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Sohail MU, Mashood F, Oberbach A, Chennakkandathil S, Schmidt F. The role of pathogens in diabetes pathogenesis and the potential of immunoproteomics as a diagnostic and prognostic tool. Front Microbiol 2022; 13:1042362. [DOI: 10.3389/fmicb.2022.1042362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022] Open
Abstract
Diabetes mellitus (DM) is a group of metabolic diseases marked by hyperglycemia, which increases the risk of systemic infections. DM patients are at greater risk of hospitalization and mortality from bacterial, viral, and fungal infections. Poor glycemic control can result in skin, blood, bone, urinary, gastrointestinal, and respiratory tract infections and recurrent infections. Therefore, the evidence that infections play a critical role in DM progression and the hazard ratio for a person with DM dying from any infection is higher. Early diagnosis and better glycemic control can help prevent infections and improve treatment outcomes. Perhaps, half (49.7%) of the people living with DM are undiagnosed, resulting in a higher frequency of infections induced by the hyperglycemic milieu that favors immune dysfunction. Novel diagnostic and therapeutic markers for glycemic control and infection prevention are desirable. High-throughput blood-based immunoassays that screen infections and hyperglycemia are required to guide timely interventions and efficiently monitor treatment responses. The present review aims to collect information on the most common infections associated with DM, their origin, pathogenesis, and the potential of immunoproteomics assays in the early diagnosis of the infections. While infections are common in DM, their role in glycemic control and disease pathogenesis is poorly described. Nevertheless, more research is required to identify novel diagnostic and prognostic markers to understand DM pathogenesis and management of infections. Precise monitoring of diabetic infections by immunoproteomics may provide novel insights into disease pathogenesis and healthy prognosis.
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Oberbach A, Schlichting N, Hagl C, Lehmann S, Kullnick Y, Friedrich M, Köhl U, Horn F, Kumbhari V, Löffler B, Schmidt F, Joskowiak D, Born F, Saha S, Bagaev E. Four decades of experience of prosthetic valve endocarditis reflect a high variety of diverse pathogens. Cardiovasc Res 2022; 119:410-428. [PMID: 35420122 DOI: 10.1093/cvr/cvac055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/04/2022] [Accepted: 03/23/2022] [Indexed: 01/18/2023] Open
Abstract
Prosthetic valve endocarditis (PVE) remains a serious condition with a high mortality rate. Precise identification of the PVE-associated pathogen/s and their virulence is essential for successful therapy, and patient survival. The commonly described PVE-associated pathogens are staphylococci, streptococci and enterococci, with Staphylococcus aureus being the most frequently diagnosed species. Furthermore, multi-drug resistance pathogens are increasing in prevalence, and continue to pose new challenges mandating a personalized approach. Blood cultures in combination with echocardiography are the most common methods to diagnose PVE, often being the only indication, it exists. In many cases, the diagnostic strategy recommended in the clinical guidelines does not identify the precise microbial agent and to frequently, false negative blood cultures are reported. Despite the fact that blood culture findings are not always a good indicator of the actual PVE agent in the valve tissue, only a minority of re-operated prostheses are subjected to microbiological diagnostic evaluation. In this review, we focus on the diversity and the complete spectrum of PVE-associated bacterial, fungal and viral pathogens in blood, and prosthetic heart valve, their possible virulence potential, and their challenges in making a microbial diagnosis. We are curious to understand if the unacceptable high mortality of PVE is associated with the high number of negative microbial findings in connection with a possible PVE. Herein, we discuss the possibilities and limits of the diagnostic methods conventionally used and make recommendations for enhanced pathogen identification. We also show possible virulence factors of the most common PVE-associated pathogens and their clinical effects. Based on blood culture, molecular biological diagnostics, and specific valve examination, better derivations for the antibiotic therapy as well as possible preventive intervention can be established in the future.
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Affiliation(s)
- Andreas Oberbach
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany.,Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany
| | - Nadine Schlichting
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany.,Munich Heart Alliance, Partner Site German Centre for Cardiovascular Disease (DZHK), Munich, Germany
| | - Stefanie Lehmann
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Yvonne Kullnick
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Maik Friedrich
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Ulrike Köhl
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Friedemann Horn
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Florida, USA
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Frank Schmidt
- Proteomics Core, Weill Cornell Medical Centre Qatar, Doha, Qatar
| | - Dominik Joskowiak
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Frank Born
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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Bagaev E, Ali A, Saha S, Sadoni S, Orban M, Naebauer M, Mehilli J, Massberg S, Oberbach A, Hagl C. Hybrid Surgery for Severe Mitral Valve Calcification: Limitations and Caveats for an Open Transcatheter Approach. Medicina (Kaunas) 2022; 58:medicina58010093. [PMID: 35056401 PMCID: PMC8777627 DOI: 10.3390/medicina58010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Mitral stenosis with extensive mitral annular calcification (MAC) remains surgically challenging in respect to clinical outcome. Prolonged surgery time with imminent ventricular rupture and systolic anterior motion can be considered as a complex of causal factors. The aim of our alternative hybrid approach was to reduce the risk of annual rupture and paravalvular leaks and to avoid obstruction of the outflow tract. A review of the current literature was also carried out. Materials and Methods: Six female patients (mean age 76 ± 9 years) with severe mitral valve stenosis and severely calcified annulus underwent an open implantation of an Edwards Sapien 3 prosthesis on cardiopulmonary bypass. Our hybrid approach involved resection of the anterior mitral leaflet, placement of anchor sutures and the deployment of a balloon expanded prosthesis under visual control. Concomitant procedures were carried out in three patients. Results: The mean duration of cross-clamping was 95 ± 31 min and cardiopulmonary bypass was 137 ± 60 min. The perioperative TEE showed in three patients an inconspicuous, heart valve-typical gradient on all implanted prostheses and a clinically irrelevant paravalvular leakage occurred in the anterior annulus. In the left ventricular outflow tract, mild to moderately elevated gradients were recorded. No adverse cerebrovascular events and pacemaker implantations were observed. All but one patient survived to discharge. Survival at one year was 83.3%. Conclusions: This “off label” implantation of the Edwards Sapien 3 prosthesis may be considered as a suitable bail-out approach for patients at high-risk for mitral valve surgery or deemed inoperable due to extensive MAC.
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Affiliation(s)
- Erik Bagaev
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Ahmad Ali
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
| | - Shekhar Saha
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
- Correspondence:
| | - Sebastian Sadoni
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
| | - Martin Orban
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
| | - Michael Naebauer
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
| | - Julinda Mehilli
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
- Medizinische Klinik I, Landshut-Achdorf Hospital, 84036 Landshut, Germany
| | - Steffen Massberg
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
| | - Andreas Oberbach
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
| | - Christian Hagl
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
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Itani MI, Oberbach A, Salimian KJ, Enderle M, Hahn H, Abbarh S, Kendrick K, Schlichting N, Anders RA, Besharati S, Farha J, Fayad L, Kalloo AN, Badurdeen D, Kumbhari V. Gastric Mucosal Devitalization (GMD): Using the Porcine Model to Develop a Novel Endoscopic Bariatric Approach. Obes Surg 2021; 32:381-390. [PMID: 34797503 DOI: 10.1007/s11695-021-05773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/10/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS As the pig model has similar gastrointestinal anatomy and physiology to humans, we used pigs to create a gastric mucosal devitalization (GMD) model in preparation for clinical translation of this technique as an endoscopic bariatric therapy (EBT). The aims of this study were to determine the ablation parameters and technique for a successful, safe, and feasible large surface area GMD that produces weight loss. METHODS We performed GMD using argon plasma coagulation (APC) in 3 phases. Phase 1 assessed the ablation energy required to accomplish selective mucosal ablation using ex vivo pig stomachs (n = 2). Phase 2 assessed the optimal percentage of mucosal surface area to be treated and was performed on 10 pigs. Phase 3 assessed feasibility, efficacy, and safety with 8 pigs randomized into GMD (n = 4) or sham (SH, n = 4) and survived for 1 month. Body weights (GMD, n = 4, SH, n = 4) were measured daily in phase 3 for 1 month, and relative body weights were calculated and analyzed using one-tailed Student's t-test. Percent body fat was compared between GMD and SH at baseline and 1 month post-GMD. RESULTS Phase 1 identified the optimal ablation parameters (120 W) that were then used in phase 2. Phase 2 revealed a trend that was suggestive that the optimal percent surface area to ablate was similar to that which is removed at laparoscopic sleeve gastrectomy. In phase 3, GMD was performed over 70% surface area of the greater curvature of the stomach in four pigs. GMD pigs had significantly lower relative body weight increase compared to SH at 1 month (1.375 ± 0.085 vs 1.575 ± 0.047, p = 0.0435). MRI showed a significantly lower body fat mass at 1 month in GMD pigs (5.9 ± 0.4% vs 12.7 ± 2.3%, p = 0.026) compared to SH. CONCLUSIONS GMD resulted in decreased weight gain in the GMD group as evidenced by a lower relative body weight at 1 month. GMD in an animal model appears to show promise as a potential weight loss therapy.
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Affiliation(s)
- Mohamad I Itani
- Department of Internal Medicine, Wayne State University, Detroit, MI, 48201, USA.,Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Kevan J Salimian
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | | | | | - Shahem Abbarh
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Katherine Kendrick
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Nadine Schlichting
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Robert A Anders
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Sepideh Besharati
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA. .,Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, 32224, USA.
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5
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Farha J, Gebran S, Itani MI, Simsek C, Abbarh S, Lopez A, Haq Z, Koller K, Dunlap M, Adam A, Khashab MA, Oberbach A, Schweitzer M, Badurdeen D, Kumbhari V. Transoral outlet reduction: could additional sutures cause more harm? Endoscopy 2021; 53:1059-1064. [PMID: 33254242 DOI: 10.1055/a-1325-4324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The double purse-string pattern (DPSP) of transoral outlet reduction (TORe) should conceivably result in a more robust scaffolding for the gastrojejunal anastomosis (GJA). However, there is a paucity of literature pertaining to post-TORe stenosis as an adverse event. Our aim was to determine the rate of stenosis, its potential predictors, and other complications of DPSP TORe. METHODS We performed a retrospective analysis of a prospectively maintained database of 129 consecutive patients who underwent DPSP TORe between December 2015 and August 2019. RESULTS The adverse event rate of TORe was 17.1 % (n = 22), with a 13.3 % (n = 17) rate of stenosis. Stenosis was not significantly associated with any baseline characteristics. GJA diameter pre- and post-TORe, the difference between these values, and procedure duration were not predictive of stenosis. Of patients who developed stenosis, 10 (58.8 %) responded to endoscopic balloon dilation and 7 (41.2 %) required stent placement. CONCLUSION As the DPSP technique is a challenging procedure, with high complication rate and limited benefit, it should not be used for TORe.
