Childhood obesity is an urgent problem of pediatric endocrinology due to the widespread occurrence, the development of metabolic complications and their steady tracking into adulthood. The developed clinical guidelines are the main working tool of the practitioner. They briefly and structurally present the main information about the epidemiology and modern classification of obesity, methods of its diagnosis and treatment based on the principles of evidence-based medicine.

The relevance of developing an individual model of psychological support for patients with bariatric surgery «12 targets» in the framework of a multidisciplinary approach to the treatment of obesity is due to the fact that the effectiveness of surgical treatment is significantly influenced by the individual psychological characteristics of the patient. A comprehensive assessment of the psychological state of patients and the implementation of psychocorrective measures before and after bariatric surgery can improve the effectiveness of surgical treatment and prevent the risk of relapse. The individual model of the psychological support of the bariatric patient is built on the principle of a psycho-correction program, which is an integrative approach using psychotherapeutic tools from various areas of clinical psychology and psychotherapy. 12 universal targets of psycho-corrective influence in work with bariatric patients have been identified. The program is implemented in two stages: psychological preparation for bariatric surgery, psychological adaptation to physiological and psychological changes in the postoperative period. 20 bariatric patients took part in the program of individual psychological support, 11 of them (group 1) participated in all stages of psycho-corrective measures; 9 people (group 2) did not undergo psychological preparation for surgery, they were already included in the second stage of work on psychological adaptation to physiological and psychological changes in the postoperative period. Intermediate results of evaluating the effectiveness of psychological support for patients, which are based on the percentage of BMI reduction, show the achievement of stability in reducing overweight in the process of psychological interventions in both groups. The described model of psychological work will allow clinical psychologists working in a multidisciplinary team in bariatrics to focus on the universal targets of the problem field of a bariatric patient.

Over the past few decades, obesity has become a growing public health problem worldwide. The goal of fighting obesity is to improve health. Sustained weight loss of more than 10% of the total body weight improves the course of many obesity-related diseases, as well as the quality of life. The high effectiveness of bariatric surgery in the treatment of obesity in achieving significant and sustained weight loss has been demonstrated in several studies. In most centers where bariatric surgery is performed, the recommendation for preoperative weight loss is followed. The enlarged left lobe of the liver makes it difficult to access the stomach and, accordingly, prevents technically correct operation. Weight loss before bariatric surgery reduces the risk of complications in the postoperative period, and therefore preoperative preparation in the form of hypocaloric nutrition and regular physical activity is recommended for patients, considering concomitant pathology. One of the problems in the postoperative period is the need to change the usual lifestyle and diet due to the need to follow the recommendations of the attending physician. This can lead to a decrease in the quality of life after surgery due to psychoemotional overstrain. The nutrition of bariatric patients implies significant changes associated with a decrease in the amount of food consumed, difficulty in assimilation of nutrients, and the poverty of flavors offered up to this day in the specialized nutrition market. With the help of food products within the framework of low-calorie diets, it becomes almost impossible to feed such a patient without reducing their nutritional value. In 2024, balanced low-calorie nutrition OPTIFAST® (OPTIFAST) appeared on the Russian market, which has proven itself worldwide for more than 50 years and has shown its effectiveness and safety in more than 80 international clinical trials with a high level of evidence. OPTIFAST provides the patient with all the necessary nutrients and allows you to manage the daily calorie intake, gives the patient a feeling of satiety necessary for high adherence to a low-calorie diet, which is indicated for patients with obesity and overweight.

