Gastroesophageal Reflux in Patients with Morbid Obesity: A Role of Obstructive Sleep Apnea Syndrome?

Background  Obesity is a risk factor for gastroesophageal reflux disease (GERD) and for obstructive sleep apnea (OSA). Our aim was to evaluate in morbidly obese patients the prevalence of OSA and GERD and their possible relationship. Methods  Morbidly obese patients [body mass index (BMI) >40 or >35 kg/m² in association with comorbidities] selected for bariatric surgery were prospectively included. Every patient underwent a 24-h pH monitoring, esophageal manometry, and nocturnal polysomnographic recording. Results  Sixty-eight patients [59 women and 9 men, age 39.1 ± 11.1 years; BMI 46.5 ± 6.4 kg/m² (mean ± SD)] were included. Fifty-six percent of patients had an abnormal Demester score, 44% had abnormal time spent at pH <4, and 80.9% had OSA [apnea hypopnea index (AHI) >10] and 39.7% had both conditions. The lower esophageal sphincter (LES) pressure was lower in patients with GERD (11.6 ± 3.4 vs 13.4 ± 3.6 mm Hg, respectively; P = 0.039). There was a relationship between AHI and BMI (r = 0.337; P = 0.005). Patients with OSA were older (40.5 ± 10.9 vs 33.5 ± 10.4 years; P = 0.039). GERD tended to be more frequent in patients with OSA (49.1% vs 23.1%, respectively; P = 0.089). There was no significant relationship between pH-metric data and AHI in either the 24-h total recording time or the nocturnal recording time. In multivariate analysis, GERD was significantly associated with a low LES pressure (P = 0.031) and with OSA (P = 0.045) but not with gender, age, and BMI. Conclusion  In this population of morbidly obese patients, OSA and GERD were frequent, associated in about 40% of patients. GERD was significantly associated with LES hypotonia and OSA independently of BMI.     

Preparation and Characterization of Nickel Nanoparticles for Binding to His-tag Proteins and Antigens

Purpose The purpose of these studies was to prepare nanoparticles (NPs) with a small amount of surface-chelated nickel for obtaining enhanced binding of histidine-tagged (his-tag) proteins compared to non-histidine-tagged protein binding to charged nanoparticles. Materials and Methods NPs were prepared from oil-in-water microemulsion precursors using emulsifying wax, 3 mM Brij 78 and 0.1 mM DOGS–NTA–Ni lipid (referred to as Ni-NPs). The amount of lipid entrapped in the NPs was quantitated by atomic emission spectroscopy (AES). The Ni-NPs were investigated for binding to two his-tag proteins, green fluorescent protein (GFP) and his-tag HIV-1 Gag p24. In vivo studies in mice were carried out to evaluate the immune responses obtained to his-tag Gag p24 bound to Ni-NPs. Results AES studies demonstrated that approximately 5% of the DOGS–NTA–Ni lipid used was entrapped in the NPs. The optimal binding ratio his-tag GFP and his-tag Gag p24 to Ni-NPs was found to be 1:33.7 and 1:35.4 w/w, respectively. This interaction was stable at 37°C in PBS, pH 7.4 over 4 h and the interaction of his-tag GFP with the Ni-NPs was enhanced compared to control NPs prepared with no Ni on the surface (NTA-NPs). The in vivo studies demonstrated enhanced serum IgG and IgG2a responses to his-tag Gag p24 bound to Ni-NPs compared to protein adjuvanted with Alum or adsorbed on the surface of control NTA-NPs. Conclusions Ni-NPs can be used to bind strongly to his-tag proteins. This system was demonstrated to have potential applications in vaccine delivery for enhancing immune responses to protein-based vaccines.     

Guidelines for reporting data and outcomes for the surgical treatment of atrial fibrillation

Atrial fibrillation is the most common sustained cardiac rhythm disturbance, affecting an estimated 2.5 million people in the United States. Atrial fibrillation may occur with or without structural heart disease. The medical and surgical literature has seen an exponential growth in reports of ablation techniques and the Cox-Maze procedure to treat atrial fibrillation. There has been no agreement or standards on the proper reporting of these techniques and results. The current literature is in disarray, and this report is an attempt to provide a framework for the necessary elements to be included in reports on this subject. The Workforce on Evidence Based Surgery of the Society of Thoracic Surgeons encourages the adoption of these guidelines for reporting clinical results derived from patients undergoing surgical procedures for atrial fibrillation. Adoption of these guidelines will greatly facilitate the comparison between the reported experiences of various authors treating different cohorts of patients at different times with different techniques and energy sources. These guidelines are also appropriate for catheter-based treatment of atrial fibrillation. Thus, more reliable evaluation and comparisons of results will advance our knowledge and further the development and application of these procedures.     

Treatment of lone atrial fibrillation with a right thoracoscopic approach

A simplified technique to treat patients in stand-alone atrial fibrillation with a right thoracoscopic approach is described. An electrical isolation of the four pulmonary veins (box lesion) is achieved with a microwave antenna.     

Extrapleural intrathoracic implantation of permanent pacemaker in the pediatric age group

Permanent pacemaker implantation in pediatric patients poses challenges in finding a suitable pocket for generator implantation. We present our experience with 6 patients in whom the pacemaker was placed in an extrapleural intrathoracic location. We find that an extrapleural intrathoracic pocket is a useful site for generator placement in the neonatal and pediatric age group. It is safe, reproducible, and both the lead and generator can be placed through a single incision. We briefly discuss the advantages and disadvantages of other techniques that require a single incision for both lead and generator placement.