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Affiliation(s)
- Jad Farha
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Selim Gebran
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, United States
| | - Mohamad I Itani
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Cem Simsek
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Shahem Abbarh
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ariana Lopez
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Zadid Haq
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Kristen Koller
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Margo Dunlap
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Atif Adam
- Department of Mental Health at The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Mouen A Khashab
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Andreas Oberbach
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States.,Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Michael Schweitzer
- Department of Surgery, The Johns Hopkins Center for Bariatric Surgery, Baltimore, Maryland, United States
| | - Dilhana Badurdeen
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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Farha J, McGowan C, Hedjoudje A, Itani MI, Abbarh S, Simsek C, Ichkhanian Y, Vulpis T, James TW, Fayad L, Khashab MA, Oberbach A, Badurdeen D, Kumbhari V. Endoscopic sleeve gastroplasty: suturing the gastric fundus does not confer benefit. Endoscopy 2021; 53:727-731. [PMID: 32777827 DOI: 10.1055/a-1236-9347] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND : There is heterogeneity regarding the technical aspects of endoscopic sleeve gastroplasty (ESG), such as applying fundal sutures. Our aim was to determine whether ESG with fundal suturing (ESG-FS) affects weight loss and the serious adverse event (SAE) rate when compared with ESG with no fundal suturing (ESG-NFS). METHODS: We conducted a two-center retrospective analysis of 247 patients who underwent ESG with or without fundal suturing. The primary outcome was percentage excess weight loss (%EWL) at 3, 6, and 12 months post-ESG. The secondary outcomes included the SAE rate and procedure duration. RESULTS: At 3, 6, and 12-months, ESG-NFS had a significantly greater mean %EWL compared with ESG-FS (38.4 % [standard deviation (SD) 15.3 %] vs. 31.2 % [SD 13.9 %], P = 0.001; 54.7 % [SD 19.2 %] vs. 37.7 % [SD 17.3 %], P < 0.001; 65.3 % [SD 21.1 %] vs. 40.6 % [SD 23.5 %], P < 0.001, respectively). There was no statistically significant difference in the SAE rates for ESG-NFS (n = 2; 2.0 %) and ESG-FS (n = 4; 2.6 %; P > 0.99). The mean procedure time was significantly shorter in the ESG-NFS group at 59.1 minutes (SD 32.7) vs. 93.0 minutes (35.5; P < 0.001), and a lower mean number of sutures were used, with 5.7 (SD 1.1) vs. 8.4 (SD 1.6; P < 0.001). CONCLUSION : ESG-NFS demonstrated greater efficacy and shorter procedure duration. Therefore, fundal suturing should not be performed.
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Affiliation(s)
- Jad Farha
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Abdellah Hedjoudje
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Shahem Abbarh
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Cem Simsek
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Trish Vulpis
- WakeMed Cary Hospital, Cary, North Carolina, USA
| | - Theodore W James
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Andreas Oberbach
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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7
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Farha J, Abbarh S, Haq Z, Itani MI, Oberbach A, Kumbhari V, Badurdeen D. Endobariatrics and Metabolic Endoscopy: Can We Solve the Obesity Epidemic with Our Scope? Curr Gastroenterol Rep 2020; 22:60. [PMID: 33205261 DOI: 10.1007/s11894-020-00798-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Obesity is a chronic relapsing disease that results in cardiovascular disease, diabetes mellitus, and non-alcoholic fatty liver disease. Currently, surgery represents the most effective treatment. However, the advent of minimally invasive endoscopic bariatric therapy (EBT) has shifted the treatment paradigm to less invasive, cost-effective procedures with minimal complications and recovery time that are preferred by patients. In this review, we will describe current and future EBTs, focusing on outcomes and safety. RECENT FINDINGS The endoscope has provided an incisionless portal into the gastrointestinal tract for placement of space-occupying devices and intraluminal procedures. EBTs are no longer solely manipulating anatomic alterations; instead, they aim to improve metabolic parameters such as glycated hemoglobin, low-density lipoprotein, cholesterol, and hepatic indices by targeting the mucosal layer of the gastrointestinal tract. The endoscope has succeeded in facilitating clinically meaningful weight loss and improvement of metabolic parameters. Future, solutions to the obesity epidemic will likely entail genetic testing, evaluation of the microbiome, and delivery of personalized therapy, utilizing combination endoscopic modalities that change the anatomy and physiology of individual patients, with new targets such as the abnormal metabolic signal.
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Affiliation(s)
- Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Shahem Abbarh
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Zadid Haq
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Badurdeen D, Hedjoudje A, Itani M, Fayad L, Farha J, Dunlap M, Cheskin L, Schweitzer M, Koller K, Hartman C, Oberbach A, Kashab MA, Kalloo A, Kumbhari V. Building an endobariatric program: lessons learned. Endosc Int Open 2020; 8:E1185-E1193. [PMID: 32908949 PMCID: PMC7473785 DOI: 10.1055/a-1198-4598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/22/2020] [Indexed: 11/16/2022] Open
Abstract
The emphasis on treating obesity has never been more critical, yet the complexity of delivering care has become more intricate due to new procedures, variable insurance coverage, and inconsistent reimbursement. This is our experience building an endobariatric program and treating overweight and obese patients with endobariatric therapies (EBTs) over 3 years. The primary intention of this manuscript was to educate the reader on how to build an endobariatric program, identify barriers, and provide succinct solutions to establish a successful program. The secondary aim was weight loss outcomes of procedures offered at our institution. We compiled a list of lessons learned, based on the difficulties we experienced to make it easy for others embarking on this journey. Herein, we present a business development strategy to overcome impediments, whilst offering high quality service. The high cost and lack of insurance coverage are significant barriers. Marketing can be costly and is often a factor that is ignored particularly early on, when finances are limited. However, it is an integral component of growing the program. The percentage total body weight loss (%TBWL) at 6 and 12 months post ESG was 17.8 ± 6.48 and 20.6 ± 8.3 ( P < 0.001), respectively. The %TBWL at 6 months post IGB was 14.9 ± 9.8 for the Orbera IGB and 12.6 ± 7.4 for the Reshape IGB. There was a trend of preference for ESG compared to IGB placement over the 3 years. The key to building a successful endobariatric program is a motivated physician leader, collaborative bariatric surgeons, institutional support, and marketing. Insurance coverage will likely occur in the near future and programs must be prepared to manage the massive influx of patients that will likely request these procedures.
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Affiliation(s)
- Dilhana Badurdeen
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Abdellah Hedjoudje
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States,Hôpital Beaujon – Département d'endoscopie digestive, Clichy, France
| | - Mohamad Itani
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Lea Fayad
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Jad Farha
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Margo Dunlap
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Lawrence Cheskin
- Johns Hopkins University Bloomberg School of Public Health – Weight Management Center, Baltimore, Maryland, United States
| | - Michael Schweitzer
- Johns Hopkins Medicine – Department of Surgery, Baltimore, Maryland, United States
| | - Kristen Koller
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Christian Hartman
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Andreas Oberbach
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Mouen A. Kashab
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Anthony Kalloo
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Johns Hopkins Medical Institutions – Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
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Schmalz G, Eisner M, Binner C, Wagner J, Rast J, Kottmann T, Haak R, Oberbach A, Borger MA, Garbade J, Ziebolz D. Oral health-related quality of life of patients after heart transplantation and those with heart failure is associated with general health-related quality of life: a cross-sectional study. Qual Life Res 2020; 29:1621-1630. [PMID: 32020562 PMCID: PMC7253387 DOI: 10.1007/s11136-020-02439-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this cross-sectional study was to examine the oral health-related quality of life (OHRQoL) in patients after heart transplantation (HTx) and those with heart failure (HF). METHODS In total, 186 participants (HTx: 104, HF: 82) were recruited from the University Department for Cardiac Surgery, Leipzig Heart Centre, Germany. OHRQoL was assessed with the German short form of the oral health impact profile (OHIP-G14). Health-related quality of life (HRQoL) was evaluated using the short form 36 survey (SF-36). Furthermore, the dental and periodontal treatment need was recorded. RESULTS With an OHIP-G14 sum score of 6.58 ± 6.40 [5; 2.5-8] in the HTx group and 5.54 ± 5.47 [5; 2-7] in the HF group, no clinically relevant or statistically significant difference was apparent (p = 0.39). The SF-36 scales for physical functioning, role-physical, general health and vitality were significantly worse in the HF group compared with the HTx group (pi < 0.01). A worse SF-36 physical component summary was significantly associated with a higher OHIP-G14 sum score (HTx: p < 0.01, HF: p = 0.04). In the HTx group, a significant association was also observed for the mental component summary (p < 0.01). Multiple regression analysis revealed physical component summary (p = 0.04) and mental component summary (p < 0.01) in HTx, and physical component summary (p = 0.02), mental component summary (p = 0.02) and smoking (p < 0.01) as significant predictors for OHIP G14 in HF. CONCLUSION The OHRQoL in HF and HTx patients appears to be mainly associated with general HRQoL. Therefore, multidisciplinary dental care concepts may be recommended to improve oral health conditions in these patients.
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Affiliation(s)
- Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Mirjam Eisner
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Christian Binner
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Justus Wagner
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Josephine Rast
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | | | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Jens Garbade
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
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Fayad L, Simsek C, Oleas R, Ichkhanian Y, Fayad GE, Ngamreungphong S, Schweitzer M, Oberbach A, Kalloo AN, Khashab MA, Kumbhari V. Safety and Efficacy of Endoscopically Secured Fully Covered Self-Expandable Metallic Stents (FCSEMS) for Post-Bariatric Complex Stenosis. Obes Surg 2020; 29:3484-3492. [PMID: 31254212 DOI: 10.1007/s11695-019-04021-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The use of fully covered self-expandable metallic stents (FCSEMS) has opened the door to treat stenosis in the post-bariatric stomach. We hypothesized that endoscopically securing a FCSEMS would be technically feasible, effective, and safe for > 30-day dwell time. OBJECTIVES To assess the technical feasibility, clinical efficacy, and safety of endoscopically secured FCSEMS in the stomach for > 30 days. METHODS A retrospective review (September 2016 to April 2018) of consecutive patients who underwent FCSEMS suturing in the stomach at a single academic institution was reviewed. Technical success, stent dwell time, symptoms, and adverse events were recorded. RESULTS Fifteen patients (median age of 49 (31-70)) were included. Stents were inserted for gastrojejunal (GJ) stricture or gastric stenosis in 9/15 and 6/15 of patients, respectively. All procedures were technically successful (100%). Immediate and short-term clinical success (prior to stent removal) was 100% in patients who did not have stent migration. Stent migration was seen in 3 cases (20%) after a median dwell time of 211 days. However, 2/3 (66.6%) had not attended their scheduled removal. Recurrence of symptoms after stent removal was seen in 53.3% of patients with 40% undergoing repeat stenting. Median stent dwell was 117 (30-342) days. Sixty percent and 33% of patients had stent dwell of at least 90 and 180 days, respectively. CONCLUSIONS A FCSEMS, if secured, may be safe and effective for even > 90-day dwell time in the post-bariatric stomach and may result in long-term clinical success for GJ stricture after stent removal.