BACKGROUND: Bariatric surgery has proven effective as a treatment for the metabolic complications of obesity, including type 2 diabetes mellitus (T2DM). Nowadays it is important to develop a personalized approach for bariatric patients generally, and for those with T2DM.AIM: Development of a scale for preoperative prediction of remission of T2DM in obese patients Russian population undergoing bariatric surgery (sleeve gastrectomy or gastric bypass).MATERIALS AND METHODS: A retrospective multicenter cohort study was conducted. The study included 112 patients (75 women and 37 men), mean age 46.25±9.29 years, mean BMI 48.71±7.66 kg/m2. A mathematical analysis of 17 preoperative clinical criteria was carried out to search for independent predictors of T2DM remission.RESULTS: A remission of T2DM was verified in 85 subjects, (75.9%), absence of remission of T2DM — in 27 subjects (24.1%). The most important prognostic factors were T2DM experience, age, HOMA-IR insulin resistance index, HbA1c, BMI, metformin therapy, SUs, insulin intake, increased levels of liver transaminases, and total cholesterol levels. The relative importance coefficient of each parameter was calculated. A formula has been developed to predict the high or low probability of T2DM remission after bariatric treatment. An online DRAMS (Diabetes Remission After Metabolic Surgery) calculator was proposed based on this formula so it is easy to use in clinical practice.CONCLUSION: An online calculator has been developed to predict the probability of T2DM remission after bariatric surgery. The received data allow us to construct a qualitative “high risk”/“low risk” scale. A number of identified predictors require further study in larger samples of patients.

Until now, there has not been organized consensus for standardization in bariatric surgery In Russia. We present the results of the first Bariatric Surgery Consensus Conference conducted in Barnaul (March, 2023). A list of questions was proposed within 6 blocks: 1) general issues of bariatric surgery, 2) sleeve gastrectomy, 3) one-anastomosis gastric bypass («mini-gastric bypass»), 4) Roux-en-Y Gastric Bypass, 5) Single Anastomosis Duodenal Switch and other options for biliopancreatic bypass, 6) rare procedures. Consensus (>70% agreement) was reached for 51 out of 96 statements. Stratification by the level of expertise was carried out, and responses of the expert group were compared with responses of all participants.

There is a great worldwide trend in the incidence of obesity, which is increasing with each passing year among all populations, including women of reproductive age. Given the impressive list of diseases associated with obesity, as well as the negative inverse correlation of the severity of obesity with fertility, this problem is global not only in the social sphere, but it also becomes demographically significant.Along with other pathogenetic mechanisms leading to persistent anovulation, an imbalance in adipokine production by adipose tissue can also serve as one of the important links in the development of reproductive dysfunction. Despite apparent interest in this topic, a large number of previously discovered adipokines are still not studied. Among adipokines, the effects of adiponectin and leptin on reproductive function are best known. Alterations in adiponectin and leptin levels can affect hypothalamic-pituitary-gonadal signaling, folliculogenesis, oogenesis and steroidogenesis. In addition, leptin is involved in the initiation of puberty, regulation of the menstrual cycle, and changes the balance between proliferation and apoptosis in ovarian cells. The leading causes of reduced fertility, infertility, and IVF failure in obese patients are mechanisms that promote the formation of chronic anovulation, delay the maturation of oocytes, reduce their quality, and/or lead to changes in endometrial susceptibility. These effects can be caused by an imbalance in the concentrations of leptin and adiponectin (leptin excess and adiponectin deficiency), lead to endometrial dysfunction, disruption of implantation and early embryogenesis. These changes, in turn, can affect just as the likelihood of spontaneous conception, so the effectiveness of assisted reproductive technologies and subsequent gestation.Thus, the study of potential pathogenetic pathways of fertility regulation in obesity, one of which is the subject of this review, is an important area for further study.

The paper presents our own experience in organizing and conducting training courses for doctors of surgical specialties using living tissue technology (Wet-Lab) and augmented virtual reality. A feature of these courses is the successful combination of Dry-Lab and Wet-Lab simulation techniques, which allows for “step-by-step” skill training with its consolidation during operations on animals in an experimental operating room.

The article describes the case of a patient with Wernicke encephalopathy, which developed 3 months after the sleeve gastrectomy. An MRI of the brain was performed to verify the diagnosis, which revealed a symmetrical non-uniform increase in the MR signal on T2-WI and Tirm from the medial part of the thalamus, mastoid bodies and gray matter around the aqueduct of Sylvius. Thiamine infusion was promptly initiated as therapy. During treatment, acute neurological symptoms almost regressed, the patient was discharged in a satisfactory condition with preservation of vertical nystagmus under the supervision of specialists at the place of residence. Wernicke–Korsakoff syndrome more often occurs as a complication of alcoholism and arising from thiamine deficiency. However, the fact that this condition also occurs under the influence of other etiopathogenetic factors is often ignored by clinicians. In the management of patients after bariatric interventions, this condition is much more common in malabsorptive operations. However, a combination of certain factors can be described in patients after restrictive types of bariatric surgeries.

