How safe is same-day discharge after laparoscopic sleeve gastrectomy?

Background

Laparoscopic sleeve gastrectomy (LSG) is associated with low morbidity and mortality and a short length of stay. Studies on the safety of same-day discharge after LSG are limited.

A 7-deaza-adenosine analog is a potent and selective inhibitor of hepatitis C virus replication with excellent pharmacokinetic properties

Improved treatments for chronic hepatitis C virus (HCV) infection are needed due to the suboptimal response rates and deleterious side effects associated with current treatment options. The triphosphates of 2'-C-methyl-adenosine and 2'-C-methyl-guanosine were previously shown to be potent inhibitors of the HCV RNA-dependent RNA polymerase (RdRp) that is responsible for the replication of viral RNA in cells. Here we demonstrate that the inclusion of a 7-deaza modification in a series of purine nucleoside triphosphates results in an increase in inhibitory potency against the HCV RdRp and improved pharmacokinetic properties. Notably, incorporation of the 7-deaza modification into 2'-C-methyl-adenosine results in an inhibitor with a 20-fold-increased potency as the 5'-triphosphate in HCV RdRp assays while maintaining the inhibitory potency of the nucleoside in the bicistronic HCV replicon and with reduced cellular toxicity. In contrast, while 7-deaza-2'-C-methyl-GTP also displays enhanced inhibitory potency in enzyme assays, due to poor cellular penetration and/or metabolism, the nucleoside does not inhibit replication of a bicistronic HCV replicon in cell culture. 7-Deaza-2'-C-methyl-adenosine displays promising in vivo pharmacokinetics in three animal species, as well as an acute oral lethal dose in excess of 2,000 mg/kg of body weight in mice. Taken together, these data demonstrate that 7-deaza-2'-C-methyl-adenosine is an attractive candidate for further investigation as a potential treatment for HCV infection.     

Evaluation of magnesium in serum and urine in patients with pulmonary diseases

We evaluated magnesium (Mg) in serum and 24-hour urine in patients with acute and chronic pulmonary diseases. Mg was determined in 114 patients, 56 with acute pulmonary diseases (group I) and 58 patients with acute exacerbation of chronic obstructive pulmonary disease (group II), at the start (To) and at the end of hospital treatment (T1). In group I, in period To, there were disturbances of Mg in serum in 14 patients (25%) which decreased in period T1 and persisted in 4 patients (7.1%) (p < 0.05). In group II the distribution of normal, decreased and increased Mg in serum was similar in periods To and T1 (p > 0.05). Hypomagnesemia was found in 9 patients (16.1%) in group I at the start of treatment (To), with accompanying increased Mg in 24-hour urine in only 4 patients (7.2%). Extrarenal elimination of Mg or transcellular distribution was a possibility. In group II in period To there was a proportional ratio between hypomagnesemia (12-20.7% patients) and increased concentration of Mg in 24-hour urine (20 - 34.5% patients) probably due to renal loss. Simultaneous determination and follow-up of Mg in serum and in 24-hour urine can give information about electrolyte disturbances in acute and chronic pulmonary diseases.     

Comparison of two methods for enumerating circulating tumor cells in carcinoma patients

BACKGROUND: Monitoring of circulating tumor cells (CTCs) in blood of carcinoma patients treated with novel compounds may be a measurement of treatment effectiveness. Before it can be used clinically, a reliably method is needed to enumerate CTCs. We compared two methods for CTC enumeration, OnkoQuick and the CellSearch system. METHODS: We drew 22.5 ml of blood into three CellSave tubes from 15 healthy donors and 61 patients with metastatic carcinoma. After pooling, 15 ml was processed with OncoQuick and 7.5 ml with CellSearch. RESULTS: With both methods no CTCs were found in healthy donors. At least one CTC was detected in 14 of 61 patients (23%) with OncoQuick and 33 of 61 patients (54%) with CellSearch (P < 0.0001). The number of CTCs detected was larger for CellSearch (mean 20 CTCs/7.5 ml of blood) than for OncoQuick (3 CTCs/7.5 ml; P < 0.0001). CONCLUSION: The CellSearch system is a more accurate and sensitive method to enumerate CTCs. Further studies are warranted to evaluate CTC enumeration by the CellSearch system as a monitoring tool for the evaluation of the efficacy of novel anticancer agents.     

Recurrence Rates of Premalignant Lesions after CO2 Laser Vaporization

Background: Use of the CO₂-Laser (λ = 10.6 μm, continuous wave, defocussed) is an established procedure for treatment of premalignant lesions. Through employment of the sp-mode as well as scanners, thermal laser effects can be reduced but, on the other hand, a lesser degree of destruction of dysplastic cells could lead to an increased recurrence rate. The purpose of this study was to evaluate prospectively the recurrence rates resulting from different methods of CO₂ laser vaporization.Methods: From May 1995 to May, 2002, 56 patients with a total of 68 premalignant lesions of the oral mucosa were treated in a prospective clinical study. Twenty-eight lesions were vaporized with the defocussed CO₂ laser (cw, 15 W, 5–15 s, mean output 2.12 Wcm⁻²). In a further 21 lesions, a scanner (Swiftlase) was additionally employed with all other parameters held constant (mean output 212.4 Wcm⁻²). In the remaining 19 lesions, vaporization was carried out in the sp-mode (pulse duration 80 μs, pulse energy 20 mJ, mean output 228 Wcm⁻²) in which, as above, a scanner was also used. Follow-up examinations were carried out according to a standard protocol. In May, 2002, the recurrence rate in the 3 groups was determined.Results: Clinically, use of the scanner in sp-mode resulted in the most irregular tissue resection. This can be accounted for by the irregular paths of the laser beam and the pulsed delivery of the laser energy. The lowest recurrence rates were yielded by the defocussed cw-technique followed by the cw-scanner and the sp-mode.Conclusions: These results indicate that for treatment of premalignant lesions of the oral mucosa, the best results can be achieved with the defocussed CO₂ laser. The incurrence of a deep thermal effect enhances destruction of deeper-lying dysplastic cells. Apparently, other methods with lesser penetration of thermal effects (e. g. sp, scanner) do not reach the deeper-lying cells and, consequently, render higher rates of recurrence.     

Regulation of oligodendrocyte precursor maintenance by chondroitin sulphate glycosaminoglycans

Chondroitin sulfate proteoglycans (CSPGs) have been proven to inhibit morphological maturation of oligodendrocytes as well as their myelination capabilities. Yet, it remained unclear, whether CSPGs and/or their respective chondroitin sulfate glycosaminoglycan (CS‐GAG) side chains also regulate the oligodendrocyte lineage progression. Here, we initially show that CS‐GAGs detected by the monoclonal antibody 473HD are expressed by primary rat NG2‐positive oligodendrocyte precursor cells (OPCs) and O4‐positive immature oligodendrocytes. CS‐GAGs become down‐regulated with ongoing oligodendrocyte differentiation. Enzymatic removal of the CS‐GAG chains by the bacterial enzyme Chondroitinase ABC (ChABC) promoted spontaneous differentiation of proliferating rat OPCs toward O4‐positive immature oligodendrocytes. Upon forced differentiation, the enzymatic removal of the CS‐GAGs accelerated oligodendrocyte differentiation toward both MBP‐positive and membrane forming oligodendrocytes. These processes were attenuated on enriched CSPG fractions, mainly consisting of Phosphacan/RPTPβ/ζ and to less extent of Brevican and NG2. To qualify CS‐GAGs as universal regulators of oligodendrocyte biology, we finally tested the effect of CS‐GAG removal on OPCs from different sources such as mouse cortical oligospheres, mouse spinal cord neurospheres, and most importantly human‐induced pluripotent stem cell‐derived radial glia‐like neural precursor cells. For all culture systems used, we observed a similar inhibitory effect of CS‐GAGs on oligodendrocyte differentiation. In conclusion, this study clearly suggests an important fundamental principle for complex CS‐GAGs to regulate the oligodendrocyte lineage progression. Moreover, the use of ChABC in order to promote oligodendrocyte differentiation toward myelin gene expressing cells might be an applicable therapeutic option to enhance white matter repair. GLIA 2016;64:270–286     

The structure of post-traumatic stress symptoms in survivors of war: Confirmatory factor analyses of the Impact of Event Scale—Revised

The study aimed at establishing the factor structure of the Impact of Event Scale—Revised (IES-R) in survivors of war. A total sample of 4167 participants with potentially traumatic experiences during the war in Ex-Yugoslavia was split into three samples: two independent samples of people who stayed in the area of conflict and one sample of refugees to Western European countries. Alternative models with three, four, and five factors of post-traumatic symptoms were tested in one sample. The other samples were used for cross-validation. Results indicated that the model of best fit had five factors, i.e., intrusion, avoidance, hyperarousal, numbing, and sleep disturbance. Model superiority was cross-validated in the two other samples. These findings suggest a five-factor model of post-traumatic stress symptoms in war survivors with numbing and sleep disturbance as separate factors in addition to intrusion, avoidance and hyperarousal.     

Region-Specific Sex-Dependent Pattern of Age-Related Changes of Proximal Femoral Cancellous Bone and Its Implications on Differential Bone Fragility

Despite evident interest in age-related bone changes, data on regional differences within the proximal femur are scarce. To date, there has been no comprehensive study on site-specific age-related changes in the trabecular architecture of three biomechanically important femoral subregions (medial neck, lateral neck, and intertrochanteric region) for both genders. In this study we investigated age-related deterioration in the trabecular architecture of those three subregions of the femoral neck for both genders. The research sample included 52 proximal femora (26 males, 26 females; age range, 26–96 years) from Forensic Department at University of Belgrade. Bone sections from the three regions of interest were scanned by micro-CT at University of Hamburg. The study revealed that proximal femoral microarchitecture cannot be perceived as homogeneous and, more importantly, that the aging process is not uniform. Besides the initial intersite differences, microarchitecture changed differently with increasing age, maintaining significant differences between the regions. In addition, we observed a different aging pattern between genders: deterioration was most significant in the intertrochanteric region in women, while the lateral neck was most affected in men. This finding supports epidemiological data about the differential occurrence of cervical vs. trochanteric fractures in aging males and females. In conclusion, the aging process in the proximal femur cannot be regarded as a simple function of quantitative bone loss but, rather, as an alteration of specific architecture that may degrade bone strength.