Background: Revisional bariatric surgery is increasingly performed due to inadequate weight loss, weight regain, or complications following primary bariatric procedures. One anastomotic gastric bypass (OAGB) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) are commonly used revisional options, yet comparative data on metabolic, nutritional, and quality-of-life outcomes remain limited. Objective: To compare metabolic, nutritional, perioperative, and quality-of-life outcomes between revisional OAGB and SADI-S. Methods A retrospective comparative cohort study was conducted at a tertiary bariatric center between 2020 and 2025. Adult patients undergoing revisional OAGB or SADI-S after primary failed sleeve gastrectomy were included. Outcomes included weight loss, metabolic and nutritional parameters, perioperative outcomes, complications, and quality of life assessed using BAROS and SF-BARI questionnaires. Results Forty-four patients were included (22 OAGB, 22 SADI-S). At one year, weight loss outcomes were comparable between groups (EWL 43% vs. 37%, p > 0.9; TWL 18% vs. 15%, p = 0.9). SADI-S demonstrated superior lipid profile improvement, including lower total cholesterol (119 vs. 153 mg/dL, p = 0.005) and LDL levels (65 vs. 85 mg/dL, p = 0.032). Vitamin B12 levels were higher after SADI-S (475 vs. 330 pg/mL, p = 0.015), while other nutritional parameters were comparable. Operative time was shorter for OAGB (90 vs. 109 minutes, p = 0.019). Quality-of-life scores were similar between groups. Conclusion Both revisional OAGB and SADI-S are safe and effective procedures with comparable weight loss and quality-of-life outcomes. SADI-S provides greater metabolic benefit, particularly in lipid profile improvement, while OAGB demonstrates a more favorable nutritional profile. Procedure selection should be individualized based on metabolic needs and nutritional risk.

Background: Anastomotic leakage remains a serious complication of colorectal surgery, often linked to impaired blood supply at the incision site. Objective: To develop and validate a reproducible rat model of colonic anastomotic leakage induced by graded mesocolon ischemia. Methods: Of 144 operated rats, 138 survived surgery and underwent end-to-end colonic anastomosis with five levels of mesocolon ligation (0–2 cm of unilateral mesocolic ischemia). Postoperative outcomes, including anastomotic integrity, abscess formation, and mortality, were assessed on postoperative day 10. Anastomotic bursting pressures were also measured in a subset of animals. Results: Leak rates increased with ischemia severity: 0% in controls, 16.7% at 0.2 cm, 42.6% at 0.4 cm, 95.8% at 1 cm, and 100% at 2 cm (p < 0.0001, trend test). Bursting pressures decreased progressively with increasing anastomotic severity. The 0.4 cm ischemia condition produced a reproducible intermediate leak rate suitable for experimental interventions. Conclusions: This rat model reliably induces graded anastomotic leaks and can serve as a platform for testing strategies to prevent leakage in high-risk colorectal surgery.

Whereas numerous studies have addressed outcomes after bariatric surgery, only a few have provided a detailed analysis of the immediate postoperative period. The aim of the present study was therefore to meticulously analyze the condition of patients during the first 16 h after single-anastomosis gastric bypass (SAGB). A prospective consecutive analysis of pain, nausea, fatigue, dizziness, vomiting, and mobilization during the first 16 h after SAGB was performed in a fast-track optimized high-volume setting. Values were recorded by means of a visual analogue scale (VAS) every 15 min in the postoperative recovery unit (first 2 h) and every 2 h on the ward. Secondary outcomes were length of stay (LOS) and surgical complications. The mean pain, nausea, fatigue, and dizziness levels never exceeded VAS 4. Two thirds of patients never vomited, whereas one third vomited once or twice. The highest incidence of minor adverse events was, unsurprisingly, seen during the first 2 h after surgery. Although these early minor adverse events after operation were expected and highly acceptable, our data also showed that 10–20

Background: Anastomotic leakage remains a serious complication following colorectal surgery, often associated with significant morbidity and mortality. Impaired blood supply at the incision site has been suggested as a key contributing factor. Objective: To develop and validate a reproducible rat model of colonic anastomotic leakage induced by graded mesocolon ischemia at the incision margins. Methods: 144 rats underwent end-to-end colonic anastomosis with five different levels of mesocolon ligation, ranging from no ligation (control) to 2 cm ischemia on each side. Postoperative outcomes, including anastomotic integrity, abscess formation, and mortality, were assessed 10 days postoperatively. Results: Anastomotic leak rates increased proportionally with the extent of mesocolic ischemia: 0% in controls, 19.04% with 0.2 cm ligation, 44.23% with 0.4 cm, and 100% with 1 and 2 cm. The model was consistent and reproducible. Conclusions: This model reliably induces graded anastomotic leaks in rats and may serve as a platform for future studies evaluating interventions to reduce leak risk in high-risk colorectal surgery patients.

Context The severity of visceral adipose tissue (VAT) inflammation in individuals with obesity is thought to signify obesity subphenotype(s) associated with higher cardiometabolic risk. Yet, this tissue is not accessible for direct sampling in the nonsurgical patient.Objective We hypothesized that circulating miRNAs (circ-miRs) could serve as biomarkers to distinguish human obesity subgroups with high or low extent of VAT inflammation.Methods Discovery and validation cohorts of patients living with obesity undergoing bariatric surgery (n = 35 and 51, respectively) were included. VAT inflammation was classified into low/high based on an expression score derived from the messenger RNA levels of TNFA, IL6, and CCL2 (determined by reverse transcription polymerase chain reaction). Differentially expressed circ-miRs were identified, and their discriminative power to detect low/high VAT inflammation was assessed by receiver operating characteristic-area under the curve (ROC-AUC) analysis.Results Fifty three out of 263 circ-miRs (20%) were associated with high-VAT inflammation according to Mann-Whitney analysis in the discovery cohort. Of those, 12 (12/53 = 23%) were differentially expressed according to Deseq2, and 6 significantly discriminated between high- and low-VAT inflammation with ROC-AUC greater than 0.8. Of the resulting 5 circ-miRs that were differentially abundant in all 3 statistical approaches, 3 were unaffected by hemolysis and validated in an independent cohort. Circ-miRs 181b-5p, 1306-3p, and 3138 combined with homeostatic model assessment of insulin resistance (HOMA-IR) exhibited ROC-AUC of 0.951 (95% CI, 0.865-1) and 0.808 (95% CI, 0.654-0.963) in the discovery and validation cohorts, respectively, providing strong discriminative power between participants with low- vs high-VAT inflammation. Predicted target genes of these miRNAs are enriched in pathways of insulin and inflammatory signaling, circadian entrainment, and cellular senescence.Conclusion Circ-miRs that identify patients with low- vs high-VAT inflammation constitute a putative tool to improve personalized care of patients with obesity.

Laparoscopic one-anastomosis gastric bypass (LOAGB) has gained popularity as safe weight-reduction procedure. Bleeding is the common postoperative complication. We present a successful treatment of recurrent bleeding after LOAGB by embolization of the left gastric artery (LGA) and later development of necrotizing pancreatitis. A 41-year-old patient with previous bariatric surgeries undergone LOAGB surgery with development of massive intraluminal bleeding in the postoperative period. Attempts of unsuccessful endoscopic treatment were done and the bleeding was stopped by LGA embolization. In the post-embolization period, the patients developed necrotizing pancreatitis. Postoperative bleeding is the serious complications of the bariatric LOAGB procedure. Transcatheter Arterial Embolization (TAE) is the possible treatments after unsuccessful endoscopic attempts to stop the bleeding. The technical and clinical success rates of TAE in post-gastrectomy bleeding are 100 and 79%, respectively. TAE can be successfully used to stop obstinate recurrent postoperative bleeding after a LOAGB procedure.

The prevalence of patients suffering from extreme obesity (body mass index (BMI) ≥ 50) has significantly increased over the past three decades, surpassing the rise in the general population of overweight patients. Weight loss outcomes after bariatric surgery in patients suffering from extreme obesity are less favorable, with a higher incidence of weight regain. Variations of existing bariatric procedures have been proposed to address this issue. One such variation is adding a gastric band to limit the expansion of the newly created pouch. Limited data exist regarding the effectiveness of this procedure, called the banded one-anastomosis gastric bypass (BOAGB) procedure, compared to other bariatric procedures. In this retrospective study, we compared all patients who underwent the BOAGB procedure at the Bariatric Surgery Unit in our Medical Center with a postoperative follow-up of at least 1 year with patients who underwent a one-anastomosis gastric bypass (OAGB) or sleeve gastrectomy (SG) procedures. Data collected included demographics, comorbidities, surgical outcomes, complications, and postoperative quality-of-life assessments. One hundred eleven patients were enlisted to our study during the relevant study period—24 patients underwent the BOAGB procedure, 43 underwent OAGB, and 44 underwent a SG. Lost to follow-up beyond 30 days was 9

Background: Intraoperative radiation therapy (IORT) has gained popularity in recent years as an alternative to external beam whole breast radiation therapy (WBRT) for early‐stage breast cancer. Here, we report 43‐month recurrence and survival outcomes in a multiethnic cohort treated with IORT in a clinical context. Method: Two hundred and eleven patients with low‐risk features were treated with IORT for early‐stage breast cancer from 2014 to 2021. Selection criteria were based on Group Europeen de Curietherapie‐European Society for Therapeutic Radiology and Oncology (GEC‐ESTRO) guidelines: preferably unifocal intraductal carcinoma (IDC), aged > 50, tumor size ≤ 2.0 cm, and without lymph node involvement. All patients received 20 Gy of radiation dose during the lumpectomy. Information on patient and tumor characteristics was collected. Results: The mean age of this cohort was 67.5 years; 95.2% of patients are Jewish, and the rest are Bedouins (4.7%). Most tumors were intraductal carcinoma (97.2%) and stage 1 (94.8%). The mean follow‐up time was 43.4 months. Bedouins had larger tumor sizes (mean 1.21 vs. 1.13 cm) and were younger at diagnosis than Jewish patients (mean 65.4 vs. 67.6 years), although the differences are not significant. The overall recurrence rate was 1.4%. One case of local recurrence (0.5%) and two cases of metastasis (0.9%) were observed during the study period. One patient died from metastasis. Conclusion: Our findings suggest that IORT in selected low‐risk patients can achieve an excellent prognosis with low rates of recurrence and metastasis.

Deconvolution algorithms rely on single-cell RNA-sequencing (scRNA-seq) data applied onto bulk RNA-sequencing (bulk RNA-seq) to extract information on the cell-types composition and proportions comprising a certain tissue. Adipose tissues’ cellular composition exhibits enormous plasticity in response to weight changes and high variance at different anatomical locations (depots). However, adipocytes – the functionally unique cell type of adipose tissue, are not amenable to scRNA-seq, a challenge recently met by applying single-nucleus RNA-sequencing (snRNA-seq). Here we aimed to develop a deconvolution method to estimate the cellular composition of human visceral and subcutaneous adipose tissues (hVAT and hSAT, respectively) using snRNA-seq to assess the true cell-type proportions. To correlate deconvolution-estimated cell-type proportions to true (snRNA-seq -derived) proportions, we analyzed seven hVAT and 5 hSAT samples by both bulk RNA-seq and snRNA-seq. snRNA-seq uncovered 15 distinct cell types in hVAT and 13 in hSAT. Deconvolution tools – SCDC, MuSiC, and Scaden exhibited low performance in estimating cell-type proportions (median |R|= 0.12 for estimated vs. true correlations). Notably, estimation accuracy somewhat improved by decreasing the number of cell-types groups, which nevertheless remained low (|R|<0.42). We therefore developed sNuConv , a novel method that employs Scaden, a deep-learning tool, trained using snRNA-seq - based data corrected by i. snRNA-seq/bulk RNA-seq highly-correlated genes, ii. corrected estimated cell-type proportions based on individual cell-type regression models. Applying sNuConv on our bulk RNA-seq data resulted in cell-type proportion estimation accuracy with median R=0.93 (range:0.76–0.97) for hVAT, and median R=0.95 (range:0.92–0.98) for hSAT. The resulting model was depot-specific, reflecting depot-differences in gene expression patterns. Thus, we present sNuConv, a novel, AI-based, method to deduce the cellular landscape of hVAT and hSAT from bulk RNA-seq data, providing proof-of-concept for producing validated deconvolution algorithms for tissues un-amenable to single-cell RNA sequencing.

BACKGROUND:In a large nationwide mass vaccination setting, the SARS-CoV-2 vaccine was recently linked to myocarditis, lymphadenopathy, herpes zoster infection and appendicitis. We aimed to examine the characteristics and management of SARS-CoV-2 vaccine-related acute appendicitis.METHODS:We performed a retrospective cohort study in a large tertiary medical centre in Israel. All patients presenting with acute appendicitis within 21 days of receiving their SARS-CoV-2 vaccination (PCVAA group) were compared with patients who presented with acute appendicitis not related to the vaccination (N-PCVAA group).RESULTS:We reviewed the records of 421 patients with acute appendicitis from December 2020 to September 2021; 38 (9%) patients presented with acute appendicitis within 21 days of receiving their SARS-CoV-2 vaccination. Patients in the PCVAA group were older than those in the N-PCVAA group (mean 41 ± 19 yr v. 33 ± 15 yr, respectively, p = 0.008), with male predominance. More patients were managed nonsurgically during the pandemic than before the pandemic (24% v. 18%, p = 0.03).CONCLUSION:With the exception of older age, the clinical characteristics of patients presenting with acute appendicitis within 21 days of receiving the SARS-CoV-2 vaccination did not differ from those of patients who presented with acute appendicitis not related to the vaccination. This finding suggests that vaccine-related acute appendicitis is similar to "classic" acute appendicitis.

Objective: In obesity, adipocyte hypertrophy is detrimental to health, but its' interrelation with fibrosis in the visceral adipose tissue (VAT) depot remains unclear. Because VAT is less accessible via biopsy, biomarkers for VAT quality are needed. The authors hypothesized that VAT adipocyte size and fibrosis are interrelated and can be estimated by circulating microRNAs (circ-miRNAs), contributing to subpheno-typing obesity. Methods: Adipocyte size and AT fibrosis were estimated in n = 43 participants (BMI >= 30 kg/m(2)). Circ-miRNAs were sequenced (Next Generation Sequencing). Results: Participants with above- versus below-median VAT adipocyte area exhibited metabolic dysfunction but lower total and pericellular fibrosis. VAT adipocyte size remained associated with metabolic dysfunction even when controlling for BMI or VAT fibrosis in the entire cohort, as in matched-pairs subanalyses. Next Generation Sequencing uncovered 22 and 6 circ-miRNAs associated with VAT adipocyte size and fibrosis, respectively, with miRNA-130b-3p common to both analyses. The combination of miRNA-130b-3p + miR-150-5p + high-density lipoprotein cholesterol discriminated among those with large versus small VAT adipocytes (receiver operating characteristic-area under the curve: 0.872 [95% CI: 0.747-0.996]), whereas miRNA-130b-3p + miRNA-15a-5p + high-density lipoprotein cholesterol discriminated among those with low and high fibrosis (receiver operating characteristic-area under the curve: 0.823 [95% CI: 0.676-0.97]). Conclusions: These findings suggest that VAT adipocyte size and fibrosis are inversely correlated in obesity and can be estimated by distinct circ-miRNAs, providing a potential tool to subphenotype obesity via a liquid biopsy-like approach to assess VAT health in nonsurgical patients.

•Abdominal surgical site aspergillosis can be seen in an immunocompetent patient.•Surgical site aspergillosis is a form of cutaneous aspergillosis.•Prevention of surgical site aspergillosis combines clinical and environmental considerations.•Therapy involves medical and surgical approach for optimal outcomes.