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Affiliation(s)
- Lea Fayad
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Cem Simsek
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Roberto Oleas
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Georges E Fayad
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Michael Schweitzer
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andreas Oberbach
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Anthony N Kalloo
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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11
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Garbade J, Rast J, Schmalz G, Eisner M, Wagner J, Kottmann T, Oberbach A, Lehmann S, Haak R, Borger MA, Binner C, Ziebolz D. Oral health and dental behaviour of patients with left ventricular assist device: a cross-sectional study. ESC Heart Fail 2020; 7:1273-1281. [PMID: 32027102 PMCID: PMC7261540 DOI: 10.1002/ehf2.12636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/08/2020] [Accepted: 01/21/2020] [Indexed: 12/26/2022] Open
Abstract
Aims The aim of this cross‐sectional study was the assessment of dental behaviour, oral health, as well as oral health‐related quality of life of patients with left ventricular assist device (LVAD). Methods and results Patients (128) with LVAD were recruited from the University Department for Cardiac Surgery at Heart Center, Leipzig, Germany. A healthy control group (HC, n = 113) was included. Dental behaviour was assessed with a standardized questionnaire, and to evaluate oral health‐related quality of life, the German short form of oral health impact profile was applied. The presence of decayed, missing, and filled teeth; dental treatment need; periodontitis severity; and periodontal treatment need were assessed. These findings were correlated to disease‐related and device‐related factors. The minority of patients used aids for interdental hygiene (16.4%). For the LVAD patients, a German short form of oral health impact profile sum score of 4.96 ± 8.67 [0.5; 0–6] was assessed. The LVAD group suffered from more missing teeth (11.91 ± 9.13 vs. 3.70 ± 3.77; P < 0.01) than HC. More severe periodontitis was found in LVAD group (LVAD = 41.4% and HC = 27.4%; P < 0.01). Periodontal treatment need was high in both groups, without a significant difference (LVAD = 84.4% vs. HC = 86.7%; P = 0.71). LVAD therapy as bridge to transplantation was correlated with periodontal treatment need (odds ratio = 11.48 [1.27; 103.86]; P = 0.03). Further correlations between treatment need and disease specific factors were not detected. Conclusions Patients with LVAD suffer from a high periodontal treatment need and a lack in oral behaviour. Interdisciplinary special care concepts appear recommendable to improve oral health in LVAD patients.
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Affiliation(s)
- Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Josephine Rast
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
| | - Mirjam Eisner
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
| | - Justus Wagner
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
| | | | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology Leipzig, Leipzig, Germany
| | - Sven Lehmann
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Christian Binner
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
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12
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Ziebolz D, Friedrich S, Binner C, Rast J, Eisner M, Wagner J, Schmickler J, Kottmann T, Haak R, Borger MA, Lehmann S, Oberbach A, Garbade J, Schmalz G. Lack in Periodontal Care of Patients Suffering from Severe Heart Diseases-Results after 12 Months Follow-Up. J Clin Med 2020; 9:jcm9020352. [PMID: 32012698 PMCID: PMC7073650 DOI: 10.3390/jcm9020352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To assess whether the standardized recommendation of patients with heart failure (HF), left-ventricular assist device (LVAD) and heart transplantation (HTx) to visit their dentist leads to improved oral conditions after 12 months. METHODS Patients from the Department of Cardiothoracic Surgery, Leipzig Heart Centre, Germany were examined at baseline and after 12 months. A dental (decayed-, missing-, and filled-teeth index (DMF-T)) and periodontal examination (periodontal probing depth, clinical attachment loss) was performed. At baseline, patients received a standardized recommendation to visit their dentist. At follow-up, a standardized questionnaire regarding the dental consultation was applied. RESULTS Eighty-eight participants (HTx: 31, LVAD: 43, HF: 14) were included. The majority of patients (79.5%) followed the recommendation to visit their dentist. Within the total cohort, periodontal treatment need was significantly reduced from 91% (baseline) to 75% (follow-up; p < 0.01). Only 10% of total cohort stated that they received periodontal treatment. The outcome in periodontal and dental treatment need at follow-up appointment revealed no statistically significant associations to the questionnaire regarding dentist consultation (p > 0.05). Conclusions: The simple recommendation to visit the dentist appears not enough to obtain sufficient dental and periodontal conditions in patients with severe heart diseases. Thereby, a lack in periodontal treatment of patients with HF, HTx and LVAD was identified, making interdisciplinary dental special care programs recommendable.
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Affiliation(s)
- Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
- Correspondence: ; Tel.: +49-341-97-21211
| | - Sylvia Friedrich
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Christian Binner
- University Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany; (C.B.); (M.A.B.); (S.L.); (J.G.)
| | - Josephine Rast
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Mirjam Eisner
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Justus Wagner
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Jan Schmickler
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Tanja Kottmann
- CRO Dr. med. Kottmann GmbH & Co. KG, 59077 Hamm, Germany;
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Michael A. Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany; (C.B.); (M.A.B.); (S.L.); (J.G.)
| | - Sven Lehmann
- University Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany; (C.B.); (M.A.B.); (S.L.); (J.G.)
| | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, 04103 Leipzig, Germany;
| | - Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany; (C.B.); (M.A.B.); (S.L.); (J.G.)
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
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13
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Born F, Wieser A, Oberbach A, Oberbach A, Ellgass R, Peterss S, Kur F, Grabein B, Hagl C. Five Years without Mycobacterium chimaera. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Fayad L, Oberbach A, Schweitzer M, Askin F, Voltaggio L, Larman T, Enderle M, Hahn H, Khashab MA, Kalloo AN, Kumbhari V. Gastric mucosal devitalization (GMD): translation to a novel endoscopic metabolic therapy. Endosc Int Open 2019; 7:E1640-E1645. [PMID: 31788546 PMCID: PMC6877422 DOI: 10.1055/a-0957-3067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/27/2019] [Indexed: 01/08/2023] Open
Abstract
Background and study aims The metabolic effects of bariatric surgery may partially result from removal of the gastric mucosa, an often underappreciated endocrine organ. Using argon plasma coagulation (APC), we may be able to selectively devitalize (ablate) the mucosa. The aim of this study was to identify the optimal tissue color that would correspond to selective gastric mucosal devitalization (GMD) using ex-vivo human stomach specimens. Patients and methods Stomach specimens were obtained at sleeve gastrectomy. Prior to APC application, a submucosal fluid cushion was created. APC was then applied over a 2 × 2-cm area to the fundus and body, aiming for the three indicator colors (white, golden, brown). Pathological analysis was then performed independently and in a blinded fashion by two pathologists to determine the depth of mucosal and submucosal percent thermal injury and mucosal percent cell death. Results Six patients were enrolled. There was a significant correlation between tissue color and mucosal percent thermal injury. The highest percent mucosal thermal injury was seen with brown (99.6 %, 95 % CI: 98.7, 100), followed by golden (92.5 %, 95 % CI: 85.5, 99.5), and then white (75.2 %, 95 % CI: 58.3, 92.1, P < 0.01). Submucosal thermal injury was seen in 88.9 % of the slides. Greater than minimal submucosal injury (> 10 % depth) was found significantly more with brown tissue color (91.6 %) than golden (75 %) or white (33.3 %, P < 0.05). However, 91.7 % of the entire sample set < 50 % injury. Conclusion GMD is achievable using APC without thermal injury to muscularis propria. A golden color results in sufficient mucosal injury with only superficial injury to the submucosa.
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Affiliation(s)
- Lea Fayad
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Andreas Oberbach
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States,Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | | | - Frederic Askin
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | | | - Tatianna Larman
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | | | | | - Mouen A. Khashab
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Anthony N. Kalloo
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States,Corresponding author Vivek Kumbhari, Associate Professor of Medicine Division of Gastroenterology and HepatologyDirector of Bariatric EndoscopyJohns Hopkins Medical InstitutionsSheikh Zayed Building1800 Orleans Street, Suite 7125GBaltimore, MD 21287
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15
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Oberbach A, Schlichting N, Kullnick Y, Heinrich M, Lehmann S, Retschlag U, Friedrich M, Fayad L, Dietrich A, Khashab MA, Kalloo AN, Kumbhari V. Gastric mucosal devitalization improves blood pressure, renin and cardiovascular lipid deposition in a rat model of obesity. Endosc Int Open 2019; 7:E1605-E1615. [PMID: 31788541 PMCID: PMC6877424 DOI: 10.1055/a-0990-9683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background and study aims In lieu of the drawbacks of metabolic surgery, a method of mimicking resection of the gastric mucosa could be of value to those with obesity-related cardiovascular disease (CVD). Our study aims to investigate the effect of gastric mucosal devitalization (GMD) on blood pressure (BP) and cardiovascular lipid deposition in a rat model of obesity. Methods GMD of 70 % of the stomach was achieved by argon plasma coagulation. GMD was compared to sleeve gastrectomy (SG) and sham (SH) in a high-fat-diet-induced rat model of obesity (48 rats). At 8 weeks, we measured noninvasive BP, renin, vessel relaxation and ghrelin receptor regulation in the aorta. In addition, we quantified cardiac lipid deposition and lipid droplet deposition in cardiac muscle and aorta. Results GMD and SG were observed to have similar reductions in body weight, visceral adiposity, and serum lipid profile compared to SH rats. GMD resulted in a significant reduction in arterial BP compared to SH. Furthermore, there were significant reductions in plasma renin activity and percentage of phenylnephrine constriction to acetylcholine at the aortic ring in GMD rats compared to SH, providing insights into the mechanisms behind the reduced BP. Interestingly, the reduced BP occurred despite a reduction in endothelial ghrelin recteptor activation. Cardiac lipid content was significantly reduced in GMD rats. Lipid deposition, as illustrated by Nile Red stain, was reduced in cardiac muscle and the aorta. Conclusion GMD resulted in a significant improvement in BP, renin and cardiovascular lipid deposition. GMD deserves further attention as a method of treating obesity-related CVD.
