almost abandoned.

Objectives: The aim of this retrospective study was to compare 5-year results of LSG and LAGB at our Institution.

Neuromuscular electrical stimulation improves exercise tolerance in patients with advanced heart failure on continuous intravenous inotropic support use-randomized controlled trial.

Objective: To evaluate the impact of a short-term neuromuscular electrical stimulation program on exercise tolerance in hospitalized patients with advanced heart failure who have suffered an acute decompensation and are under continuous intravenous inotropic support.

Design: A randomized controlled study.

Subjects: Initially, 195 patients hospitalized for decompensated heart failure were recruited, but 70 were randomized.

The role of MRI in predicting Ki-67 in breast cancer: preliminary results from a prospective study.

Purpose: In the last decade contrast-enhanced magnetic resonance imaging (MRI) has gained a growing role as a complementary tool for breast cancer diagnosis. Currently the relationship between the kinetic features of a breast lesion and pathologic prognostic factors has become a popular field of research. Our aim is to verify whether breast MRI could be considered a useful tool to predict Ki-67 score, thus resulting as a breast cancer prognosis indicator.

Changes in the MicroRNA Profile Observed in the Subcutaneous Adipose Tissue of Obese Patients after Laparoscopic Adjustable Gastric Banding.

. Laparoscopic adjustable gastric banding (LAGB) results in significant lasting weight loss and improved metabolism in obese patients. To evaluate whether epigenetic factors could concur to these benefits, we investigated the subcutaneous adipose tissue (SAT) microRNA (miRNA) profile before (T0) and three years (T1) after LAGB in three morbidly obese women.

Specific CpG hyper-methylation leads to Ankrd26 gene down-regulation in white adipose tissue of a mouse model of diet-induced obesity.

Epigenetic modifications alter transcriptional activity and contribute to the effects of environment on the individual risk of obesity and Type 2 Diabetes (T2D). Here, we have estimated the in vivo effect of a fat-enriched diet (HFD) on the expression and the epigenetic regulation of the Ankyrin repeat domain 26 (Ankrd26) gene, which is associated with the onset of these disorders. In visceral adipose tissue (VAT), HFD exposure determined a specific hyper-methylation of Ankrd26 promoter at the -436 and -431 bp CpG sites (CpGs) and impaired its expression.

A Cycle Ergometer Exercise Program Improves Exercise Capacity and Inspiratory Muscle Function in Hospitalized Patients Awaiting Heart Transplantation: a Pilot Study.

Objective: The purpose of this study was to evaluate the effect of a cycle ergometer exercise program on exercise capacity and inspiratory muscle function in hospitalized patients with heart failure awaiting heart transplantation with intravenous inotropic support.

Methods: Patients awaiting heart transplantation were randomized and allocated prospectively into two groups: 1) Control Group (n=11) - conventional protocol; and 2) Intervention Group (n=7) - stationary cycle ergometer exercise training. Functional capacity was measured by the six-minute walk test and inspiratory muscle strength assessed by manovacuometry before and after the exercise protocols.

Can axillary node dissection be safely omitted in the elderly? A retrospective study on axillary management of early breast cancer in older women.

Introduction: Sentinel lymph node biopsy (SLNB) is a minimally invasive technique to stage the axillary lymph node status. The burden of nodal metastasis is of great concern, as the clinical relevance and therapeutic implications of pN1mi and pN0(i+) in the sentinel lymph node (SLN) remain a matter of debate.

Materials And Methods: We examined the pathological features of 901 patients above the age of 65 presenting with clinical T1-T2 N0M0 breast tumours (<3 cm), detecting tumours related to llary non-sentinel node (NSN) metastases when the SLN was minimally involved.

Oxidative Stress Mediates the Antiproliferative Effects of Nelfinavir in Breast Cancer Cells.

The discovery of the anti-proliferative activity of nelfinavir in HIV-free models has encouraged its investigation as anticancer drug. Although the molecular mechanism by which nelfinavir exerts antitumor activity is still unknown, its effects have been related to Akt inhibition. Here we tested the effects of nelfinavir on cell proliferation, viability and death in two human breast cancer cell lines and in human normal primary breast cells.

Laparoscopic Adjustable Gastric Banding (LAGB) Plus Anterior Fundoplication Versus LAGB Alone: A Prospective Comparative Study.

