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Extraction conditions can have a substantial effect on protein complexes isolated from within cells. A platform for rapid, systematic screening of these conditions is described, which should enable the identification of biologically relevant complexes. We must reliably map the interactomes of cellular macromolecular complexes in order to fully explore and understand biological systems. However, there are no methods to accurately predict how to capture a given macromolecular complex with its physiological binding partners. Here, we present a screening method that comprehensively explores the parameters affecting the stability of interactions in affinity-captured complexes, enabling the discovery of physiological binding partners in unparalleled detail. We have implemented this screen on several macromolecular complexes from a variety of organisms, revealing novel profiles for even well-studied proteins. Our approach is robust, economical and automatable, providing inroads to the rigorous, systematic dissection of cellular interactomes.

Laparoscopic adjustable gastric banding (LAGB) is considered to be a safe and effective method of weight loss and reduction of comorbidities associated with obesity. Despite its improved early safety profile compared with Roux-en-Y gastric bypass, patients with LAGB can manifest unique complications that must be recognized and managed appropriately to achieve good outcomes. This review will prepare the general surgeon to identify, diagnose and manage the common complications encountered in patients presenting following LAGB.

Obesity can be considered to be one of the most important chronic diseases facing Canadians of all ages. Whereas patients with a very high body mass index may have the most to gain from procedures such as Roux-en-Y gastric bypass or biliopancreatic diversion/duodenal switch, the increased risk of postoperative complications often makes them poor surgical candidates. As a result, several “bridging” procedures have been proposed to impart clinically effective weight loss and reduce the risk of complications and improve outcomes in the definitive weight-loss procedure. In this article, we provide a review of the evidence in support of laparoscopic sleeve gastrectomy as an innovative new surgical procedure used as a bridging procedure in patients with severe obesity and discuss new findings for its possible role as a definitive procedure for some individuals with less severe obesity. Finally, we comment on a possible approach to introduce this innovative new procedure to Canadian bariatric centres.

Ahealthy 35-year-old, multiparous woman presented to the emergency department with nausea, vomiting and a painful, bloated abdomen. On examination, the patient was afebrile and passing flatus. She had a distended abdomen that was silent and tympanitic, with mild tenderness in the lower left quadrant. The results of basic laboratory investigations (i.e., complete blood count, electrolyte panel) were normal. Computed tomography showed dilated loops of distal small bowel in the lower abdomen consistent with a partial obstruction of the small bowel. A diagnostic laparoscopy showed an internal herniation of the small bowel through a 5-cm defect in the broad ligament, between the round ligament and left adnexa (Figure 1A). After reduction of the herniated bowel, the broad ligament was cut to prevent recurrence.

A 56-year-old man who had undergone gastric bypass 7 years earlier presented with midabdominal pain, nausea, and bilious emesis. Swirling of the bowel and mesenteric vessels, shown in a video, was noted on CT. A 56-year-old man presented after a day and a half of midabdominal pain, nausea, and bilious emesis. The patient had undergone Roux-en-Y gastric bypass 7 years earlier. During the physical examination, tachycardia and tachypnea were noted. The abdominal examination showed a distended, tympanic abdomen with severe generalized abdominal tenderness, involuntary guarding, and rebound tenderness consistent with peritonitis. Radiography (Panel A) and computed tomography (CT) (Panel B) showed dilated loops of small bowel distal to the jejunojejunostomy staple line with proximal decompression. Swirling of the bowel and mesenteric vessels was noted on CT as they herniated through the jejunojejunostomy mesenteric defect. . . .

