This longitudinal study was aimed to evaluate the electromyographic activity (EMG) of the masticatory muscles during mandibular tasks in women with grade II and III obesity, who were eligible for bariatric surgery. Twenty-one patients were followed up for 3 and 6 months after the Roux-en-Y gastric bypass. The EMG included analyses of the masseter and temporalis muscles during rest, right and left laterality, protrusion, and dental clenching at maximal voluntary contraction with and without parafilm. Data were tabulated and submitted for statistical analysis using the repeated measures test (P<0.05) with the Bonferroni post-test. Significant differences were observed between the right temporal muscle during maximal voluntary contraction (P=0.003) and maximal voluntary contraction with Parafilm M for the right masseter (P=0.01), left masseter (P=0.03), right temporal (P=0.002), and left temporal (P=0.03) muscles. There was gradual decrease in the resting EMG of the masticatory muscles 6 months after surgery. There was an increase in the EMG of the muscles that are the most active in the neuroanatomical movements of laterality and protrusion 6 months after surgery. There was an increase in EMG in maximal voluntary contraction with and without parafilm, 3 and 6 months after surgery. This study suggests that women with severe obesity who underwent bariatric surgery had better functional results of the masticatory muscles 3 and 6 months after the procedure, which is an important parameter in surgical planning, functional recovery, and nutritional status.

• MeSH
• bariatrická chirurgie metody   MeSH
• dospělí MeSH
• elektromyografie * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• morbidní obezita chirurgie   patofyziologie   MeSH
• musculus masseter * patofyziologie   MeSH
• musculus temporalis * patofyziologie   MeSH
• obezita patofyziologie   chirurgie   MeSH
• svalová kontrakce fyziologie   MeSH
• žaludeční bypass metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• antihypertenziva farmakologie   terapeutické užití   MeSH
• bariatrická chirurgie metody   MeSH
• diabetes mellitus 1. typu patofyziologie   prevence a kontrola   MeSH
• diabetes mellitus 2. typu * farmakoterapie   metabolismus   prevence a kontrola   MeSH
• hypoglykemika farmakologie   terapeutické užití   MeSH
• látky proti obezitě farmakologie   terapeutické užití   MeSH
• lidé MeSH
• metabolický syndrom diagnóza   metabolismus   patofyziologie   MeSH
• morbidní obezita chirurgie   patofyziologie   MeSH
• obezita etiologie   farmakoterapie   prevence a kontrola   MeSH
• poměr pasu a boků škodlivé účinky   MeSH
• primární prevence MeSH
• psychotropní léky farmakologie   škodlivé účinky   terapeutické užití   MeSH
• rizikové faktory MeSH
• sekundární prevence MeSH
• statiny farmakologie   škodlivé účinky   terapeutické užití   MeSH
• zdravotně rizikové chování MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: The endoscopically implanted duodenal-jejunal bypass liner (DJBL) is an attractive alternative to bariatric surgery for obese diabetic patients. This article aims to study dynamical aspects of the glycaemic profile that may influence DJBL effects. METHODS: Thirty patients underwent DJBL implantation and were followed for 10 months. Continuous glucose monitoring (CGM) was performed before implantation and at month 10. Dynamical variables from CGM were measured: coefficient of variation of glycaemia, mean amplitude of glycaemic excursions (MAGE), detrended fluctuation analysis (DFA), % of time with glycaemia under 6.1 mmol/L (TU6.1), area over 7.8 mmol/L (AO7.8) and time in range. We analysed the correlation between changes in both anthropometric (body mass index, BMI and waist circumference) and metabolic (fasting blood glucose, FBG and HbA1c) variables and dynamical CGM-derived metrics and searched for variables in the basal CGM that could predict successful outcomes. RESULTS: There was a poor correlation between anthropometric and metabolic outcomes. There was a strong correlation between anthropometric changes and changes in glycaemic tonic control (∆BMI-∆TU6.1: rho = - 0.67, P < .01) and between metabolic outcomes and glycaemic phasic control (∆FBG-∆AO7.8: r = .60, P < .01). Basal AO7.8 was a powerful predictor of successful metabolic outcome (0.85 in patients with AO7.8 above the median vs 0.31 in patients with AO7.8 below the median: Chi-squared = 5.67, P = .02). CONCLUSIONS: In our population, anthropometric outcomes of DJBL correlate with improvement in tonic control of glycaemia, while metabolic outcomes correlate preferentially with improvement in phasic control. Assessment of basal phasic control may help in candidate profiling for DJBL implantation.