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Affiliation(s)
- Andreas Oberbach
- Department of Medicine and Division of Gastroenterology and Hepatology. The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States,Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany,Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Nadine Schlichting
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany,Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Yvonne Kullnick
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany
| | - Marco Heinrich
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany
| | - Stefanie Lehmann
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany,Department of Internal Medicine, University of Leipzig, Leipzig, Germany
| | - Ulf Retschlag
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany,Integrated Research and Treatment Centre Obesity Diseases, Leipzig University, Leipzig, Germany
| | - Maik Friedrich
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany
| | - Lea Fayad
- Department of Medicine and Division of Gastroenterology and Hepatology. The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Arne Dietrich
- Integrated Research and Treatment Centre Obesity Diseases, Leipzig University, Leipzig, Germany
| | - Mouen A. Khashab
- Department of Medicine and Division of Gastroenterology and Hepatology. The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Anthony N. Kalloo
- Department of Medicine and Division of Gastroenterology and Hepatology. The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Department of Medicine and Division of Gastroenterology and Hepatology. The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States,Corresponding author Vivek Kumbhari Assistant Professor of MedicineDivision of Gastroenterology and HepatologyDirector of Bariatric EndoscopyJohns Hopkins Medical InstitutionsSheikh Zayed Building1800 Orleans Street, Suite 7125GBaltimore, MD 21287
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16
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Luehr M, Bauernschmitt N, Peterss S, Li Y, Heyn O, Dashkevich A, Oberbach A, Bagaev E, Pichlmaier MA, Juchem G, Hagl C. Incidence and Surgical Outcomes of Patients With Native and Prosthetic Aortic Valve Endocarditis. Ann Thorac Surg 2019; 110:93-101. [PMID: 31794735 DOI: 10.1016/j.athoracsur.2019.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/23/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to retrospectively evaluate the incidence and surgical outcomes of patients with native infective endocarditis (IE) and prosthetic aortic valve endocarditis (PVE) over the past decade at a single institution. METHODS Between January 2005 and December 2015, 289 patients (mean age, 63.3 ± 14.2 years) suffering from native IE (n = 186) and PVE (n = 103) of the aortic valve underwent surgical procedures. Perioperative data were acquired retrospectively for statistical analysis. RESULTS During the study period the mean incidence of endocarditis increased from 22.0 ± 4.2 (2005-2009) to 29.8 ± 10.1 (2010-2015) cases per year. In-hospital mortality was significantly increased in PVE (22.3%) versus IE (9.1%) patients (P < .001). In elective cases in-hospital mortality between the 2 groups was comparable (2.2% vs 4.6%; P = .288). Multivariate analysis identified urgent surgery (odds ratio [OR], 6.461; 95% CI, 1.941-21.509; P = .002), mitral regurgitation II (OR, 4.230; 95% CI, 1.249-14.331; P = .021), previous homograft operation (OR, 66.096; 95% CI, 2.369-1844.272; P = .0.14), and left ventricular ejection fraction < 40% (OR, 8.267; 95% CI, 1.931-35.388; P = .004) as independent risk factors for in-hospital mortality, whereas pathogen identification by preoperative blood cultures (OR, .228; 95% CI, 0.063-0.817; P = .023) was found to be independently protective. CONCLUSIONS Surgery for native IE and PVE of the aortic valve may be performed with satisfactorily results at experienced cardiac surgical centers. In comparison PVE patients suffer from a more than twice as high in-hospital mortality, more postoperative complications, and inferior long-term survival. However preoperative identification of causative pathogens in IE and PVE allows for improved in-hospital survival.
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Affiliation(s)
- Maximilian Luehr
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany.
| | - Nina Bauernschmitt
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, New Jersey
| | - Oliver Heyn
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Alexey Dashkevich
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Oberbach
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Gerd Juchem
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
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Oberbach A, Schlichting N, Friedrich M, Lehmann S, Kullnick Y, Pichlmaier M, Hagl C, Bagaev E. Quantification of Multiple Bacteria in Calcified Structural Valvular Heart Disease. Semin Thorac Cardiovasc Surg 2019; 32:255-263. [PMID: 31605771 DOI: 10.1053/j.semtcvs.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 11/11/2022]
Abstract
Genome studies of heart valve tissue (HVT) in patients with structural valvular heart disease (sVHD) and acute infective endocarditis (aIE) showed polymicrobial infections. Subject of this study is the quantification of bacterial DNA in HVT of sVHD in comparison to aIE. It will be examined whether the bacterial DNA concentration can be used as surrogate marker to differentiate chronic and acute infections. DNA was isolated from HVT of 100 patients with sVHD and 23 microbiologically positively tested patients with aIE. Selected pathogens (Cutibacterium acnes, Enterococcus faecalis, Enterococcus faecium, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus agalactiae, Clostridium difficile, and Klebsiella pneumoniae) were quantified using TaqMan-qPCR. Polymicrobial infiltration of HVT was investigated by immunohistologic methods. Of 100 sVHD patients, 94 tested positive for bacteria by 16S-rDNA and 72 by TaqMan-qPCR. In 29% of the sVHD cohort and in 70% of the aIE cohort, a coinfection with more than 2 bacteria was observed as indication of a polymicrobial infection. The most common pathogens in the sVHD patients were C. acnes (59%; 5-4074 pg/mL), E. faecalis (16%, 174-2781 pg/mL), and S. aureus (15%, 8-105 pg/mL). The DNA concentration of E. faecalis (P = 0.0285) and S. aureus (P = 0.0149) is significantly lower in the sVHD cohort than in the aIE cohort. sVHD is associated with bacterial infection and infiltration of the HVT in a majority of cases. TaqMan-qPCR is a valid instrument for the specific detection of bacteria in HVT and allows discrimination between sVHD and aIE for E. faecalis and S. aureus.
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Affiliation(s)
- Andreas Oberbach
- Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany; Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Nadine Schlichting
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Maik Friedrich
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Stefanie Lehmann
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Department of Internal Medicine, University of Leipzig, Leipzig, Germany
| | - Yvonne Kullnick
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | | | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany
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- CardiOmics Group Including Vivek Kumbhari, MD, Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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- Clinical Microbiology Group Including Sandra Gräber and Arne C. Rodloff, MD, Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
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- Clinical Management Group Including Maximilian Luehr, MD, Miriam Gruhle, Marion Alber, Sven Peters, MD, Felix Kur, MD, Gerd Juchem, MD, and Alexey Dashkevich, MD, Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany
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Oberbach A, Friedrich M, Lehmann S, Schlichting N, Kullnick Y, Gräber S, Buschmann T, Hagl C, Bagaev E. Bacterial infiltration in structural heart valve disease. J Thorac Cardiovasc Surg 2019; 159:116-124.e4. [PMID: 30885626 DOI: 10.1016/j.jtcvs.2019.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The pathology of structural valvular heart disease (sVHD) ranges from basic diseases of rheumatologic origin to chronic degenerative remodeling processes after acute bacterial infections. Molecular genetic methods allow detection of the complete microbial spectrum in heart valve tissues independent of microbiological cultivation. In particular, whole-metagenome analysis is a sensitive and highly specific analytical method that allows a deeper insight into the pathogenicity of the diseases. In the present study we assessed the pathogen spectrum in heart valve tissue from 25 sVHD patients using molecular and microbiological methods. METHODS Twenty-five sVHD patients were selected randomly from an observational cohort study (March 2016 to January 2017). The explanted native heart valves were examined using microbiological methods and immunohistological structural analysis. In addition, the bacterial metagenome of the heart valve tissue was determined using next-generation sequencing. RESULTS The use of sonication as a pretreatment of valve tissue from 4 sVHD patients permitted successful detection of Clostridium difficile, Enterococcus faecalis, Staphylococcus saccharolyticus, and Staphylococcus haemolyticus using microbial cultivation. Histological staining revealed intramural localization. Metagenome analysis identified a higher rate of bacterial infiltration in 52% of cases. The pathogen spectrum included both gram-positive and gram-negative bacteria. CONCLUSIONS Microbiological and molecular biological studies are necessary to detect the spectrum of bacteria in a calcified heart valve. Metagenome analysis is a valid method to gain new insight into the polymicrobial pathophysiology of sVHD. Our results suggest that an undetected proportion of sVHD might be triggered by chronic inflammation or influenced by secondary bacterial infiltration.
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Affiliation(s)
- Andreas Oberbach
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany; Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Md.
| | - Maik Friedrich
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Stefanie Lehmann
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Department of Internal Medicine, University of Leipzig, Leipzig, Germany
| | - Nadine Schlichting
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Yvonne Kullnick
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Sandra Gräber
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Tilo Buschmann
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
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Lehmann S, Linder N, Retschlag U, Schaudinn A, Stange R, Garnov N, Dietrich A, Oberbach A, Kahn T, Busse H. MRI assessment of changes in adipose tissue parameters after bariatric surgery. PLoS One 2018; 13:e0206735. [PMID: 30388152 PMCID: PMC6214540 DOI: 10.1371/journal.pone.0206735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/18/2018] [Indexed: 12/17/2022] Open
Abstract
Bariatric surgery and other therapeutic options for obese patients are often evaluated by the loss of weight, reduction of comorbidities or improved quality of life. However, little is currently known about potential therapy-related changes in the adipose tissue of obese patients. The aim of this study was therefore to quantify fat fraction (FF) and T1 relaxation time by magnetic resonance imaging (MRI) after Roux-en-Y gastric bypass surgery and compare the resulting values with the preoperative ones. Corresponding MRI data were available from 23 patients (16 females and 7 males) that had undergone MRI before (M0) and one month after (M1) bariatric surgery. Patients were 22–59 years old (mean age 44.3 years) and their BMI ranged from 35.7–54.6 kg/m2 (mean BMI 44.6 kg/m2) at M0. Total visceral AT volumes (VVAT-T, in L) were measured by semi-automatic segmentation of axial MRI images acquired between diaphragm and femoral heads. MRI FF and T1 relaxation times were measured in well-defined regions of visceral (VAT) and subcutaneous (SAT) adipose tissue using two custom-made analysis tools. Average BMI values were 45.4 kg/m2 at time point M0 and 42.4 kg/m2 at M1. Corresponding VVAT-T values were 5.94 L and 5.33 L. Intraindividual differences in both BMI and VVAT-T were highly significant (p<0.001). Average relaxation times T1VAT were 303.7 ms at M0 and 316.9 ms at M1 (p<0.001). Corresponding T1SAT times were 283.2 ms and 280.7 ms (p = 0.137). Similarly, FFVAT differences (M0: 85.7%, M1: 83.4%) were significant (p <0.01) whereas FFSAT differences (M0: 86.1, M1: 85.9%) were not significant (p = 0.517). In conclusion, bariatric surgery is apparently not only related to a significant reduction in common parameters of adipose tissue distribution, here BMI and total visceral fat volume, but also significant changes in T1 relaxation time and fat fraction of visceral adipose tissue. Such quantitative MRI measures may potentially serve as independent biomarkers for longitudinal and cross-sectional measurements in obese patients.