Objective: Long-standing gastroesophageal reflux disease is the most common cause of a cicatricial stricture of the esophagus. The treatment of this pathology involves a wide range of methods including conservative and surgical options. Surgeons can encounter technical difficulties in case of concomitant neck and chest pathology. Clinical case: We report a case of a decompensated cicatricial stricture of the esophagus with concomitant paraesophageal hiatal hernia, refractory gastroesophageal reflux disease, and nontoxic multinodular goiter (166.9 cm 3 ). Selecting the optimal management for such patients is often a challenge. Staged treatment significantly improves postoperative quality of life, but the increased length of hospital stay can negatively impact patient compliance.

Background . Significant proportion of patients with obesity and type 2 diabetes mellitus (DM) have significant weight loss and improved metabolic outcomes as a result of bariatric surgery. To predict the effect of surgical treatment of DM, several scales have been proposed, including ABCD and IMS. Objective . To estimate accuracy of the ABCD and IMS scales in predicting DM remission in patients undergoing bariatric surgery. Design and methods . 38 patients with type 2 diabetes were identified after bariatric surgery with a follow-up period of at least 1 year. The KNIME Analytics Platform 4.3.6 (KNIME AG, Switzerland) was used for data processing. Results . 12.8 % of patients achieved partial remission, 52.6 % complete remission, and 31.6 % did not achieve remission. According to the IMS, no significant results were detected in the remission groups. IMS scale have a low predictive value. A significant result was obtained for the ABCD after CAIM binning. For the binary classification (“Remission”/”Haven’t remission”): AUC = 0.98 and Cohen’s kappa k = 0.86 for probability treshold 0.55399, that maximized F-measure (0.96) were obtained. So, ABCD predictive value is high. Conclusion . The ABCD have a better predictive value. Ease of use, good prognostic effect allows us to recommend ABCD before bariatric treatment.

Аневризма селезеночной артерии — достаточно редкая патология, при этом ее лечение является актуальной проблемой в связи с высоким уровнем осложнений и смертности при ее разрыве. Пациент П., 81 год, поступил в плановом порядке для хирургического лечения аневризмы селезеночной артерии. При ангиографии выявлена извитость селезеночной артерии с аневризматическим расширением до 28 мм в дистальном сегменте. Провели лапароскопическую изоляцию аневризмы селезеночной артерии с помощью сшивающего аппарата. Течение послеоперационного периода без особенностей. Пациента выписали на 5-е сутки. Лапароскопия — метод выбора у пациентов с выраженной извитостью селезеночной артерии и дистальным расположением аневризмы в рамках органосохраняющей тактики. Поступила в редакцию 20 декабря 2021 г. Исправлена 13 апреля 2022 г. Принята к печати 26 апреля 2022 г. Информированное согласие Получено информированное согласие пациента на публикацию и использование его медицинских данных в научных целях. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Обзор литературы: А.Г. Ванюркин, Ю.А. Кудаев Написание статьи: Н.С. Одинцов, Ю.К. Белова Исправление статьи: А.Е. Неймарк, М.А. Чернявский Выполнение операций: А.Е. Неймарк Утверждение окончательного варианта статьи: все авторы