• MeSH
• biologické markery analýza   MeSH
• diabetes mellitus 2. typu komplikace   chirurgie   MeSH
• dospělí MeSH
• duodenum chirurgie   MeSH
• glykovaný hemoglobin analýza   MeSH
• hmotnostní úbytek MeSH
• jejunum chirurgie   MeSH
• krevní glukóza analýza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metabolický syndrom etiologie   prevence a kontrola   MeSH
• morbidní obezita patofyziologie   chirurgie   MeSH
• následné studie MeSH
• prognóza MeSH
• senioři MeSH
• žaludeční bypass metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Aim of the study: The aim was to perform a morphometric analysis of subcutaneous and visceral adipose tissue of morbidly obese women and to determine the relationship between adipocyte size and the development of type 2 diabetes (T2D). Materials and methods: White adipose tissue of morbidly obese women was obtained from subcutaneous and omental adipose tissue during bariatric surgery. The same tissues were obtained at judicial autopsy in non-obese (lean) non-diabetic patients. The harvested tissue was embedded in paraffin and 5 μm thick hematoxylin-eosin stained sections were analyzed by the Olympus cellSens system. Statistical evaluation was performed by GraphPad Prism 6.1 software. Results: We found a relationship between adipocyte size and the presence of T2D. The most pronounced changes were seen in visceral adipocytes (cell diameter increased from 61.9 μm in controls to 79.5 μm in patients with T2D). Also, the size of the subcutaneous adipocytes increased against the control. A statistically significant difference between diabetic and non-diabetic patients was not proven in subcutaneous adipocytes. We also observed differences in the distribution of adipocyte mean diameters. Whilst in the control group there was a normal (Gaussian) distribution, in the morbidly obese we found an asymmetric distribution with a positive skewness to the right. Conclusion: We have demonstrated that in morbidly obese women a significant increase in visceral adipocyte size is associated with the development of both insulin resistance and T2D.

• MeSH
• bílé tukové buňky cytologie   MeSH
• diabetes mellitus 2. typu patofyziologie   MeSH
• dospělí MeSH
• lidé MeSH
• morbidní obezita * chirurgie   patofyziologie   MeSH
• nitrobřišní tuk cytologie   MeSH
• podkožní břišní tuk cytologie   patofyziologie   MeSH
• tukové buňky cytologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND Obesity and associated comorbidities increase the probability of sexual disorders. The present study evaluated sexual satisfaction levels in obese women prior to and following bariatric surgery, utilizing the validated Female Sexual Function Index (FSFI) to also evaluate the sexual satisfaction in obese and non-obese women. MATERIAL AND METHODS 60 obese women (mean initial BMI of 43.7±5.9 kg/m²; mean age of 41.7±10.8 years) were administered the questionnaire on sexual function (FSFI) preceding bariatric surgery (laparoscopic adjustable gastric banding, 22 women; gastric plication, 33 women; and biliopancreatic diversion, 5 women), 6 months and 12 months after the procedure, i.e., following substantial weight reduction (final mean BMI of 35.5±5.5 kg/m²). The control group comprised 60 non-obese women (mean BMI of 22.2±1.9kg/m²; mean age of 36.4±10.7 years). RESULTS Our findings indicate that baseline sexual function in the preoperative obese females was significantly lower than in non-obese women, with p<0.01 in each domain. Data gathered at the 6- and 12-month points following the procedure indicated no significant difference. Before the procedure, 31 obese subjects (51.6%) exceeded the cutoff for FSD, at the 6-month evaluation point, 17 women (39.5%) exceeded the cutoff, and at 12 months postoperatively, 18 subjects (41.9%) exceeded the cutoff, indicative of FSD. Among the non-obese controls, only 9 subjects (15%) exceeded the cutoff threshold. CONCLUSIONS These findings show that substantive weight reduction resulting from bariatric surgery results in reduced sexual dysfunction in female subjects.

• MeSH
• bariatrická chirurgie * MeSH
• dospělí MeSH
• hmotnostní úbytek MeSH
• komorbidita MeSH
• lidé středního věku MeSH
• lidé MeSH
• morbidní obezita patofyziologie   chirurgie   MeSH
• obezita patofyziologie   chirurgie   MeSH
• orgasmus fyziologie   MeSH
• průzkumy a dotazníky MeSH
• sexuální dysfunkce fyziologická patofyziologie   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• diabetes mellitus 1. typu * diagnóza   farmakoterapie   komplikace   MeSH
• duševní poruchy diagnóza   epidemiologie   psychologie   MeSH
• dyslipidemie diagnóza   epidemiologie   MeSH
• glykovaný hemoglobin normy   MeSH
• lidé MeSH
• metformin farmakologie   terapeutické užití   MeSH
• morbidní obezita * epidemiologie   genetika   patofyziologie   terapie   MeSH
• rizikové faktory MeSH
• stravovací zvyklosti psychologie   účinky léků   MeSH
• střevní mikroflóra genetika   MeSH
• Check Tag
• lidé MeSH