Few prospective studies have compared changes of nutrient intake while assessing effectiveness of thiamin, vitamin B^sub 12^, and folate supplementation to prevent B vitamin deficiencies immediately following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Therefore, we determined the response to 3 months supplementation on maintaining blood B vitamin concentrations. Women undergoing RYGB (n=11) and SG (n=11) consumed bariatric vitamin supplements (12 mg thiamin, 350 [mu]g vitamin B^sub 12^, 800 [mu]g folic acid) daily for 3 months. Height, weight, body mass index, and blood vitamin concentrations were measured preoperatively and at 3 months. Wilcoxon signed-rank analyses compared body weight parameters, laboratory indices, and nutrient intake at baseline and 3 months. Supplementation for 3 months maintained blood thiamin, increased serum folate from 13.1±5.4 to 16.3±6.0 nmol/L (P=0.049), and increased serum vitamin B^sub 12^ concentrations from 498±150 to 736±340 pg/mL (P=0.005). Dietary intake of thiamin and folate decreased in the combined surgical groups, while dietary intake of B^sub 12^ was maintained. Bariatric B vitamin supplements provided multiple intakes of the Recommended Dietary Allowances (1090 % thiamin, 14,583 % vitamin B^sub 12^, 200 % folate). Although energy intake decreased 64 %, B vitamin supplementation for 3 months resulted in a 48 % increase of serum vitamin B^sub 12^, a modest increase of serum folate, and no reduction of blood thiamin concentrations. Long-term effects of the rapid rise of serum B^sub 12^ levels attributed to the high content of supplements warrant further investigation.

Background Vitamin D deficiency is common with bariatric surgery, and few prospective studies comparing different surgical procedures have evaluated appropriate vitamin D supplementation levels. Therefore, vitamin D 3 and calcium supplementation were evaluated following gastric bypass and sleeve gastrectomy. Methods Women consumed 2,000 international units (IU) of vitamin D 3 and 1,500 mg calcium citrate daily for 3 months following gastric bypass ( n  = 11) and sleeve gastrectomy ( n  = 12). Height, weight, body mass index (BMI), serum 25-hydroxyvitamin D [25(OH)D], and serum PTH concentrations were measured preoperatively and at 3 months. Wilcoxon signed rank analyses compared body weight parameters, serum 25(OH)D and PTH concentrations, and dietary intakes of vitamin D and calcium preoperatively and at 3 months. Vitamin D deficiency was defined as a serum 25(OH)D concentration <20 ng/mL (50 nmol/L). Results Vitamin D deficiency decreased from 60.6 % preoperatively to 26.1 % after 3 months ( P  < 0.005). Serum 25(OH)D concentrations increased an average of 8 ng/mL ( P  < 0.001), and PTH concentrations decreased an average of 9 ng/L, although reductions were not significant. Overall, the response to supplementation following gastric bypass and sleeve gastrectomy did not differ. Conclusions Reduced food intake increased the risk of vitamin D deficiency following bariatric surgery. However, daily supplementation with 2,000 IU of vitamin D 3 and 1,500 mg calcium citrate significantly increased 25(OH)D concentrations and reduced the percent of women who were vitamin D deficient. Although serum 25(OH)D concentrations did not reach levels associated with detrimental health effects, several women remained vitamin D deficient and more aggressive supplementation may be indicated.

IntroductionIn cardiac and orthopedic surgery, elevated glycosylated hemoglobin (HbA1c) is a modifiable risk factor for postoperative complications. However, in bariatric surgery, there is insufficient evidence to assess the effectiveness of preoperative HbA1c assessment and its association with postoperative complications. The objective of this study was to assess the impact of HbA1c on early postoperative outcomes in bariatric surgery patients.MethodsPatients who underwent laparoscopic sleeve gastrectomy and laparoscopic Roux-En-Y Gastric Bypass between 2017 and 2018 were selected for a retrospective review from the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP) database. The study population of 118,742 patients was analyzed for our primary outcome which was defined as a composite of any postoperative complications occurring within 30 days. Two groups were defined by HbA1c cutoff: comparison point A (≤ 8% vs > 8%) and comparison point B (≤ 10% vs > 10%). Procedure-related complications were also examined on subgroup analysis. Propensity score matching (PSM) was used with one-to-one matching. The complication rates before and after PSM were calculated and assessed by Fisher’s exact test and conditional logistic regression, respectively.ResultsAfter PSM, demographic and clinical characteristics were all balanced and elevated HbA1C was not associated with worse outcomes. After adjusting for underlying comorbidities, there was no statistically significant difference seen in the composite outcome for comparison point A HbA1C ≤ 8 and HbA1C > 8 (p = 0.22). For comparison point B, patients with HbA1C ≤ 10 had more composite complications compared to patients with HbA1C > 10 (p < 0.001). Also, on subgroup analysis after PSM for procedure-specific complications, patients above the cutoff threshold of 8 did not have worsened composite outcomes (p = 0.58 and 0.89 for sleeve and bypass, respectively). Again, at cutoff threshold of 10, patients in HbA1C ≤ 10 had more composite complications (p = 0.001 and 0.007 for sleeve and bypass, respectively).ConclusionIn this study of bariatric patients, elevated HbA1c > 8% or 10% was not associated with increased postoperative complications. HbA1c lower than 10% was associated with some types of adverse outcomes in this bariatric dataset. More studies are needed to investigate these findings further. A high HbA1c alone may not disqualify a patient from proceeding with bariatric surgery.

