Do Male Patients Benefit from Laparoscopic Adjustable Gastric Banding More than Female Patients? A Retrospective Cohort Study

Abstract

              <span> 
                </span><h3>Background</h3> 
                <p>Clinical trials in the field of bariatrics, and specifically laparoscopic adjustable gastric banding (LAGB), have frequently been gender imbalanced, with males representing only 20% of examinees. Long-term gender-oriented results, and specifically quality of life (QOL) parameters, have not been addressed sufficiently. The aim of our study was to examine the long-term gender association with outcome of LAGB including the impact on QOL.</p> 

              <span> 
                </span><h3>Methods</h3> 
                <p>A retrospective cohort study of patients who underwent LAGB between 2006 and 2014 by a single surgeon was conducted. Data were collected from the hospital registry and a telephone interview that included a standardized questionnaire. Outcomes including BMI reduction, evolution of comorbidities, complications, reoperations, and QOL were compared according to the Bariatric Analysis and Reporting Outcome System (BAROS).</p> 

              <span> 
                </span><h3>Results</h3> 
                <p>Included were 114 males and 127 females, with a mean age of 38.2 years at surgery, and an average post-surgery follow-up of 6.5 years. Similar BMI reduction (<em>p</em> = 0.68) and perioperative complication rates (<em>p</em> = 0.99) were observed. Males had a greater improvement in comorbidities (<em>p</em> &lt; 0.001), less band slippage (<em>p</em> = 0.006), underwent fewer reoperations (<em>p</em> = 0.02), and reported higher QOL scores (<em>p</em> = 0.02) than females. The total BAROS score was significantly higher for males than females (<em>p</em> &lt; 0.001).</p> 

              <span> 
                </span><h3>Conclusions</h3> 
                <p>LAGB surgery results in better outcomes for male than female patients as measured by the BAROS, despite a similar BMI reduction. Gender-specific outcomes should be taken into consideration in optimizing patient selection and preoperative patient counseling.</p> 
              <br /><br />

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Biodegradation of pulp and paper mill effluent by co-culturing ascomycetous fungi in repeated batch process

Abstract

                <p>The competence of novel fungal consortium, consisting of <em>Nigrospora sp.</em> LDF00204 (accession no. KP732542) and <em>Curvularia lunata</em> LDF21 (accession no. KU664593), was investigated for the treatment of pulp and paper mill effluent. Fungal consortium exhibited enhanced biomass production under optimized medium conditions, i.e., glucose as carbon (C), sodium nitrate as nitrogen (N), C/N 1.5:0.5, pH 5, temperature 30 °C, and agitation 140 rpm, and significantly reduced biochemical oxygen demand (85.6%), chemical oxygen demand (80%), color (82.3%), and lignin concentration (76.1%) under catalytic enzyme activity; however, unutilized ligninolytic enzymes, such as laccase (Lac), manganese peroxidase (MnP), and lignin peroxidase (LiP), were observed to be 13.5, 11.4, and 9.4 U/ml after the third cycle of effluent treatment in repeated batch process. Scanning electron microscopy (SEM) of fungal consortium revealed their compatibility through intermingled hyphae and spores, while the FTIR spectra confirmed the alteration of functional groups ensuring structural changes during the effluent treatment. Gas chromatography/mass spectroscopy (GC-MS) analysis showed the reduction of complex compounds and development of numerous low-molecular-weight metabolites, such as 1-3-dimethyl benzene, 2-chloro-3-methyl butane, pentadecanoic acid, and 1-2-benzene dicarboxylic acid, during the treatment, demonstrating the massive potential of the novel fungal consortium to degrade recalcitrant industrial pollutants.</p><br /><br />

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Psychiatric Emergencies for Clinicians: Emergency Department Management of Cocaine-Related Presentations

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Publication date: Available online 31 August 2017
Source:The Journal of Emergency Medicine
Author(s): Jagoda Pasic, Paul Zarkowski, Kimberly Nordstrom, Michael P. Wilson

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LMO1 Synergizes with MYCN to Promote Neuroblastoma Initiation and Metastasis