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Affiliation(s)
- Stefanie Lehmann
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Nicolas Linder
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Ulf Retschlag
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Alexander Schaudinn
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Roland Stange
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Nikita Garnov
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Arne Dietrich
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Section of Bariatric Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
- * E-mail:
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Agnihotri A, Xie A, Bartalos C, Kushnir V, Sullivan S, Islam S, Islam E, Lamet M, Lamet A, Farboudmanesch R, Overholt BF, Altawil J, Early DS, Bennett M, Lowe A, Mullady DK, Adeyeri CS, El Zein M, Mishra P, Fayad L, Dunlap M, Oberbach A, Cheskin LJ, Kalloo AN, Khashab MA, Kumbhari V. Real-World Safety and Efficacy of Fluid-Filled Dual Intragastric Balloon for Weight Loss. Clin Gastroenterol Hepatol 2018; 16:1081-1088.e1. [PMID: 29481969 DOI: 10.1016/j.cgh.2018.02.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/23/2018] [Accepted: 02/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Reshape Duo is a saline-filled dual, integrated intragastric balloon (IGB) approved by the Food and Drug Administration for weight loss in patients with obesity. In a prospective, randomized trial, obese patients who received the balloon had significantly greater percent excess weight loss (%EWL) compared with patients treated with diet and exercise alone. However, there are limited data on the real-world efficacy of the Reshape balloon. METHODS We performed a retrospective study of data collected from 2 academic centers and 5 private practices in which all patients paid for the IGB and follow-up visits out of pocket. The IGB was removed after 6 months. We collected data (demographic, medical, and laboratory) from 202 adults (mean age 47.8 ± 10.8 years; 83% female) with a baseline mean body mass index of 36.8 + 8.4 kg/m2 who had IGB insertion for weight loss therapy, along with counselling on lifestyle modifications focused on diet and exercise. Primary outcomes were percent total body weight loss (%TBWL) and %EWL at 1, 3, 6, 9, and 12 months after the procedure. RESULTS Mean %TBWL at 1, 3, 6, 9 and 12 months was 4.8 ± 2.4%, 8.8 ± 4.3%, 11.4 ± 6.7%, 13.3 ± 7.8%, and 14.7 ± 11.8%, respectively. Data were available from 101 patients at 6 months and 12 patients at 12 months; 60.4% of patients achieved more than 10% TBWL and 55.4% had more than 25% EWL. Seventeen patients (8.4%) had esophageal tears during balloon insertion, with no intervention required. Thirteen patients (6.4%) had their IGB removed before the end of the 6-month treatment period. Nausea, vomiting, and abdominal pain were the most common adverse effects, occurring in 149 (73.8%), 99 (49%), and 51 (25.2%) patients. In one patient, the IGB migrated distally leading to small intestinal obstruction requiring surgical removal. CONCLUSION In a retrospective analysis of real-world patients who received the Reshape Duo IGB, we found it to be a safe and efficacious endoscopic method for producing weight loss, with most patients achieving greater than 10% TBWL at 6 months.
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Affiliation(s)
- Abhishek Agnihotri
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy Xie
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Vladimir Kushnir
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | | | | | - Ebtesam Islam
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Mark Lamet
- Center for Gastrointestinal Disorders, Hollywood, Florida
| | - Ari Lamet
- Center for Gastrointestinal Disorders, Hollywood, Florida
| | - Ramin Farboudmanesch
- Advanced Gastroenterology and Hepatology of Greater Washington, Vienna, Virginia
| | | | | | - Dayna S Early
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Michael Bennett
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Abigail Lowe
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Daniel K Mullady
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | | | - Mohamad El Zein
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Priya Mishra
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lea Fayad
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Margo Dunlap
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andreas Oberbach
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence J Cheskin
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anthony N Kalloo
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mouen A Khashab
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Oberbach A, Friedrich M, Feder S, Buschmann T, Gräber S, Rodloff A, Schlichting N, Kullnick Y, Lehmann S, Luehr M, Peterß S, Pichlmaier M, Borger M, Hagl C, Bagaev E. Bacterial Infiltration of Structural Heart Valve Disease. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. Oberbach
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - M. Friedrich
- Department for Diagnostics, Fraunhofer IZI, Leipzig, Germany
| | - S. Feder
- Department of Cardiac Surgery, Heart Centre Leipzig - University Leipzig, Leipzig, Germany
| | - T. Buschmann
- Department for Diagnostics, Fraunhofer IZI, Leipzig, Germany
| | - S. Gräber
- Institut for Microbiology, University of Leipzig, Leipzig, Germany
| | - A. Rodloff
- Institut for Microbiology, University of Leipzig, Leipzig, Germany
| | - N. Schlichting
- Department for Diagnostics, Fraunhofer IZI, Leipzig, Germany
| | - Y. Kullnick
- Department for Diagnostics, Fraunhofer IZI, Leipzig, Germany
| | - S. Lehmann
- Department for Diagnostics, Fraunhofer IZI, Leipzig, Germany
| | - M. Luehr
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - S. Peterß
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - M. Pichlmaier
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - M. Borger
- Department of Cardiac Surgery, Heart Centre Leipzig - University Leipzig, Leipzig, Germany
| | - C. Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - E. Bagaev
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
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Bagaev E, Oberbach A, Pichlmaier M, Sadoni S, Guenther S, Orban M, Mehilli J, Massberg S, Hagl C. Pitfalls and Safeguards in the Open Implantation of Mitral Transcatheter Valves in Patients with Increased Risk of Annulus Rupture. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E. Bagaev
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - A. Oberbach
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - M. Pichlmaier
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - S. Sadoni
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - S. Guenther
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - M. Orban
- Department of Cardiology, Ludwig Maximilian University Munich, Munich, Germany
| | - J. Mehilli
- Department of Cardiology, Ludwig Maximilian University Munich, Munich, Germany
| | - S. Massberg
- Department of Cardiology, Ludwig Maximilian University Munich, Munich, Germany
| | - C. Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
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Eifert S, Oberbach A, Kur F, Dohmen P, Garbade J, Hagl C, Mehilli J, Gruhle M, Witt R, Lehmann S, Bagaev E. Gender Differences in Surgical Patients Suffering from Active Infective Endocarditis (AIE). Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S. Eifert
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - A. Oberbach
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - F. Kur
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - P. Dohmen
- Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany
| | - J. Garbade
- Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany
| | - C. Hagl
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - J. Mehilli
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - M. Gruhle
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - R. Witt
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - S. Lehmann
- Frauenhofer Institut, IZI, Leipzig, Germany
| | - E. Bagaev
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
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Oberbach A, Schlichting N, Heinrich M, Kullnick Y, Retschlag U, Lehmann S, Khashab MA, Kalloo AN, Kumbhari V. Gastric mucosal devitalization reduces adiposity and improves lipid and glucose metabolism in obese rats. Gastrointest Endosc 2018; 87:288-299.e6. [PMID: 28479494 DOI: 10.1016/j.gie.2017.04.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 04/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The gastric mucosa is an endocrine organ that regulates satiation pathways by expression of orexigenic and anorexigenic hormones. Vertical sleeve gastrectomy (VSG) excludes gastric mucosa and reduces gastric volume. Our study aimed to investigate the independent effects of altering gastric mucosa on obesity and its related comorbidities. METHODS Gastric mucosa devitalization (GMD) of 70% of the stomach was achieved by argon plasma coagulation in a high-fat diet rat model and was compared with VSG and sham surgery. In an 8-week follow-up study, we quantified body weight, visceral adiposity, insulin resistance index, cholesterol profiles, and free fatty acid profiles by enzyme-linked immunosorbent assay (ELISA). Following a 2-hour oral glucose tolerance test, the kinetics of ghrelin, glucagon-like peptide-1, peptide YY, and serum and liver bile acid levels were measured. Liver lipid content was quantified by ELISA. RESULTS GMD resulted in significant reductions in body weight, visceral and subcutaneous adipose tissue, and hepatic steatosis as well as an improvement in lipid metabolism. GMD resulted in significant reductions in food intake and intestinal malabsorption of free fatty acids, both contributing to improved body composition and metabolic profile. Mechanistically, GMD resulted in a significant reduction in serum palmitate levels as well as an increase in serum and liver bile acid levels, known to alter glucose and lipid metabolism. Similar changes were noted when VSG rats were compared with sham surgery rats. CONCLUSIONS Devitalization of gastric mucosa, independent of altering gastric volume, was able to reduce obesity-related comorbidities. The gastric mucosa may be a potential target for treating obesity and its associated comorbidities.
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Affiliation(s)
- Andreas Oberbach
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Department of Cardiac Surgery, Ludwig Maximilians University Munich, Munich, Germany; Fraunhofer Institute for Cell Therapy and Immunology, University of Leipzig, Leipzig, Germany
| | - Nadine Schlichting
- Fraunhofer Institute for Cell Therapy and Immunology, University of Leipzig, Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Marco Heinrich
- Fraunhofer Institute for Cell Therapy and Immunology, University of Leipzig, Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Yvonne Kullnick
- Fraunhofer Institute for Cell Therapy and Immunology, University of Leipzig, Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Ulf Retschlag
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Stefanie Lehmann
- Fraunhofer Institute for Cell Therapy and Immunology, University of Leipzig, Leipzig, Germany; Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Mouen A Khashab
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Oberbach A, Schlichting N, Retschlag U, Heinrich Fraunhofer M, Kullnick Y, Lehman S, Enderle M, Dietrich A, Khashab MA, Kalloo A, Kumbhari V. Endoscopic Gastric Mucosal Devitalization (GMD) results in a similar reduction in visceral adiposity compared to sleeve gastrectomy (SG): A Randomized Controlled Trial. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mangner N, Bowen TS, Werner S, Fischer T, Kullnick Y, Oberbach A, Linke A, Steil L, Schuler G, Adams V. Exercise Training Prevents Diaphragm Contractile Dysfunction in Heart Failure. Med Sci Sports Exerc 2017; 48:2118-2124. [PMID: 27327028 DOI: 10.1249/mss.0000000000001016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Patient studies have demonstrated the efficacy of exercise training in attenuating respiratory muscle weakness in chronic heart failure (HF), yet direct assessment of muscle fiber contractile function together with data on the underlying intracellular mechanisms remains elusive. The present study, therefore, used a mouse model of HF to assess whether exercise training could prevent diaphragm contractile fiber dysfunction by potentially mediating the complex interplay between intracellular oxidative stress and proteolysis. METHODS Mice underwent sham operation (n = 10) or a ligation of the left coronary artery and were randomized to sedentary HF (n = 10) or HF with aerobic exercise training (HF + AET; n = 10). Ten weeks later, echocardiography and histological analyses confirmed HF. RESULTS In vitro diaphragm fiber bundles demonstrated contractile dysfunction in sedentary HF compared with sham mice that was prevented by AET, with maximal force 21.0 ± 0.7 versus 26.7 ± 1.4 and 25.4 ± 1.4 N·cm, respectively (P < 0.05). Xanthine oxidase enzyme activity and MuRF1 protein expression, markers of oxidative stress and protein degradation, were ~20% and ~70% higher in sedentary HF compared with sham mice (P < 0.05) but were not different when compared with the HF + AET group. Oxidative modifications to numerous contractile proteins (i.e., actin and creatine kinase) and markers of proteolysis (i.e., proteasome and calpain activity) were elevated in sedentary HF compared with HF + AET mice (P < 0.05); however, these indices were not significantly different between sedentary HF and sham mice. Antioxidative enzyme activities were also not different between groups. CONCLUSION Our findings demonstrate that AET can protect against diaphragm contractile fiber dysfunction induced by HF, but it remains unclear whether alterations in oxidative stress and/or protein degradation are primarily responsible.
