Prevalence and Predictors of Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy

Background and Aims

Laparoscopic sleeve gastrectomy (LSG) might be associated with a new onset or worsening of gastroesophageal reflux disease (GERD). We aim to evaluate the prevalence of post-LSG GERD symptoms and its predictors.

Methods

We included patients who underwent primary LSG at a university hospital from 2009 to 2015. We used the GERD-Health-Related Quality of Life (GERD-HRQL) questionnaire and included questions regarding regurgitation to evaluate symptoms before and after LSG; each item was scored from 1 to 5 based on the symptom severity.

Results

A total of 213 patients (mean age, 36.08 ± 10.22 years; 48.36% were men) were included. The mean preoperative body mass index (BMI) was 47.84 kg/m², mean percent total weight loss was 37.99% (95% CI, 36.64 to 39.34), mean percent excess weight loss was 84.14% (95% CI, 80.91 to 87.36), and the mean percent excess BMI loss was 84.17% (95% CI, 80.94 to 87.41). The mean heartburn score while standing increased (0.71 vs. 1.09, p < 0.01) as well as the score of heartburn requiring a diet change (0.67 vs. 1.16, p < 0.01) post-LSG. The scores for dysphagia, odynophagia, and regurgitation increased. New-onset heartburn was reported in 47.06% of our cohort. Those with high preoperative BMIs were less likely to develop new-onset or worsening symptoms of GERD (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95–0.99). More severe heartburn symptoms while standing were associated with higher risks of developing or worsening GERD symptoms (OR, 1.22; 95% CI, 1.01–1.47). None of the other variables could predict the development or worsening of the GERD symptoms.

Conclusion

Symptoms of heartburn and regurgitation are common after LSG; however, none of the variables preoperatively could strongly predict patients who would develop new onset or experience worsening of symptoms postoperatively.

     

Testosterone secreting adrenal adenoma in an adult female patient

Adrenal tumours that secrete testosterone are extremely rare and we describe such a case in a 35 years old female with virilization. She had steroid biochemical profile in normal limit, except increased serum testosterone level. She had left adrenal adenoma 7.5 X 6.4 cm in size, her ovaries were normal. After left adrenalectomy the serum testosterone level returns to normal and has remained in the normal range. Hirsutism decreasing gradually and menstruation restarts after 3 months. Histopathological examination confirmed the diagnosis of adrenal adenoma.     

Real time responses of fibroblasts to plastically compressed fibrillar collagen hydrogels

In vitro reconstituted type I collagen hydrogels are widely utilized for tissue engineering studies. However, highly hydrated collagen (HHC) gels exhibit insufficient mechanical strength and unstable geometrical properties, thereby limiting their therapeutic application. Plastic compression (PC) is a simple and reproducible approach for the immediate production of dense fibrillar collagen (DC) scaffolds which demonstrate multiple improvements for tissue engineered constructs including extracellular matrix (ECM)-like meso scale characteristics, increased mechanical properties (modulus and strength), enhanced cell growth and differentiation, and reduced long-term scaffold deformation. In order to determine at which stage these benefits become apparent, and the underlying mechanisms involved, the immediate response of NIH/3T3 fibroblasts to PC as well as longer-term cell growth within DC scaffolds were examined herein. The real time three-dimensional (3D) distribution of fluorescently labelled cells during PC was sequentially monitored using confocal laser scanning microscopy (CLSM), observing excellent cell retention and negligible numbers of expelled cells. Relative to cells grown in HHC gels, a significant improvement in cell survival within DC scaffolds was evident as early as day 1. Cell growth and metabolic activity within DC gels were significantly increased over the course of one week. While cells within DC scaffolds reached confluency, an inhomogeneous distribution of cells was present in HHC gels, as detected using x-ray computed micro-tomography analysis of phosphotungstic acid labelled cells and CLSM, which both showed a significant cell loss within the HHC core. Therefore, PC generates a DC gel scaffold without detrimental effects towards seeded cells, surpassing HHC gels as a 3D scaffold for tissue engineering.     

Kaposi’s sarcoma following living donor kidney transplantation: review of 7,939 recipients

Introduction  Kaposi’s sarcoma (KS) is one of the most common tumors to occur in kidney recipients, especially in the Middle East countries. Limited data with adequate sample size exist about the development of KS in living kidney recipients. Methods  Therefore, we made a plan for a multicenter study, accounting for up to 36% (n = 7,939) of all kidney transplantation in Iran, to determine the incidence of KS after kidney transplantation between 1984 and 2007. Results  Fifty-five (0.69%) recipients who developed KS after kidney transplantation were retrospectively evaluated with a median follow-up of 24 (1–180) months. KS occurred more often in older age when compared to patients without KS (49 ± 12 vs. 38 ± 15 years, P = 0.000). KS was frequently found during the first 2 years after transplantation (72.7%). Skin involvement was universal. Furthermore, overall mortality rate was 18%, and it was higher in patients with visceral involvement compared to those with mucocutaneous lesions (P = 0.01). However, KS had no adverse affect on patient and graft survival rates compared to those without KS. Forty-four patients with limited mucocutaneous disease and four with visceral disease responded to withdrawal or reduction of immunosuppression with or without other treatment modalities. Renal function was preserved when immunosuppression was reduced instead of withdrawn in patients with and without visceral involvement (P = 0.001 and 0.008, respectively). Conclusion  The high incidence of KS in this large population studied, as compared to that reported in other transplant patient groups, suggests that genetic predisposition may play a pathogenetic role.     