Publication date: Available online 31 August 2017
Source:Cancer Cell
Author(s): Shizhen Zhu, Xiaoling Zhang, Nina Weichert-Leahey, Zhiwei Dong, Cheng Zhang, Gonzalo Lopez, Ting Tao, Shuning He, Andrew C. Wood, Derek Oldridge, Choong Yong Ung, Janine H. van Ree, Amish Khan, Brittany M. Salazar, Edroaldo Lummertz da Rocha, Mark W. Zimmerman, Feng Guo, Hong Cao, Xiaonan Hou, S. John Weroha, Antonio R. Perez-Atayde, Donna S. Neuberg, Alexander Meves, Mark A. McNiven, Jan M. van Deursen, Hu Li, John M. Maris, A. Thomas Look
A genome-wide association study identified LMO1, which encodes an LIM-domain-only transcriptional cofactor, as a neuroblastoma susceptibility gene that functions as an oncogene in high-risk neuroblastoma. Here we show that dβh promoter-mediated expression of LMO1 in zebrafish synergizes with MYCN to increase the proliferation of hyperplastic sympathoadrenal precursor cells, leading to a reduced latency and increased penetrance of neuroblastomagenesis. The transgenic expression of LMO1 also promoted hematogenous dissemination and distant metastasis, which was linked to neuroblastoma cell invasion and migration, and elevated expression levels of genes affecting tumor cell-extracellular matrix interaction, including loxl3, itga2b, itga3, and itga5. Our results provide in vivo validation of LMO1 as an important oncogene that promotes neuroblastoma initiation, progression, and widespread metastatic dissemination.

Teaser

High expression of LMO1 is associated with neuroblastoma (NB) metastases. Zhu et al. show that LMO1 synergizes with MYCN to promote NB development and metastasis in zebrafish and that LMO1 elevates expression of genes affecting tumor cell-extracellular matrix interaction and promotes NB cell invasion.

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Single-incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy: a systematic review and meta-analysis

Abstract

                <span> 
                  </span><h3>Background</h3> 
                  <p>Single-incision laparoscopic cholecystectomy (SILC) might maximize the advantages of laparoscopic cholecystectomy (LC) by reducing postoperative pain and improving cosmesis. However, the safety and feasibility of SILC has not yet been established. This study assesses safety, patient reported outcome measures and feasibility of SILC versus conventional LC.</p> 

                <span> 
                  </span><h3>Methods</h3> 
                  <p>Literature search for RCT’s comparing SILC with conventional LC in gallstone-related disease was performed in PubMed and Embase. The conventional LC was defined as two 10-mm and two 5-mm ports. Study selection was done according to predefined criteria. Two reviewers assessed the risk of bias. Pooled outcomes were calculated for adverse events, pain, cosmesis, quality of life and feasibility using fixed-effect and random-effects models.</p> 

                <span> 
                  </span><h3>Results</h3> 
                  <p>Nine RCT’s were included with total of 860 patients. No mortality was observed. More mild adverse events (RR 1.55; 95% CI 0.99–2.42) and significantly more serious adverse events (RR 3.00; 95% CI 1.05–8.58) occurred in the SILC group. Postoperative pain (MD -0.46; 95% CI -0.74 to -0.18) and cosmesis (SMD 2.38; 95% CI 1.50–3.26) showed significantly better results for the SILC group, but no differences were observed in quality of life. Operating time (MD 23.12; 95% CI 11.59–34.65) and the need for additional ports (RR 11.43; 95% CI 3.48–37.50) were significantly higher in the SILC group. No difference was observed in conversion to open cholecystectomy or hospital stay longer than 24 h.</p> 

                <span> 
                  </span><h3>Conclusions</h3> 
                  <p>SILC does not provide any clear advantages over conventional LC except for less postoperative pain and improved cosmesis. It is questionable whether these advantages outweigh the higher occurrence of adverse events and shortcomings in feasibility. Considering considerable heterogeneity and low methodological quality of the studies it is advisable to perform well-designed RCT’s in the future to address the safety and clinical benefits of SILC.</p> 
                <br /><br />

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OR fire virtual training simulator: design and face validity

Abstract

                <span> 
                  </span><h3>Background</h3> 
                  <p>The Virtual Electrosurgical Skill Trainer is a tool for training surgeons the safe operation of electrosurgery tools in both open and minimally invasive surgery. This training includes a dedicated team-training module that focuses on operating room (OR) fire prevention and response. The module was developed to allow trainees, practicing surgeons, anesthesiologist, and nurses to interact with a virtual OR environment, which includes anesthesia apparatus, electrosurgical equipment, a virtual patient, and a fire extinguisher. Wearing a head-mounted display, participants must correctly identify the “fire triangle” elements and then successfully contain an OR fire. Within these virtual reality scenarios, trainees learn to react appropriately to the simulated emergency. A study targeted at establishing the face validity of the virtual OR fire simulator was undertaken at the 2015 Society of American Gastrointestinal and Endoscopic Surgeons conference.</p> 

                <span> 
                  </span><h3>Methods</h3> 
                  <p>Forty-nine subjects with varying experience participated in this Institutional Review Board-approved study. The subjects were asked to complete the OR fire training/prevention sequence in the VEST simulator. Subjects were then asked to answer a subjective preference questionnaire consisting of sixteen questions, focused on the usefulness and fidelity of the simulator.</p> 