Se šířící se epidemií obezity se v praxi stále častěji setkáváme s nárůstem arteriální hypertenze, mnohdy rezistentní na běžnou terapii. Obezita je onemocnění, které samo o sobě snižuje účinek antihypertenziv, zároveň je provázena patologickými stavy, které k arteriální hypertenzi vedou. Popisovány jsou nejčastěji zvýšená aktivita sympatiku, ovlivnění systému renin-angiotenzin- aldosteron, hyperinzulinemie a hyperleptinemie. Tyto skutečnosti by měly být zahrnuty do volby nejvhodnějšího typu antihypertenziva. Vzhledem k farmakokinetickým změnám u obézních pacientů bývá nutné užití vyšších dávek antihypertenziv. V terapii preferujeme inhibitory angiotenzin konvertázy nebo sartany. Pravděpodobně se nevyhneme více-kombinaci antihypertenziv, lze zvolit blokátory kalciových kanálů, nízké dávky diuretik, agonisty imidazolinových receptorů nebo dle komorbidit blokátory alfa či beta-receptorů. Účinek všech antihypertenziv je potencován redukcí váhy a úpravou životního stylu.

Prevalence of arterial hypertension, which is in most cases resistant to standard therapy, is on the increase due to the obesity epidemic. Obesity is one of the main causes of hypertension, disrupting the efficacy of antihypertensive therapy. Obesity-related hypertension is triggered by an increase of sympathomimetic activity, an impaired renin-angiotensin-aldosterone system, hyperinsulinemia and hyperleptinemia. These pathophysiological alterations determine the appropriate choice of antihypertensive agents used. According to pharmacokinetic changes in obese patients, higher doses of antihypertensives are now required. The preferred agents are angiotensin-converting inhibitors or sartans. In multiple combinations, calcium channel blockers, small doses of diuretics, imidazoline receptor agonists and alpha and beta-receptor antagonists are also used. Excessive weight reduction and lifestyle modifications are essential parts of therapy.

• MeSH
• antihypertenziva farmakokinetika   terapeutické užití   MeSH
• beta blokátory terapeutické užití   MeSH
• blokátory kalciových kanálů MeSH
• blokátory receptorů AT1 pro angiotensin II farmakokinetika   terapeutické užití   MeSH
• diuretika škodlivé účinky   terapeutické užití   MeSH
• hypertenze * farmakoterapie   patofyziologie   MeSH
• inhibitory ACE terapeutické užití   MeSH
• lidé MeSH
• metaanalýza jako téma MeSH
• metabolický syndrom MeSH
• morbidní obezita patofyziologie   MeSH
• renin-angiotensin systém účinky léků   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• přehledy MeSH

BACKGROUND: The surgical technique of laparoscopic sleeve gastrectomy (LSG) has not been fully standardized yet and there is the unresolved question of what is the optimum size of retained pyloric antrum. The aim of our research was to prove that even after a radical resection of the pyloric antrum the physiological stomach evacuation function can still be preserved. METHODS: Our study was based on 12 patients, who were randomly divided into two groups. Patients undergoing radical antrum resection (RA group) underwent gastric emptying scintigraphy to determine the evacuation half-time (T1/2) and food retention in the 90th minute of the test (%GE) both before the operation and 3 months afterward. Patients in whom the antrum was preserved (PA group) served as a control group for comparison of postoperative weight loss (in kilogram), decrease in body mass index (BMI), and decline in excess weight (%EWL). The resulting changes were statistically processed. RESULTS: In the RA group, the average time T1/2 declined from 57.5 to 32.25 min (p = 0.016) and average retention %GE dropped from 20.5 to 9.5% (p = 0.073). Differences in the average values of weight, BMI, or %EWL between both groups were of no statistical significance (p > 0.8). CONCLUSIONS: In the RA group, an increase in gastric emptying postoperatively was noted. Complications such as failure of stomach evacuation were not observed in the RA group. Our results suggest that even more radical resection of the pyloric antrum performed by LSG is possible without concerns of postoperative disorder of the stomach evacuation function.

