Learning curve and robot set-up/operative times in singly docked totally robotic Roux-en-Y Gastric bypass

Background

The robotic platform might offer superior ergonomics over other minimally invasive approaches. However, the increased time required for instrument set-up, operations, and surgical training are perceived as major drawbacks. There is limited literature on this topic, therefore we report our experience at an academic tertiary medical center in the USA. The primary aim of this study was to analyze the learning curve and the times for necessary steps for singly docked totally robotic Roux-en-Y gastric bypass (RREYGB).

Materials and methods

From November 2010 to April 2013, all consecutive patients who underwent RREYGB were retrospectively analyzed from a prospectively maintained database. Variables of interest for this study were patient demographics, preoperative body mass index, previous surgical history, clinically relevant perioperative events, and operative times for various steps in the procedure.

Results

During the study period, a total of 32 patients were enrolled. The mean age was 39.9 ± 9.7 years (range 25–60), preoperative weight was 120.9 ± 21.5 kg (range 76.7–184.6), and body mass index (BMI) was 44.7 ± 5.3 kg/m² (range 36.1–61). The mean total operative time was 187.3 ± 36.4 min (range 130–261). The time necessary for trocar placement was 11.9 ± 4.5 min (range 4–23), robot set-up was 8.5 ± 3.6 min (range 3–20), pouch creation was 32 ± 10.11 min (range 16–56), gastrojejunal anastomosis was 59.5 ± 12.3 min (range 39–90), jejunojejunal anastomosis was 33.5 ± 9.6 min (range 18–65), and endoscopy/hemostasis was 12.9 ± 7.2 min (range 2–34). Operative time significantly improved after eight cases.

Conclusion

In a high-volume established robotic bariatric center, robot set-up, operative times, and learning curve are shorter than previously reported.     

Evaluation of immune responses to an oral typhoid vaccine,Ty21a,in children from 2 to 5 years of age in Bangladesh

Young children are very susceptible to typhoid fever, emphasizing the need for vaccination in under five age groups. The parenteral Vi polysaccharide vaccine is not immunogenic in children under 2 years and the oral Ty21a vaccine (Vivotif) available in capsular formulation is only recommended for those over 5 years.     

Biarylmethoxy Nicotinamides As Novel and Specific Inhibitors of Mycobacterium tuberculosis

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The role of M2-2 PDZ-binding motifs in pulmonary innate immune responses to human metapneumovirus

Human metapneumovirus (HMPV) is a leading cause of lower respiratory tract infection (LRTI) in pediatric and geriatric populations. We recently found that two PDZ-binding motifs of the M2-2 protein, 29-DEMI-32 and 39-KEALSDGI-46, play a significant role in mediating HMPV immune evasion in airway epithelial cells (AECs). However, their role in the overall pulmonary responses to HMPV infection has not been investigated. In this study, we found that two recombinant HMPVs (rHMPV) lacking the individual M2-2 PDZ-binding motif are attenuated in mouse lungs. Mice infected with mutants produce more cytokines/chemokines in bronchoalveolar lavage (BAL) fluid compared to mice infected with wild-type rHMPV. In addition, both mutants are able to enhance the pulmonary recruitment of dendritic cells (DCs) and T cells and induce effective protections against the HMPV challenge. The DC maturation is also significantly improved by the motif mutation. Taken together, our data provide proof-of-principle for two live-attenuated M2-2 mutants to be promising HMPV vaccine candidates that are effective in inducing higher pulmonary innate immunity and generating protection against HMPV infection.     

Making smart drugs smarter: The importance of linker chemistry in targeted drug delivery

Smart drugs, such as antibody-drug conjugates, for targeted therapy rely on the ability to deliver a warhead to the desired location and to achieve activation at the same site. Thus, designing a smart drug often requires proper linker chemistry for tethering the warhead with a vehicle in such a way that either allows the active drug to retain its potency while being tethered or ensures release and thus activation at the desired location. Recent years have seen much progress in the design of new linker activation strategies. Herein, we review the recent development of chemical strategies used to link the warhead with a delivery vehicle for preferential cleavage at the desired sites.     

Efficacy of systemic bisphosphonate delivery on osseointegration of implants under osteoporotic conditions: Lessons from animal studies

Background

The aim was to systematically review the role of systemic bisphosphonate (BP) delivery on osseointegration of implants under osteoporotic conditions.

Methods

The addressed focused question was “Does systemic BP delivery enhance osseointegration of implants under osteoporotic conditions?” PubMed/MEDLINE and Google-Scholar databases were searched from 1994 up to and including December 2013 using different combinations of the following keywords: “bone to implant contact”, “implant”, “bisphosphonate”, “osseointegration” and “osteoporosis”. Review articles, case-reports, commentaries, letters to the Editor, unpublished articles and articles published in languages other than English were excluded.

Results

Fifteen animal studies fulfilled our eligibility criteria. Osteoporotic conditions were induced via bilateral ovariectomy (OVX). BPs used in the studies were ibandronate, zoledronic acid and alendronate. Results from 12 studies showed that systemic BP delivery significantly increased bone volume and bone-to-implant contact under osteoporotic conditions. Two studies reported no significant difference in osseointegration among OVX animals with and without systemic BP delivery. In one study, systemic BP delivery negatively influenced implant osseointegration. Rough-surfaced and polished implants were used in 11 and one study respectively. In 3 studies implant surface characteristics remained unclear.

Conclusion

Within the limits of the present study, it is concluded that systemic BP delivery enhances implant osseointegration in animals with induced osteoporotic conditions. However, in a clinical scenario, the potential risk of BP related ONJ in osteoporotic patients undergoing dental implant therapy cannot be disregarded.     

Glucose-Stimulated Insulin Secretion in Gastric Bypass Patients with Hypoglycemic Syndrome: No Evidence for Inappropriate Pancreatic β-cell Function

Background  

Roux-en-Y gastric bypass surgery (RYGB) has been associated with a hypoglycemic syndrome characterized by postprandial hypoglycemia and hyperinsulinemia. The syndrome is believed to occur due to insulin hypersecretion from either pancreatic β-cell hyperplasia or hyperfunction.