Sleeve gastrectomy, originally proposed as part of a two-stage operation, more than 15 years ago, is recognized as an independent, effective intervention for the treatment of obesity. The purpose of this review was to evaluate the effectiveness of sleeve gastrectomy based on data on long-term follow-up of patients. A search was performed in two databases, 33 literary sources were selected based on the results of the selection. In this review, the authors evaluated some parameters characterizing the effectiveness of sleeve gastrectomy in the long term after surgery. The percentage of follow-up of patients in the long-term period (follow up, %) varied from 5,6% to 97%, the expected decrease in % follow up over time did not occur. The authors have suggested similar results due to the heterogeneity of the data of the analyzed sources. By the five-year period, the detected average % of follow-up did not correspond to the optimal recommended level of follow-up for operated patients by this time. The most common criterion for assessing the return of weight is an increase in body weight by more than 10 kg from the lowest achieved. The prevalence of this phenomenon ranged from 26.3% to 44%. Among the reasons predisposing to weight loss are the initial high BMI, old age, dilatation of the formed stomach. In the absence of a universal definition of various terms (follow up, unsatisfactory result of surgery, weight loss, etc.), the results among the same patients when using different definitions will differ, there is a need to adopt standards when describing these phenomena. Despite the likelihood of weight loss after longitudinal resection, this operation is relatively simple from a technical point of view, safer, it can be used to improve the course of concomitant pathology (diabetes mellitus, hypertension), improve the quality and increase the life expectancy of patients.

Splenic artery aneurysm is a rather rare abnormality, and its treatment is a pressing issue due to high morbidity and mortality in case of its rupture.Our aim is to show the advantages of the laparoscopy for splenic artery aneurysms.Patient P., 81 years old, was admitted for surgical treatment of the splenic artery aneurysm. Angiography revealed the tortuosity of the splenic artery with a 28-mm distal aneurysm. Laparoscopic treatment of the aneurysm was performed using a stapler. No complications were observed during the postoperative period, so the patient was discharged on day 5.The laparoscopic treatment is a method of choice in patients with a tortuos splenic artery and a distal aneurysm to spare a spleen. Received 20 December 2021. Revised 13 April 2022. Accepted 26 April 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsLiterature review: A.G. Vanyurkin, Yu.A. KudaevDrafting the article: N.S. Odintsov, Yu.K. BelovaCritical revision of the article: A.E. Neimark, M.A. ChernyavskiySurgical treatment: A.E. NeimarkFinal approval of the version to be published: N.S. Odintsov, Yu.K. Belova, A.G. Vanyurkin, Yu.A. Kudaev, A.E. Neimark, M.A. Chernyavskiy

Obesity and type 2 diabetes mellitus (T2DM) are often combined and pathologically affect many tissues due to changes in circulating bioactive molecules. In this work, we evaluated the effect of blood plasma from obese (OB) patients or from obese patients comorbid with diabetes (OBD) on skeletal muscle function and metabolic state. We employed the mouse myoblasts C2C12 differentiation model to test the regulatory effect of plasma exposure at several levels: (1) cell morphology; (2) functional activity of mitochondria; (3) expression levels of several mitochondria regulators, i.e., Atgl, Pgc1b, and miR-378a-3p. Existing databases were used to computationally predict and analyze mir-378a-3p potential targets. We show that short-term exposure to OB or OBD patients' plasma is sufficient to affect C2C12 properties. In fact, the expression of genes that regulate skeletal muscle differentiation and growth was downregulated in both OB- and OBD-treated cells, maximal mitochondrial respiration rate was downregulated in the OBD group, while in the OB group, a metabolic switch to glycolysis was detected. These alterations correlated with a decrease in ATGL and Pgc1b expression in the OB group and with an increase of miR-378a-3p levels in the OBD group.