• MeSH
• analýza rozptylu MeSH
• antrum pyloricum patofyziologie   chirurgie   MeSH
• dospělí MeSH
• gastroplastika metody   MeSH
• hmotnostní úbytek MeSH
• index tělesné hmotnosti MeSH
• laparoskopie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• morbidní obezita patofyziologie   chirurgie   MeSH
• následné studie MeSH
• pilotní projekty MeSH
• tělesná hmotnost MeSH
• vyprazdňování žaludku * MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Laparoscopic greater curvature plication (LGCP) is a new metabolic/bariatric surgical procedure that requires no resection, bypass, or implantable device. We report LGCP outcomes in 244 morbidly obese patients. METHODS: Between 2010 and 2011, patients underwent LGCP. Body mass index (BMI, kilogram per square meter) evolution, excess BMI loss (%EBMIL), excess weight loss (%EWL), complications, and type 2 diabetes mellitus (T2DM) changes were recorded. Repeated-measures analysis of variance (ANOVA) was used to assess weight change at 6, 12, and 18 months. Subgroup analyses were conducted to provide benchmark outcomes at 6 months. Logistic regression was used to identify characteristics predictive of suboptimal weight loss. RESULTS: Mean baseline BMI (±SD) was 41.4 ± 5.5 (80.7 % women, mean age 46.1 ± 11.0 years, 68 [27.9 %] patients had T2DM). Mean operative time was 70.6 min; mean hospitalization, 36 h (24-72). Sixty-eight patients (27.9 %) experienced postoperative nausea and/or vomiting that was controlled within 36 h. There was no mortality. Major complication rate was 1.2 % (n = 3). Repeated-measures ANOVA indicated significant weight loss across time points (p < 0.001). At 6 months (n = 105), BMI, %EBMIL, and %EWL were 36.1 ± 4.7, 34.8 ± 17.3, and 31.8 ± 15.9. Preoperative BMI was the only predictor of weight loss. Patients with BMI <40 lost more weight than those ≥40, although by 9 months, differences were no longer significant. In patients with preoperative BMI <40, 18-month %EWL approached 50 % and %EBMIL exceeded 50 %. At 6 months, 96.9 % of patients' T2DM was significantly improved/resolved. CONCLUSIONS: Over the short term, LGCP results in effective weight loss and significant T2DM reduction with a very low rate of complications.

• MeSH
• analýza rozptylu MeSH
• diabetes mellitus 2. typu krev   komplikace   patofyziologie   MeSH
• gastroplastika škodlivé účinky   metody   MeSH
• hmotnostní úbytek MeSH
• index tělesné hmotnosti MeSH
• laparoskopie MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• morbidní obezita krev   komplikace   patofyziologie   chirurgie   MeSH
• následné studie MeSH
• prospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Intraband pressure (IBP) measurement may be a less invasive method to assess esophageal motility response to band adjustment and restrictive integrity of the device in Swedish adjustable gastric band (SAGB) patients. However, the relationship between IBP and esophageal function is not yet established. Our aim was to characterize in vivo IBP-peristalsis associations in SAGB patients. Ten patients in their second postoperative year were prospectively recruited. IBP was measured via percutaneous port, and concurrent esophageal manometry was performed using an 8-channel catheter. Contraction length and amplitude were measured with both methods. The IBP-peristalsis correlation was computed using the R-square of the regression analysis (R (2)) for band volumes ranging from 4 to 9 mL. One hundred ten swallows were studied. Excellent IBP-peristalsis correlation was observed in 6 of 10 patients (267 contractions): contraction length R (2) = 0.8537 and amplitude R (2) = 0.7365 (p-value of slope < 0.001). Mean contraction length was 17 +/- 7 (4-42) s for manometry and 18 +/- 7 (5-43) s for IBP. Mean amplitude was 55 +/- 55 (9-209) mm Hg for manometry and 67 +/- 47 (7-190) mm Hg for IBP. A weak IBP-peristalsis correlation was observed in the remaining four patients: two had impaired lower sphincter relaxation, one had band slippage, and one had disruption of the port needle connection. In vivo IBP measurement may be reliable in the assessment of esophageal peristalsis in response to band adjustments and the restrictive integrity of the device in patients with intact esophageal function. More studies are warranted to completely assess the potential for IBP to be indicative of the presence of band-related complications.

• MeSH
• dolní jícnový svěrač fyziologie   MeSH
• dospělí MeSH
• ezofágus fyziologie   MeSH
• gastrointestinální motilita MeSH
• gastroplastika MeSH
• lidé středního věku MeSH
• lidé MeSH
• manometrie MeSH
• morbidní obezita patofyziologie   chirurgie   MeSH
• peristaltika fyziologie   MeSH
• polykání fyziologie   MeSH
• poruchy motility jícnu diagnóza   etiologie   MeSH
• prospektivní studie MeSH
• tlak MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH