OBJECTIVEIt is of vital importance to elucidate the triggering factors of obesity and type 2 diabetes to improve patient care. Bariatric surgery has been shown to prevent and even cure diabetes, but the mechanism is unknown. Elevated levels of lipopolysaccharide (LPS) predict incident diabetes, but the sources of LPS are not clarified. The objective of the current study was to evaluate the potential impact of plasma LPS on abdominal obesity and glycemic control in subjects undergoing bariatric surgery.RESEARCH DESIGN AND METHODSThis was a prospective observational study involving a consecutive sample of 49 obese subjects undergoing bariatric surgery and 17 controls. Main assessments were plasma LPS, HbA1c, adipose tissue volumes (computed tomography), and quantified bacterial DNA in adipose tissue compartments.RESULTSPlasma levels of LPS were elevated in obese individuals compared with controls (P < 0.001) and were reduced after bariatric surgery (P = 0.010). LPS levels were closely correlated with HbA1c (r = 0.56; P = 0.001) and intra-abdominal fat volumes (r = 0.61; P < 0.001), but only moderately correlated with subcutaneous fat volumes (r = 0.33; P = 0.038). Moreover, there was a decreasing gradient (twofold) in bacterial DNA levels going from mesenteric via omental to subcutaneous adipose tissue compartments (P = 0.041). Finally, reduced LPS levels after bariatric surgery were directly correlated with a reduction in HbA1c (r = 0.85; P < 0.001).CONCLUSIONSOur findings support a hypothesis of translocated gut bacteria as a potential trigger of obesity and diabetes, and suggest that the antidiabetic effects of bariatric surgery might be mechanistically linked to, and even the result of, a reduction in plasma levels of LPS.

Background: Trimethylamine-N-oxide (TMAO) is formed in the liver from trimethylamine (TMA), a product exclusively generated by the gut microbiota from dietary phosphatidylcholine and carnitine. An alternative pathway of TMAO formation from carnitine is via the microbiota-dependent intermediate γ-butyrobetaine (γBB). Elevated TMAO levels are associated with cardiovascular disease (CVD), but little is known about TMAO in obesity. Given the proposed contribution of microbiota alterations in obesity and type 2 diabetes (T2D), we investigated the potential impact of obesity, lifestyle-induced weight loss, and bariatric surgery on plasma levels of TMAO, its microbiota-dependent intermediate γBB, and its diet-dependent precursors carnitine and choline.Methods: TMAO, γBB, carnitine, and choline were measured by high-performance liquid chromatography in 34 obese individuals (17 with and 17 without T2D) undergoing bariatric surgery and 17 controls.Results: TMAO was not elevated in obese patients or reduced by lifestyle interventions but increased approximately twofold after bariatric surgery. Similar to TMAO, plasma levels of γBB were not influenced by lifestyle interventions but increased moderately after bariatric surgery. In contrast, carnitine and choline, which are abundant in nutrients, such as in red meat and eggs, and not microbiota dependent, were reduced after lifestyle interventions and rebounded after bariatric surgery.Conclusions: The major increase in TMAO after bariatric surgery was unexpected because high TMAO levels have been linked to CVD, whereas bariatric surgery is known to reduce CVD risk. Prospective studies of gut microbiota composition and related metabolites in relation to long-term cardiovascular risk after bariatric surgery are warranted.

Objective. To assess the reliability of lumbar facet arthropathy evaluation with computed tomography (CT) or magnetic resonance imaging (MRI) in patients with and without lumbar disc prosthesis, and to estimate the reliability for individual CT and MRI findings indicating facet arthropathy. Methods. Metal-artefact reducing CT and MRI protocols were performed at follow-up of 114 chronic back pain patients treated with (n=66) or without (n=48) lumbar disc prosthesis. Three experienced radiologists independently rated facet joint space narrowing, osteophyte/hypertrophy, erosions, subchondral cysts, and total grade facet arthropathy at each of the three lower lumbar levels on both CT and MRI, using Weishaupt et al.'s rating system. CT and MRI examinations were randomly mixed and rated independently. Findings were dichotomised before analysis. Overall kappa and (due to low prevalence) prevalence-and bias-adjusted kappa were calculated to assess interobserver agreement. Results. Interobserver agreement on total grade facet arthropathy was moderate at all levels with CT (kappa 0.47-0.48) and poor to fair with MRI (kappa 0.20-0.32). Mean prevalence and bias-adjusted kappa was lower for osteophyte/hypertrophy versus other individual findings

Study Design. A prospective study of patients originally randomized to total disc replacement (TDR) or multidisciplinary rehabilitation. Objective. To assess the long-term development of facet arthropathy (FA) after TDR versus nonoperative treatment, and to analyze the association between FA and clinical outcome. Summary of Background Data. FA may appear or increase following TDR, but the natural course of FA is unclear, and no previous study has evaluated the long-term development of FA following TDR compared with nonoperative treatment. Methods. The study included 126 patients with chronic low back pain and degenerative changes in the lumbar intervertebral discs. The patients underwent pretreatment and 8-year follow-up magnetic resonance imaging (MRI) and 8-year follow-up computed tomography (CT) of the lumbar spine. The primary outcome measure was FA development (yes/no) on MRI at index level L4/L5 or L5/S1, defined as increased FA grade value from pretreatment to follow-up according to Weishaupt grading system. Secondary outcomes included the association between FA (on MRI and CT) and Oswestry Disability Index (ODI) or back pain as well as reoperations. Results. Increased index level FA grade was more frequent after TDR versus nonoperative treatment (36%, 25/69 vs. 2%, 1/57 of patients, P < 0.001), but was not related to change in ODI or back pain. At follow-up, index level FA grades were higher after TDR versus nonoperative treatment (odds ratio 4.0 MRI and 5.9 CT), but were not related to ODI less than or equal to 22. Four patients (6%) treated with TDR and no patients treated nonoperatively were operated for lateral recess stenosis with posterior decompression at the index level during follow-up. Conclusion. Index level FA development was more likely after TDR compared with nonoperative treatment but was not associated with the 8-year clinical outcome. Index level FA may have contributed to reoperations in the TDR group. Level of Evidence: 2

Nevrologisk avdeling Nordlandssykehuset Merethe Karlberg er spesialist i nevrologi og overlege. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Diagnostisk klinikk Nordlandssykehuset Hanne Thoresen er spesialist i radiologi og overlege. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nevrofysiologisk seksjon Nordlandssykehuset Diana Hristova Berg er spesialist i nevrologi og LIS-lege i klinisk nevrofysiologi. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nevrofysiologisk seksjon Nordlandssykehuset Oana-Gratiela Ciopat er spesialist i nevrofysiologi. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nevrologisk avdeling Nordlandssykehuset og Universitetet i Tromsø Karl Bjørnar Alstadhaug er spesialist i nevrologi, overlege og professor. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. En mann i 40-årene med aku forvirring | Tidsskrift for Den norske legeforening