Abstract Introduction Prior bariatric surgery (BS) significantly improves survival after myocardial infarction (MI). We assume that reduction in fatal MI after BSs could be attributed to the infarct size-limiting effect of the interventions and that this effect is not associated with an improvements in the diabetes mellitus and obesity. Purpose The aim of the study was to evaluate the infarct-limiting effect of various types of bariatric surgery in non-obese non-diabetic rats. Methods Rats were randomized into the following groups: no surgery (CON), sham surgery (SHAM), Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and ileal transposition (IT). 10 weeks after BS, the animals were subjected to ischemia-reperfusion, followed by histochemical determination of infarct area (IA) and no-reflow zone. At the 90th minute of reperfusion, all animals were injected intravenously with indocyanine green at a dose of 1 mg/kg to measure size of no-reflow zone. Results None of bariatric surgery procedures led to body weight reduction. A temporal high postprandial glucose was observed during oral glucose tolerance test (OGTT) in SG and RYGB rats at 30th minute followed by decrease at 120 minutes in comparison with SHAM. Blood insulin concentration increased at 60th minutes in response to OGTT glucose in the SG group compared to CON and SHAM. On the contrary, there was a decrease in insulin level in the IT group after 60 and 120 minutes. In RYGB, basal leptin was low at 120 minutes after glucose administration, while in SG it decreased at 60 and 120 minutes compared with CON and SHAM. Compared to the SHAM, the rats with RYGB and SG had lower IA by 22% and 10% and no-reflow size by 38% and 32%. Conclusions We demonstrated that both bariatric surgeries procedures, RYGB and SG, increase myocardial tolerance to ischemia-reperfusion injury in rats without diabetes and obesity. The infarct-limiting effect was accompanied by a significant decrease in basal plasma leptin level. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health Care of Russian Federation. Governmental funding research

Objective : to evaluate the effectiveness of endosonography guided fine needle aspiration (EUS-FNA) of focal lesions of the pancreas. Assessment of the impact of age, gender, size of the lesion and its localization on informativity of the puncture. Material and methods : the retrospective study included 244 patients between 2012 and 2020 who underwent EUS-FNA for pancreatic lesions. The factors influencing the information content were determined and their statistical processing was carried out. Results : 454 morphological studies were performed in 244 patients. Of these, 211 are cytological, 149 are histological, and 94 are immunohistochemical (IHC). The frequency of informative conclusions was higher in the IHC group compared to cytological (p=1.611×10-6) and histological studies (p=3.617×10-5). The information content in the puncture of solid formations was 75.5%, cystic-solid — 80.4%, and cystic — 28.9%. (p=9.393×10-7). Informativity is significantly reduced when EUS signs of background pancreatitis are detected (p=0.0026). Conclusion : EUS-FNA is an effective and safe method for obtaining material for morphological diagnostics. EUS-FNA of cystic formations is the least informative and is associated with the greatest cases of complications. Age, gender, size of the lesion, and its localization has no effect on informativity of the puncture. Background chronic pancreatitis significantly reduces the informativity of EUS-TAP.

The article presents a non-systematic review of studies on breathing-related sleep disorders in patients with morbid obesity, and on the use of non-invasive ventilation in the pre-, peri-, and postoperative period of bariatric surgery, with an assessment of cardiovascular effects.

Purpose. To study the frequency of general surgical diseases development snd their features in patients after heart transplantation (HTx). Methods. From January 2010 to December 2018 it was performed 112 HTx (mean age - 46.7 +/- 14.0 years old; 82 - male, 30 - female). During 30 days after HTx 9 patients died. After discharge all recipients (n=98) were included in dispensary observation list. We retrospectively analyzed patients (n=35) who underwent general surgery manipulations in more than 30 days after HTx. All surgical interventions have been done under the reduction of immunosuppression therapy. Results. During 9 years of post-heart transplant follow-up 45 surgical interventions were performed, 7 % (n=3) of them due to infectious complications, 31 % (n=14) oncology and others (62%, n=28). Most of manipulations were planned (39 from 45, 87 %), the following general surgery interventions prevailed: laparoscopic cholecystectomy (n=13) and those to remove inguinal and umbilical hernia (n=12). During the 1st year the frequency of diseases required surgical treatment was 26 % (n=11), infectious causes took place in 5 patients, non-infectious - in 6. Subsequently the incidence of infectious complications decreased that could be associated with the minimization of immunosuppressive therapy. Oncology was more frequent long-term after HTx - more than 3 years: among them the development of colon polyps prevailed and all recipients underwent polypectomy. There was no impact of age, gender, causes of chronic heart failure, obesity, immunosuppressive regimen (including the induction) on the frequency of general surgery diseases development (p>0.05). Conclusion. Based on our experience, we proposed an algorithm of examination, the features of surgical tactics and preparation for it in heart transplanted recipients are described. The important role of post-heart transplant follow-up in the timely detection of diseases requiring general surgical care is given.