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Affiliation(s)
- Norman Mangner
- 1Department of Internal Medicine and Cardiology, Leipzig University-Heart Center, Leipzig, GERMANY; 2Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, GERMANY; 3Department of Cardiac Surgery, Leipzig University-Heart Center, Leipzig, GERMANY; and 4Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, GERMANY
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Oberbach A, Schlichting N, Feder S, Lehmann S, Kullnick Y, Buschmann T, Blumert C, Horn F, Neuhaus J, Neujahr R, Bagaev E, Hagl C, Pichlmaier M, Rodloff AC, Gräber S, Kirsch K, Sandri M, Kumbhari V, Behzadi A, Behzadi A, Correia JC, Mohr FW, Friedrich M. New insights into valve-related intramural and intracellular bacterial diversity in infective endocarditis. PLoS One 2017; 12:e0175569. [PMID: 28410379 PMCID: PMC5391965 DOI: 10.1371/journal.pone.0175569] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/28/2017] [Indexed: 12/17/2022] Open
Abstract
Aims In infective endocarditis (IE), a severe inflammatory disease of the endocardium with an unchanged incidence and mortality rate over the past decades, only 1% of the cases have been described as polymicrobial infections based on microbiological approaches. The aim of this study was to identify potential biodiversity of bacterial species from infected native and prosthetic valves. Furthermore, we compared the ultrastructural micro-environments to detect the localization and distribution patterns of pathogens in IE. Material and methods Using next-generation sequencing (NGS) of 16S rDNA, which allows analysis of the entire bacterial community within a single sample, we investigated the biodiversity of infectious bacterial species from resected native and prosthetic valves in a clinical cohort of 8 IE patients. Furthermore, we investigated the ultrastructural infected valve micro-environment by focused ion beam scanning electron microscopy (FIB-SEM). Results Biodiversity was detected in 7 of 8 resected heart valves. This comprised 13 bacterial genera and 16 species. In addition to 11 pathogens already described as being IE related, 5 bacterial species were identified as having a novel association. In contrast, valve and blood culture-based diagnosis revealed only 4 species from 3 bacterial genera and did not show any relevant antibiotic resistance. The antibiotics chosen on this basis for treatment, however, did not cover the bacterial spectra identified by our amplicon sequencing analysis in 4 of 8 cases. In addition to intramural distribution patterns of infective bacteria, intracellular localization with evidence of bacterial immune escape mechanisms was identified. Conclusion The high frequency of polymicrobial infections, pathogen diversity, and intracellular persistence of common IE-causing bacteria may provide clues to help explain the persistent and devastating mortality rate observed for IE. Improved bacterial diagnosis by 16S rDNA NGS that increases the ability to tailor antibiotic therapy may result in improved outcomes.
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MESH Headings
- Aged
- Aged, 80 and over
- Bacteria/genetics
- Bacteria/isolation & purification
- Endocarditis/diagnosis
- Endocarditis/microbiology
- Female
- Heart Valves/microbiology
- High-Throughput Nucleotide Sequencing
- Humans
- Male
- Metagenome
- Microscopy, Electron, Scanning
- Middle Aged
- Phenotype
- RNA, Ribosomal, 16S/chemistry
- RNA, Ribosomal, 16S/genetics
- RNA, Ribosomal, 16S/metabolism
- Sequence Analysis, DNA
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Affiliation(s)
- Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
- University of Leipzig/Heart Center Leipzig, Department of Cardiac Surgery, Leipzig, Germany
- Department of Medicine and Division of Gastroenterology and Hepatology. The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - Nadine Schlichting
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Stefan Feder
- University of Leipzig/Heart Center Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Stefanie Lehmann
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Yvonne Kullnick
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Tilo Buschmann
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Conny Blumert
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Friedemann Horn
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
- Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Jochen Neuhaus
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Ralph Neujahr
- Carl Zeiss Microscopy GmbH, Global Sales Support Life Sciences Microscopy Labs Munich, Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | | | - Arne Christian Rodloff
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Sandra Gräber
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Katharina Kirsch
- University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Marcus Sandri
- University of Leipzig, Heart Centre, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Vivek Kumbhari
- Department of Medicine and Division of Gastroenterology and Hepatology. The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - Armirhossein Behzadi
- University of Leipzig/Heart Center Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Amirali Behzadi
- University of Leipzig/Heart Center Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Joao Carlos Correia
- University of Leipzig/Heart Center Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Friedrich Wilhelm Mohr
- University of Leipzig/Heart Center Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Maik Friedrich
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
- * E-mail:
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Al-Naamani A, Meyer A, Jawad K, Fischer J, Siegemund A, Siegemund T, Oberbach A, Hahn J, Lehmann S, Mohr F, Garbade J. Antiphospholipid Syndrome in Patients with Left Ventricular Assist Device. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Oberbach A, Haange SB, Schlichting N, Heinrich M, Lehmann S, Till H, Hugenholtz F, Kullnick Y, Smidt H, Frank K, Seifert J, Jehmlich N, von Bergen M. Metabolic in Vivo Labeling Highlights Differences of Metabolically Active Microbes from the Mucosal Gastrointestinal Microbiome between High-Fat and Normal Chow Diet. J Proteome Res 2017; 16:1593-1604. [PMID: 28252966 DOI: 10.1021/acs.jproteome.6b00973] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The gastrointestinal microbiota in the gut interacts metabolically and immunologically with the host tissue in the contact zone of the mucus layer. For understanding the details of these interactions and especially their dynamics it is crucial to identify the metabolically active subset of the microbiome. This became possible by the development of stable isotope probing techniques, which have only sparsely been applied to microbiome research. We applied the in vivo stable isotope approach using 15N-labeled diet with subsequent identification of metabolically active bacterial species. Four-week old male Sprague-Dawley rats were randomly assigned to chow diet (CD, n =15) and high-fat diet (HFD, n =15). After 11 weeks, three animals from each group were sacrificed for baseline characterization of anthropometric and metabolic obesity. The remaining animals were exposed to either a 15N-labeled (n =9) or a 14N-unlabeled experimental diet (n =3). Three rats from each cohort (HFD and CD) were sacrificed at 12, 24, and 72 h. The remaining three animals from each cohort, which received the 14N-unlabeled diet, were sacrificed after 72 h. The colon was harvested and divided into three equal sections (proximal, medial, and distal), and the mucus layer of each specimen was sampled by scraping. We identified the active subset in an HFD model of obesity in comparison with lean controls rats using metaproteomics. In addition, all samples were investigated by 16S rRNA amplicon gene sequencing. The active microbiome of the HFD group showed an increase in bacterial taxa for Verrucomicrobia and Desulfovibrionaceae. In contrast with no significant changes in alpha diversity, time- and localization-dependent effects in beta-diversity were clearly observed. In terms of enzymatic functions the HFD group showed strong affected metabolic pathways such as energy production and carbohydrate metabolism. In vivo isotope labeling combined with metaproteomics provides a valuable method to distinguish the active from the non-active bacterial phylogenetic groups that are relevant for microbiota-host interaction. For morbid obesity such analysis may provide potentially new strategies for targeted pre- or probiotic treatments.
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Affiliation(s)
- Andreas Oberbach
- Department of Cardiac Surgery, University of Leipzig, Heart Center , 04289 Leipzig, Germany
| | - Sven-Bastiaan Haange
- Department of Molecular Systems Biology, UFZ-Helmholtz Centre for Environmental Research , 04318 Leipzig, Germany
| | - Nadine Schlichting
- Department of Cardiac Surgery, University of Leipzig, Heart Center , 04289 Leipzig, Germany.,Department of Pediatric Surgery, University of Leipzig , 04103 Leipzig, Germany
| | - Marco Heinrich
- Department of Cardiac Surgery, University of Leipzig, Heart Center , 04289 Leipzig, Germany.,Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig , 04103 Leipzig, Germany
| | - Stefanie Lehmann
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig , 04103 Leipzig, Germany
| | - Holger Till
- Department of Paediatric and Adolescent Surgery, Medical University of Graz , 8036 Graz, Austria
| | - Floor Hugenholtz
- Laboratory of Microbiology, Wageningen University , 6708 PB Wageningen, The Netherlands
| | - Yvonne Kullnick
- Department of Cardiac Surgery, University of Leipzig, Heart Center , 04289 Leipzig, Germany.,Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig , 04103 Leipzig, Germany
| | - Hauke Smidt
- Laboratory of Microbiology, Wageningen University , 6708 PB Wageningen, The Netherlands
| | - Karin Frank
- Department of Ecological Modelling, UFZ-Helmholtz Centre for Environmental Research , 04318 Leipzig, Germany
| | - Jana Seifert
- Department of Molecular Systems Biology, UFZ-Helmholtz Centre for Environmental Research , 04318 Leipzig, Germany
| | - Nico Jehmlich
- Department of Molecular Systems Biology, UFZ-Helmholtz Centre for Environmental Research , 04318 Leipzig, Germany
| | - Martin von Bergen
- Department of Molecular Systems Biology, UFZ-Helmholtz Centre for Environmental Research , 04318 Leipzig, Germany.,Institute of Biochemistry, Faculty of Biosciences, Pharmacy and Psychology, University of Leipzig , 04103 Leipzig, Germany.,Department of Life Sciences and Chemistry, Centre for Microbial Communities, University of Aalborg , 9220 Aalborg, Denmark
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Bagaev E, Friedrich M, Schlichting N, Kullnick Y, Lidzba N, Gruhle M, Pichlmaier M, Kuhr F, Lühr M, Hagl C, Oberbach A. Chronic Infection of Stenotic Aortic Valves with Staphylococcus aureus: Implications for Perioperative Treatment? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- E. Bagaev
- Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
| | - M. Friedrich
- Fraunhofer Institute Leipzig, Department of Diagnostics and New Technologies, Leipzig, Germany
| | - N. Schlichting
- Fraunhofer Institute Leipzig, Department of Diagnostics and New Technologies, Leipzig, Germany
| | - Y. Kullnick
- Fraunhofer Institute Leipzig, Department of Diagnostics and New Technologies, Leipzig, Germany
| | - N. Lidzba
- Fraunhofer Institute Leipzig, Department of Diagnostics and New Technologies, Leipzig, Germany
| | - M.S. Gruhle
- Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
| | - M. Pichlmaier
- Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
| | - F. Kuhr
- Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
| | - M. Lühr
- Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
| | - C. Hagl
- Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
| | - A. Oberbach
- Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
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Garnov N, Linder N, Schaudinn A, Dietrich A, Lehmann S, Retschlag U, Oberbach A, Kahn T, Busse H. Einfluss einer bariatrischen OP auf das Fettgewebe: Follow-up-Charakterisierung mittels MRT. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Eifert S, Meyer A, Lehmann S, Fischer J, Oberbach A, Langenstroth E, Mohr F, Garbade J. Anticoagulative Treatment in LVAD Patients: Telemonitoring by Use of Vitaphone®. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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33
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Oberbach A, Adams V, Schlichting N, Heinrich M, Kullnick Y, Lehmann S, Lehmann S, Feder S, Correia JC, Mohr FW, Völker U, Jehmlich N. Proteome profiles of HDL particles of patients with chronic heart failure are associated with immune response and also include bacteria proteins. Clin Chim Acta 2015; 453:114-22. [PMID: 26688386 DOI: 10.1016/j.cca.2015.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 01/29/2023]
Abstract
Besides modulation of reverse cholesterol transport, high density lipoprotein (HDL) is able to modulate vascular function by stimulating endothelial nitric oxide synthase. Recently, it could be documented that this function of HDL was significantly impaired in patients with chronic heart failure (CHF). We investigated alterations in the HDL proteome in CHF patients. Therefore, HDL was isolated from 5 controls (HDLhealthy) and 5 CHF patients of NYHA-class IIIb (HDLCHF). Proteome analysis of HDL particles was performed by two-dimensional liquid chromatography-mass spectrometry (SCX/RP LC-MS/MS). In total, we identified 494 distinct proteins, of which 107 proteins were commonly found in both groups (HDLCHF and HDLhealthy) indicating a high inter-subject variability across HDL particles. Several important proteins (e.g. ITGA2, APBA1 or A2M) varied in level. Functional analysis revealed regulated pathways. A minor proportion of bacteria-derived proteins were also identified in the HDL-particles. The extension of the list of HDL-associated proteins allows besides their mere description new insights into alterations in HDL function in diseases. In addition, the detection of bacterial proteins bound to HDL will broaden our view of HDL not only as a cholesterol carrier but also as a carrier of proteins.