Background Few prospective studies have compared changes of nutrient intake while assessing effectiveness of thiamin, vitamin B 12 , and folate supplementation to prevent B vitamin deficiencies immediately following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Therefore, we determined the response to 3 months supplementation on maintaining blood B vitamin concentrations. Methods Women undergoing RYGB ( n  = 11) and SG ( n  = 11) consumed bariatric vitamin supplements (12 mg thiamin, 350 μg vitamin B 12 , 800 μg folic acid) daily for 3 months. Height, weight, body mass index, and blood vitamin concentrations were measured preoperatively and at 3 months. Wilcoxon signed-rank analyses compared body weight parameters, laboratory indices, and nutrient intake at baseline and 3 months. Results Supplementation for 3 months maintained blood thiamin, increased serum folate from 13.1 ± 5.4 to 16.3 ± 6.0 nmol/L ( P  = 0.049), and increased serum vitamin B 12 concentrations from 498 ± 150 to 736 ± 340 pg/mL ( P  = 0.005). Dietary intake of thiamin and folate decreased in the combined surgical groups, while dietary intake of B 12 was maintained. Bariatric B vitamin supplements provided multiple intakes of the Recommended Dietary Allowances (1090 % thiamin, 14,583 % vitamin B 12 , 200 % folate). Conclusions Although energy intake decreased 64 %, B vitamin supplementation for 3 months resulted in a 48 % increase of serum vitamin B 12 , a modest increase of serum folate, and no reduction of blood thiamin concentrations. Long-term effects of the rapid rise of serum B 12 levels attributed to the high content of supplements warrant further investigation.

IntroductionFollowing bariatric surgery, ongoing postoperative testing is required to measure nutritional deficiencies; the purpose of this study was to quantify the prevalence of these nutritional deficiencies based on two-year follow-up tests at recommended time points.Methods and proceduresA retrospective data analysis was conducted of all laboratory tests for bariatric patients who underwent surgery between May 2016 and January 2018 with available lab data (n = 397). Results for nine different nutritional labs were categorized into six recommended postoperative time periods based on time elapsed since the procedure date. Binary variables were created for each laboratory result to calculate descriptive statistics of abnormalities for each lab test over time and used in the individual GEE logistic regression models. Grouped logistic regression examined the total nutritional deficiencies of the nine combined nutrients considering total available labs.ResultsMultiple lab tests indicated a very low frequency of abnormalities (e.g., Vitamin A, Vitamin B12, Copper, and Folate). Many of the nine included nutritional labs had an average deficiency of less than 10% across all time points. The grouped logistic model found preoperative nutritional deficiency to be predictive of postoperative nutritional deficiency (OR 3.70, p < 0.001).ConclusionsWe found the vast majority of routine lab test results to be normal at multiple time points. Current practice can add up to significant lab expenses over time. The frequency of postoperative testing in this population may be redundant and of very little value. Unnecessary follow-up laboratory testing costs the patients and the health care system in both time and resources. Patients with preoperative deficiencies appear to be at higher risk for nutritional deficiencies when compared to bariatric surgery patients that did not have preoperative nutritional deficiencies. Future research should focus on defining cost effective postoperative lab testing guidelines for at risk bariatric patients.