Background: Laparoscopic adjustable gastric banding (LAGB) is a well-established and effective bariatric procedure, whose outcomes can be compromised by the slippage and the following removal of the band; the association between LAGB and gastric plication has recently been proved as a successful treatment for morbid obesity. The aim of this prospective randomized study was to compare weight loss and slippage rate between LAGB and LAGB plus anterior fundoplication.

Methods: From January 2012 to May 2012, a total of 40 patients were allocated to undergo either LAGB (group A, n=20) or LAGB plus anterior fundoplication (group B, n=20).

Rhabdomyolysis after bariatric surgery: a multicenter, prospective study on incidence, risk factors, and therapeutic strategy in a cohort from South Italy.

Background: At present, prospectively collected data on rhabdomyolysis (RML) after bariatric surgery are limited.

Objectives: To evaluate the incidence, risk factors, and therapeutic strategy of RML in different bariatric procedures.

Setting: University hospitals, Italy.

Open-Lung Ventilation Improves Clinical Outcomes in Off-Pump Coronary Artery Bypass Surgery: A Randomized Controlled Trial.

Objective: To compare pulmonary function, functional capacity, and clinical outcomes among conventional mechanical ventilation (CMV), early open-lung (EOL), and late open-lung (LOL) strategies after off-pump coronary artery bypass surgery (OPCAB).

Design: Prospective, randomized, and double-blinded study.

Setting: Two hospitals of the Federal University of Sao Paulo, Brazil.

Recurrent abdominal pain in 52-year-old male.

Key Clinical Message Intussusception of the appendix is a rare condition. Symptoms vary widely, whereas some patients are asymptomatic. Diagnosis is generally challenging and few cases have been diagnosed by colonoscopy.

Long-term survival after curative resection for pancreatic ductal adenocarcinoma--Surgical treatment.

Introduction: Recent reports have demonstrated improvement in the 5-years serviva with resecate ductal adenocarcinoma. The aim of study is to determinate the factor influencing long-term survival after DCP.

Materials And Methods: We have critically reviewed a group of 85 patients how were admitted to our department with diagnosis of ductal adenocarcinoma of the head of pancreas between January 1974 and January 1998.

Confocal laser endomicroscopy in breast surgery: a pilot study.

Background: Breast neoplasms include different histopathological entities, varying from benign tumors to highly aggressive cancers. Despite the key role of imaging, traditional histology is still required for a definitive diagnosis. Confocal Laser Endomicroscopy (CLE) is a new technique, which enables to obtain histopathological images in vivo, currently used in the diagnosis of gastrointestinal diseases.

Endoscopic snare papillectomy: a single institutional experience of a standardized technique. A retrospective cohort study.

Background: Indications for endoscopic snare papillectomy (ESP) remain controversial. Main concerns with ESP are related to the incomplete removal of the lesion, high recurrence rates and inadequate oncological resection. Aim of the study is to report short and long term outcomes after endoscopic papillectomy in a single institutional series with strict inclusion criteria and a standardized technique.

Intragastric balloon for obesity treatment: results of a multicentric evaluation for balloons left in place for more than 6 months.

Background: Obesity is a major risk factor for several chronic diseases. The BioEnterics(®) Intragastric Balloon (BIB(®)) is used worldwide as a short-term (6 months) treatment in morbid obese patients. However, removal of BIB(®) past 6 months is a common occurrence in clinical practice often as a result of patient factors.

A case of coffee-ground emesis in an elderly patient.

Black esophagus is an exceeding rare disorder with a multifactorial etiology. Clinical presentation is generally related to upper gastrointestinal bleeding. Diagnosis is based on endoscopic images.

The use of a fibrin glue with a low concentration of thrombin decreases seroma formation in postbariatric patients undergoing circular abdominoplasty.

Background: The serum collection under the abdominal flap is the most common complication after a lipo-abdominoplasty. The frequency of seroma increases further among obese patients, who have achieved massive weight loss after bariatric surgery. The purpose of this study is to demonstrate the effectiveness of fibrin glues with a low concentration of thrombin in reducing seroma formation after a lipo-abdominoplasty.

Clinically cN0 breast cancer in elderly: what surgery?

Introduction: Breast carcinoma is the most common cancer in women worldwide. The incidence increases with age. Elderly patients have more advanced disease than younger ones, but they have a more favorable biologic tumor profile overall.