Cerebrospinal fluid analysis, predictors of bacterial meningitis: a study in 312 patients with suspected meningial infection

Objective： Patients with cerebrospinal fluid （CSF） pleocytosis are routinely admitted to the hospital and treated with parenteral antibiotics, although few have bacterial meningitis （BM）. The aim of this study was to evaluate predictors to differentiate BM from aseptic meningitis （ASM）. Methods：The study was conducted in Razi hospital, a training center affiliated to Ahvaz Joundishapoor University of Medical Sciences in Iran. and all patients were 18 years old or above and were treated in the hospital between 2003 and 2007. Data of those who had meningitis, tested as CSF pleocytosis but had not received antibiotic treatment before lumbar puncture were retrospectively analyzed. Results： Among 312 patients with CSF pleocytosis, two hundred fifteen （68.9%） had BM and ninety seven （31.1%） had ASM. The mean age for patients with BM was （34.7 - 17.7） years （P = 0.22, NS）. Sixty percent of the BM cases and 61.2% of the ASM cases occurred in men （ P = 0.70, NS）. We identified the following predictors of BM： CSF-WBC count 〉 100 per micro liter, CSF-glucose level 〈 40 mg/dL, CSF-protein level 〉 80 mg/dL. Sensitivity, specificity, PPV, NPV of these predictors, and LR for BM are 86.5% ,52.6% ,80.2% , 63.7% and 104. 1 for CSF-WBC count and 72.1% , 83.5% , 90.6% ,57.4% and 164.2% for CSF glucose, and 49.7% , 91.8% , 93.4% ,45. 2% and 104.5% for CSF protein. Conclusion：The CSF WBC count should not be used alone to rule out bacterial meningitis. When it is combined with other factors such as CSF glucose and protein improved decision making in patients with suspected BM may occur.     

A decision tree-based approach for determining low bone mineral density in inflammatory bowel disease using WEKA software

BACKGROUND: Decision tree classification is a standard machine learning technique that has been used for a wide range of applications. Patients with inflammatory bowel disease (IBD) are at increased risk of developing low bone mineral density (BMD). This study aimed at developing a new approach to select truly affected IBD patients who are indicated for densitometry, hence, subjecting fewer patients for bone densitometry and reducing expenses. MATERIALS AND METHODS: Simple decision trees have been developed by means of WEKA (Waikato Environment for Knowledge Analysis) package of machine learning algorithms to predict factors influencing the bone density among IBD patients. The BMD status was the outcome variable whereas age, sex, duration of disease, smoking status, corticosteroid use, oral contraceptive use, calcium or vitamin D supplementation, menstruation, milk abstinence, BMI, and levels of calcium, phosphorous, alkaline phosphatase, and 25-OH vitamin D were all attributes. RESULTS: Testing showed the decision trees to have sensitivities of 65.7-82.8%, specificities of 95.2-96.3%, accuracies of 86.2-89.8%, and Matthews correlation coefficients of 0.68-0.79. Smoking status was the most significant node (root) for ulcerative colitis and IBD-associated trees whereas calcium status was the root of Crohn's disease patients' decision tree. CONCLUSION: BD specialists could use such decision trees to reduce substantially the number of patients referred for bone densitometry and potentially save resources.     

Immunogenicity of recombinant hepatitis B virus vaccine in patients with and without chronic hepatitis C virus infection： A case-control study

AIM： To compare the response of standard hepatitis B virus （HBV） vaccination between patients with chronic hepatitis C virus （HCV） infection and healthy individuals. METHODS： This is a prospective case-control study. A total of 38 patients with chronic HCV infection and 40 healthy controls were included. Vaccination was performed by injection of 20μg recombinant HBsAg into the deltoid muscle at mo 0,1 and 6. Anti-HBs concentration was determined 3 mo after the last dose and compared between the two groups. The response pattern was characterized as （1） high-response when the anti-HBs antibody titer was 〉 100 IU/L, （2） low-response when the titer was 10-100 IU/L. and （3） no-response when the titer was 〈 10 IU/L. RESULTS： In the patient group, there were 10/38 （26.3%） non-responders, 8/38 （21.1%） Iow-responders and 20/38 （52.6%） high-responders. The corresponding values in the control group were 2/40 （5.0%）, 7/40 （17.5%） and 31/40 （77.5%）, respectively. The response pattern was statistically different between the two groups. In multivariate analysis, smoking was a significant confounder, while HCV infection lost its significant correlation with lower antibody response. CONCLUSION： Patients with chronic HCV infection tend to respond weakly to HBV vaccination compared to healthy individuals, though this correlation is not independent according to multivariate analysis.