                <span> 
                  </span><h3>Results</h3> 
                  <p>On a 5-point scale, 12 of 13 questions were rated at a mean of 3 or greater (92%). Five questions were rated above 4 (38%), particularly those focusing on the simulator effectiveness and its usefulness in OR fire safety training. A total of 33 of the 49 participants (67%) chose the virtual OR fire trainer over the traditional training methods such as a textbook or an animal model.</p> 

                <span> 
                  </span><h3>Conclusions</h3> 
                  <p>Training for OR fire emergencies in fully immersive VR environments, such as the VEST trainer, may be the ideal training modality. The face validity of the OR fire training module of the VEST simulator was successfully established on many aspects of the simulation.</p> 
                <br /><br />

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Effect of ultrasound-guided phrenic nerve block on shoulder pain after laparoscopic cholecystectomy—a prospective, randomized controlled trial

Abstract

                <span> 
                  </span><h3>Background</h3> 
                  <p>Post-laparoscopic shoulder pain (PLSP) frequently follows a laparoscopic cholecystectomy. A proposed mechanism for PLSP is the irritation or injury of the phrenic nerve by the CO<sub>2</sub> pneumoperitoneum during laparoscopic surgery. Here, we investigated whether a phrenic nerve block (PNB), performed under ultrasound guidance, could reduce the incidence and severity of PLSP after laparoscopic cholecystectomy.</p> 

                <span> 
                  </span><h3>Method</h3> 
                  <p>Sixty patients were randomized into two groups, with one group receiving PNB with 4 ml (30 mg) of 0.75% ropivacaine (group P, <em>n</em> = 28) and a control group (group C, <em>n</em> = 32). The existence and severity of PLSP were assessed for 2 days postoperatively. A pulmonary function test (PFT) and diaphragmatic excursion test were performed pre- and postoperatively.</p> 

                <span> 
                  </span><h3>Results</h3> 
                  <p>With ultrasound guidance, all PNBs were performed successfully in group P. In group P, the overall incidence and severity of PLSP decreased significantly. There were no significant differences in incisional pain, visceral pain, and analgesic requirements between the groups. Right-side diaphragmatic excursion decreased significantly in group P at 1 h postoperatively. The PFT results and respiratory discomfort assessed by a modified Borg’s scale were not different significantly between the groups.</p> 

                <span> 
                  </span><h3>Conclusion</h3> 
                  <p>Based on these findings, ultrasound-guided PNB can prevent or reduce the PLSP without clinically significant respiratory discomfort.</p> 
                <br /><br />

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Effects of laparoscopic myotomy on the esophageal motility pattern of esophageal achalasia as measured by high-resolution manometry

Abstract

                <span> 
                  </span><h3>Background</h3> 
                  <p>Esophageal achalasia can be classified on the grounds of three distinct manometric patterns that correlate well with final outcome after laparoscopic Heller-Dor myotomy (LHM). No analytical data are available, however, on the postoperative picture and its possible correlation with final outcome. The aims of this study were: (a) to investigate whether manometric patterns change after LHM for achalasia; (b) to ascertain whether postoperative patterns and/or changes can predict final outcome; and (c) to test the hypothesis that the three known patterns represent different stages in the evolution of the disease.</p> 

                <span> 
                  </span><h3>Methods</h3> 
                  <p>During the study period, we prospectively enlisted 206 consecutive achalasia patients who were assessed using high-resolution manometry (HRM) before undergoing LHM. Symptoms were scored using a detailed questionnaire. Barium swallow, endoscopy and HRM were performed, before and again 6 months after surgery.</p> 

                <span> 
                  </span><h3>Results</h3> 
                  <p>Preoperative HRM revealed the three known patterns with statistically different esophageal diameters (pattern I having the largest), and patients with pattern I had the highest symptom scores. The surgical treatment failed in 10 cases (4.9%). The only predictor of final outcome was the preoperative manometric pattern (<em>p</em> = 0.01). All patients with pattern I preoperatively had the same pattern afterward, whereas nearly 50% of patients with pattern III before LHM had patterns I or II after surgery. There were no cases showing the opposite trend.</p> 

                <span> 
                  </span><h3>Conclusions</h3> 
                  <p>Neither a change of manometric pattern after surgery nor a patient’s postoperative pattern was a predictor of final outcome, whereas preoperative pattern confirmed its prognostic significance. The three manometric patterns distinguishable in achalasia may represent different stages in the disease’s evolution, pattern III and pattern I coinciding with the early and final stages of the disease, respectively.</p> 
                <br /><br />

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