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Affiliation(s)
- Andreas Oberbach
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Germany; Division of Diagnostics, Experimental Surgery/CardiOMICs, Fraunhofer-Institute for Cell Therapy and Immunology IZI, Leipzig, Germany
| | - Volker Adams
- Department of Cardiology, University of Leipzig, Heart Center Leipzig, Germany
| | - Nadine Schlichting
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Germany; Department of Pediatric Surgery, University of Leipzig, Germany
| | - Marco Heinrich
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Germany
| | - Yvonne Kullnick
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Germany
| | - Stefanie Lehmann
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Germany
| | - Sven Lehmann
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Germany
| | - Stefan Feder
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Germany
| | - Joao Carlos Correia
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Germany
| | | | - Uwe Völker
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Germany; DZHK (German Center for Cardiovascular Research) Partner Site Greifswald, Germany
| | - Nico Jehmlich
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Germany.
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Oberbach A, Schlichting N, Heinrich M, Kullnick Y, Lehmann S, Adams V, Stolzenburg JW, Neuhaus J. [High fat diet-induced molecular and physiological dysfunction of the urinary bladder]. Urologe A 2015; 53:1805-11. [PMID: 25412909 DOI: 10.1007/s00120-014-3659-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obesity with its multiple comorbidities has become a global pandemia. We here report on the pathophysiological aspects of obesity-associated urinary bladder dysfunctions. MATERIAL AND METHODS Our results are based on multiple in vitro and in vivo studies including a high fat diet (HFD) rat animal model of which the details are given in the cited publications. RESULTS In cultured human detrusor muscle cells, obesity-related pathophysiological mechanisms were directly induced by the saturated free fatty acid palmitate. In HFD animals, we found serious fibrosis of the bladder wall and downregulation of the muscarinic M3-receptor leading to diminished contractility of the urinary bladder. Bariatric surgical intervention (sleeve gastrectomy) reversed the fibrosis. CONCLUSION Our results support the relevance of obesity for urological bladder dysfunction. The epidemic dimension of obesity with its steadily growing number of cases requires a re-evaluation of this pathological condition in the urological context.
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Affiliation(s)
- A Oberbach
- Klinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Deutschland
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Lehmann S, Merk DR, Etz CD, Oberbach A, Uhlemann M, Emrich F, Funkat AK, Meyer A, Garbade J, Bakhtiary F, Misfeld M, Mohr FW. Porcine xenograft for aortic, mitral and double valve replacement: long-term results of 2544 consecutive patients. Eur J Cardiothorac Surg 2015; 49:1150-6. [DOI: 10.1093/ejcts/ezv383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/21/2015] [Indexed: 11/12/2022] Open
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Abstract
PURPOSE OF REVIEW Endoscopic approaches to obesity may help fulfill the unmet need of over half the US adult population who would benefit from therapy for obesity but are not receiving it. Endoluminal approaches have the potential to be more efficacious than antiobesity medications and have a lower risk-cost profile compared with bariatric surgery. This review outlines the current state of primary endoscopic weight loss and metabolic therapies and sheds light on the challenges faced toward making endoscopic bariatric therapies 'ready for prime time'. RECENT FINDINGS Endoscopic approaches to obesity are being increasingly modeled on the proposed mechanisms contributing to the benefits of bariatric surgery.Therapies targeted at the stomach induce weight loss with only a proportional benefit to underlying metabolic disorders.Therapies targeting the proximal small bowel appear to modulate various neurohormonal pathways resulting in an improvement in metabolic profile in excess to that accounted for by weight loss itself. SUMMARY Rigorous scientific assessment of endoscopic approaches to obesity is necessary to allow its integration into the treatment algorithm of obesity. The endoscopic armamentarium against obesity continues to evolve with the endoscopist poised to be a key player in the management of this disease. VIDEO ABSTRACT http://links.lww.com/COG/A12.
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Affiliation(s)
- Vivek Kumbhari
- aDepartment of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA bDepartment of Cardiac Surgery, University Leipzig Heart Center Leipzig, Leipzig, Germany
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Kumbhari V, Heinrich M, Khashab MA, Kalloo AN, Oberbach A. Gastric restriction and delayed gastric emptying may not be the keys to an effective endoscopic metabolic therapy. Gastrointest Endosc 2015; 82:185-6. [PMID: 26074043 DOI: 10.1016/j.gie.2015.01.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 01/31/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Marco Heinrich
- Department of Cardiac Surgery, University of Leipzig, Leipzig, Germany
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Andreas Oberbach
- Department of Cardiac Surgery, University of Leipzig, Leipzig, Germany
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Leontyev S, Davierwala PM, Krögh G, Feder S, Oberbach A, Bakhtiary F, Misfeld M, Borger MA, Mohr FW. Early and late outcomes of complex aortic root surgery in patients with aortic root abscesses. Eur J Cardiothorac Surg 2015; 49:447-54; discussion 454-5. [DOI: 10.1093/ejcts/ezv138] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/19/2015] [Indexed: 11/13/2022] Open
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Lehmann S, Merk DR, Etz CD, Seeburger J, Schroeter T, Oberbach A, Uhlemann M, Hoellriegel R, Haensig M, Leontyev S, Garbade J, Misfeld M, Mohr FW. Minimally invasive aortic valve replacement: the Leipzig experience. Ann Cardiothorac Surg 2015; 4:49-56. [PMID: 25694976 DOI: 10.3978/j.issn.2225-319x.2014.11.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/18/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Minimally invasive techniques are progressively challenging traditional approaches in cardiothoracic surgery. Minimally invasive aortic valve replacement (AVR) has become a routine procedure at our institution. METHODS We retrospectively analyzed all patients undergoing minimally invasive isolated AVR between January 2003 and March 2014, at our institution. Mean follow-up was 4.7±4.3 years (range: 0-18 years) and was 99.8% complete. RESULTS There were 1,714 patients who received an isolated minimally invasive AVR. The mean (± SD) patient age was 65±12.8 years, ejection fraction 60%±12% and log EuroSCORE 5.3%±5.1%. Mean cross-clamp time was 58±18 minutes and mean cardiopulmonary bypass (CPB) time was 82.9±26.7 minutes. Thirty-day survival was 97.8%±0.4%, and 69.4%±1.7% at 10-years. The multivariate analysis revealed age at surgery [P=0.016; odds ratio (OR), 1.1], length of surgery time (P=0.002; OR, 1.01), female gender (P=0.023; OR, 3.54), preoperative myocardial infarction (MI) (P=0.006; OR, 7.87), preoperative stroke (P=0.001; OR, 13.76) and preoperative liver failure (P=0.015; OR, 10.28) as independent risk factors for mortality. Cox-regression analysis revealed the following predictors for long term mortality: age over 75 years (P<0.001; OR, 3.5), preoperative dialysis (P<0.01; OR, 2.14), ejection fraction less than 30% (P=0.003; OR, 3.28) and urgent or emergency operation (P<0.001; OR, 2.3). CONCLUSIONS Minimally invasive AVR can be performed safely and effectively with very few perioperative complications. The early and long-term outcomes in these patients are acceptable.
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Affiliation(s)
- Sven Lehmann
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Denis R Merk
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Christian D Etz
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Joerg Seeburger
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Thomas Schroeter
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Andreas Oberbach
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Madlen Uhlemann
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Robert Hoellriegel
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Martin Haensig
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jens Garbade
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Martin Misfeld
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Friedrich W Mohr
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
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Till H, Schlichting N, Oberbach A. Tumor-associated energy homeostasis: hepatoblastoma and neuroblastoma affect glucose and lipid metabolism as well as ghrelin, GLP-1, and PYY in nude rats. Eur J Pediatr Surg 2015; 25:128-31. [PMID: 25111274 DOI: 10.1055/s-0034-1386640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The "metabolic competition" for nutrients between cancer cells and the patient has emerged as an important research area. For pediatric oncology, it remains unclear whether the neuroendokrine regulation of appetite by gastrointestinal hormones such as ghrelin "eat", GLP-1 (glucagon-like peptide, "do not eat"), and PYY (peptide tyrosine-tyrosine, "do not eat") is influenced by tumor growth. MATERIAL AND METHODS In a prospective randomized study, human hepatoblastoma (HB) and neuroblastoma (NB) cells (3 × 10(6)) were transplanted into the abdominal wall of immune-incompetent (nu/nu) rats (ethic committee approval: TVV43/11). Sham-operated animals received cell culture medium only. Tumor growth was allowed for 8 weeks. Then, all the animals underwent a 2-hour oGTT (oral glucose tolerance test) and were assessed for serum levels of glucose, insulin, ghrelin, GLP-1, and PYY. Finally, all tumor masses and adipose tissues were excised and calculated. RESULTS Total body weight (including tumor masses) differed for HB (329+31 g), but not for NB (358+22 g) compared with Sham (361+35 g). Subcutaneous adipose tissue was significantly decreased for both the tumor groups (HB=2.6 g, NB=2.1 g, and Sham=3.5 g). Only for NB, fasting glucose (3.4 + 0.6 mmol/L) and insulin (0.89+0.11 ng/mL) levels were significantly decreased compared with Sham (4.4+0.6 mmol/L; 1.19+0.36 ng/mL) only. During the oGTT (all data calculated as area under the curve, AUC) glucose levels were significantly increased for HB (104 ± 10) and NB (102 ± 13) compared with Sham (84 ± 3), but insulin levels remained similar for either group. Triglyceride levels were increased for HB (0.51 mmol/L) and especially NB (0.73 mmol/L) compared with Sham (0.34 mmol/L). Inflammatory parameters did not differ between the groups. Total ghrelin levels were significantly increased for NB (111 ± 10) and altered for HB (102 ± 15) compared with Sham (84 ± 8). Vice versa GLP-1 was statistically decreased in HB (92 ± 7) and NB (88 ± 12) compared with Sham (127 ± 13). Finally, PYY levels were nonsignificantly reduced for HB (117 ± 5) and NB (120 ± 4) compared with Sham (146 ± 12).
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Affiliation(s)
- Holger Till
- Department of Paediatric and Adolescent Surgery, University of Graz, Graz, Austria
| | - Nadine Schlichting
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Saxony, Germany
| | - Andreas Oberbach
- Department of Heart Surgery, University of Leipzig, Leipzig, Germany
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Lehmann S, Merk D, Etz C, Seeburger J, Garbade J, Meyer A, Funkat A, Oberbach A, Holzhey D, Misfeld M, Mohr F. Short and Midterm Follow- up of 869 Patients Treated with Trifecta Aortic Valve Bioprothesis. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Feder S, Siegemund A, Correia C, Lehmann S, Meyer A, Garbade J, Misfeld M, Bakhtiary F, Mohr FW, Oberbach A. Clinical Application of Thrombin Generation: A Deeper Reflection of Plasmatic Haemostasis of Ventricular Assist Device Recipients. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lehmann S, Emrich F, Merk D, Etz C, Garbade J, Meyer A, Funkat A, Oberbach A, Misfeld M, Bakhtiary F, Mohr F. Longterm Follow- Up of 1040 Consecutive Adult Patients Treated with Extracorporeal Membrane Oxygenation for Refractory Postcardiotomy Cardiogenic Shock. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Oberbach A, Schlichting N, Neuhaus J, Kullnick Y, Lehmann S, Heinrich M, Dietrich A, Mohr FW, von Bergen M, Baumann S. Establishing a Reliable Multiple Reaction Monitoring-Based Method for the Quantification of Obesity-Associated Comorbidities in Serum and Adipose Tissue Requires Intensive Clinical Validation. J Proteome Res 2014; 13:5784-800. [DOI: 10.1021/pr500722k] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Andreas Oberbach
- Department
of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany
| | | | | | - Yvonne Kullnick
- Department
of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany
| | | | | | | | - Friedrich Wilhelm Mohr
- Department
of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany
| | - Martin von Bergen
- Department
of Biotechnology, Chemistry and Environmental Engineering, University of Aalborg, Aalborg, Denmark
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Bowen TS, Mangner N, Werner S, Glaser S, Kullnick Y, Schrepper A, Doenst T, Oberbach A, Linke A, Steil L, Schuler G, Adams V. Diaphragm muscle weakness in mice is early-onset post-myocardial infarction and associated with elevated protein oxidation. J Appl Physiol (1985) 2014; 118:11-9. [PMID: 25359720 DOI: 10.1152/japplphysiol.00756.2014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Heart failure induced by myocardial infarction (MI) causes diaphragm muscle weakness, with elevated oxidants implicated. We aimed to determine whether diaphragm muscle weakness is 1) early-onset post-MI (i.e., within the early left ventricular remodeling phase of 72 h); and 2) associated with elevated protein oxidation. Ligation of the left coronary artery to induce MI (n = 10) or sham operation (n = 10) was performed on C57BL6 mice. In vitro contractile function of diaphragm muscle fiber bundles was assessed 72 h later. Diaphragm mRNA and protein expression, enzyme activity, and individual carbonylated proteins (by two-dimensional differential in-gel electrophoresis and mass spectrometry) were subsequently assessed. Infarct size averaged 57 ± 1%. Maximal diaphragm function was reduced (P < 0.01) by 20% post-MI, with the force-frequency relationship depressed (P < 0.01) between 80 and 300 Hz. The mRNA expression of inflammation, atrophy, and regulatory Ca(2+) proteins remained unchanged post-MI, as did the protein expression of key contractile proteins. However, enzyme activity of the oxidative sources NADPH oxidase and xanthine oxidase was increased (P < 0.01) by 45 and 33%, respectively. Compared with sham, a 57 and 45% increase (P < 0.05) was observed in the carbonylation of sarcomeric actin and creatine kinase post-MI, respectively. In conclusion, diaphragm muscle weakness was rapidly induced in mice during the early left ventricular remodeling phase of 72 h post-MI, which was associated with increased oxidation of contractile and energetic proteins. Collectively, these findings suggest diaphragm muscle weakness may be early onset in heart failure, which is likely mediated in part by posttranslational oxidative modifications at the myofibrillar level.
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Affiliation(s)
- T Scott Bowen
- Department of Internal Medicine and Cardiology, Leipzig University-Heart Center, Leipzig, Germany;
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Leipzig University-Heart Center, Leipzig, Germany
| | - Sarah Werner
- Department of Internal Medicine and Cardiology, Leipzig University-Heart Center, Leipzig, Germany
| | - Stefanie Glaser
- Department of Internal Medicine and Cardiology, Leipzig University-Heart Center, Leipzig, Germany
| | - Yvonne Kullnick
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Andrea Schrepper
- Department of Cardiothoracic Surgery, University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University of Jena, Jena, Germany
| | - Andreas Oberbach
- Department of Cardiac Surgery, Leipzig University-Heart Center, Leipzig, Germany; and
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Leipzig University-Heart Center, Leipzig, Germany
| | - Leif Steil
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Gerhard Schuler
- Department of Internal Medicine and Cardiology, Leipzig University-Heart Center, Leipzig, Germany
| | - Volker Adams
- Department of Internal Medicine and Cardiology, Leipzig University-Heart Center, Leipzig, Germany
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Oberbach A, Feder S, Neuhaus J, Schlichting N, Kullnick Y, Mohr F. 169 * METAGENOMIC ANALYSIS OF NATIVE- AND PROSTHETIC-VALVE INFECTIVE ENDOCARDITIS. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oberbach A, Adams V, Schlichting N, Jehmich N, Voelker U, Mohr FW, Neuhaus J. P773Uric acid regulates multiple interacting major cellular pathways in human aortic endothelial cells: a global proteome approach. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Oberbach A, Neuhaus J, Schlichting N, Kugler J, Baumann S, Till H. Sleeve gastrectomy reduces xanthine oxidase and uric acid in a rat model of morbid obesity. Surg Obes Relat Dis 2014; 10:684-90. [DOI: 10.1016/j.soard.2013.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 01/01/2023]
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Fink LN, Costford SR, Lee YS, Jensen TE, Bilan PJ, Oberbach A, Blüher M, Olefsky JM, Sams A, Klip A. Pro-inflammatory macrophages increase in skeletal muscle of high fat-fed mice and correlate with metabolic risk markers in humans. Obesity (Silver Spring) 2014; 22:747-57. [PMID: 24030890 DOI: 10.1002/oby.20615] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/08/2013] [Accepted: 09/04/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE In obesity, immune cells infiltrate adipose tissue. Skeletal muscle is the major tissue of insulin-dependent glucose disposal, and indices of muscle inflammation arise during obesity, but whether and which immune cells increase in muscle remain unclear. METHODS Immune cell presence in quadriceps muscle of wild type mice fed high-fat diet (HFD) was studied for 3 days to 10 weeks, in CCL2-KO mice fed HFD for 1 week, and in human muscle. Leukocyte presence was assessed by gene expression of lineage markers, cyto/chemokines and receptors; immunohistochemistry; and flow cytometry. RESULTS After 1 week HFD, concomitantly with glucose intolerance, muscle gene expression of Ly6b, Emr1 (F4/80), Tnf, Ccl2, and Ccr2 rose, as did pro- and anti-inflammatory markers Itgax (CD11c) and Mgl2. CD11c+ proinflammatory macrophages in muscle increased by 76%. After 10 weeks HFD, macrophages in muscle increased by 47%. Quadriceps from CCL2-KO mice on HFD did not gain macrophages and maintained insulin sensitivity. Muscle of obese, glucose-intolerant humans showed elevated CD68 (macrophage marker) and ITGAX, correlating with poor glucose disposal and adiposity. CONCLUSION Mouse and human skeletal muscles gain a distinct population of inflammatory macrophages upon HFD or obesity, linked to insulin resistance in humans and CCL2 availability in mice.
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MESH Headings
- Adipose Tissue/immunology
- Animals
- Antigens, CD/genetics
- Antigens, CD/immunology
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/genetics
- Antigens, Differentiation, Myelomonocytic/immunology
- Antigens, Differentiation, Myelomonocytic/metabolism
- CD11c Antigen/genetics
- CD11c Antigen/immunology
- CD11c Antigen/metabolism
- Calcium-Binding Proteins
- Chemokine CCL2/genetics
- Chemokine CCL2/metabolism
- Diet, High-Fat
- Gene Expression
- Humans
- Insulin Resistance
- Macrophages/metabolism
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Muscle, Skeletal/cytology
- Muscle, Skeletal/immunology
- Obesity/metabolism
- Phosphorylation
- Proto-Oncogene Proteins c-akt/genetics
- Proto-Oncogene Proteins c-akt/metabolism
- Receptors, CCR2/genetics
- Receptors, CCR2/metabolism
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/metabolism
- Receptors, G-Protein-Coupled
- Risk Factors
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Affiliation(s)
- Lisbeth N Fink
- Cell Biology Program, The Hospital for Sick Children, Toronto, Canada; Diabetes Research Unit, Novo Nordisk A/S, Måløv, Denmark
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Oberbach A, Neuhaus J, Inge T, Kirsch K, Schlichting N, Blüher S, Kullnick Y, Kugler J, Baumann S, Till H. Bariatric surgery in severely obese adolescents improves major comorbidities including hyperuricemia. Metabolism 2014; 63:242-9. [PMID: 24332707 DOI: 10.1016/j.metabol.2013.11.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/13/2013] [Accepted: 11/15/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Serum uric acid (sUA) is believed to contribute to the pathogenesis of metabolic comorbidities like hypertension, insulin-resistance (IR) and endothelial dysfunction (EDF) in obese children. The present pilot study investigated the association between sUA concentrations and loss of body weight following laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y-gastric bypass (RYGB) in severely obese adolescents. MATERIALS/METHODS 10 severely obese adolescents underwent either LSG (n=5) or RYGB (n=5). 17 normal weight, healthy, age- and gender-matched adolescents served as a normal weight peer group (NWPG). Pre- and 12 months postoperatively, sUA and relevant metabolic parameters (glucose homeostasis, transaminases, lipids) were compared. RESULTS Preoperatively, sUA was significantly elevated in patients with severe obesity compared to NWPG. Twelve months after LSG and RYGB, a significant decrease in sUA, BMI, CVD risk factors, hepatic transaminases, and HOMA-IR was observed. Reduction in SDS-BMI significantly correlated with changes in sUA. CONCLUSIONS sUA levels and metabolic comorbidities improved following bariatric surgery in severely obese adolescents. The impact of changes in sUA on long-term clinical complications of childhood obesity deserves further study.
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Affiliation(s)
- Andreas Oberbach
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany; University of Dresden, Department of Health Sciences/Public Health, Dresden, Germany
| | - Jochen Neuhaus
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Thomas Inge
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katharina Kirsch
- Department of Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Nadine Schlichting
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Leipzig, Leipzig, Germany
| | - Susann Blüher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Leipzig, Leipzig, Germany; Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Yvonne Kullnick
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Leipzig, Leipzig, Germany
| | - Joachim Kugler
- University of Dresden, Department of Health Sciences/Public Health, Dresden, Germany
| | - Sven Baumann
- Helmholtz Centre for Environmental Research, Department of Metabolomics, Leipzig, Germany
| | - Holger Till
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
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