Common Limb Length Does Not Influence Weight Loss After Standard Laparoscopic Roux-En-Y Gastric Bypass

Background

Although Roux-en-Y gastric bypass (RYGBP) has proven its reliability over time in terms of weight loss and resolution of comorbidities, there continues to be a significant controversy in terms of used limb lengths. In the classical RYGBP, most surgeons have reported an alimentary limb length (ALL) of 100 to 150 cm and a bilio-pancreatic limb length (BPLL) of 50 to 75 cm. On the other hand, the common limb length (CLL) remains unknown in all the patients. As it is theoretically related to the level of malabsorption, CLL could influence weight loss after RYGBP.

Materials and Methods

We performed a laparoscopic RYGBP in 90 patients with a mean preoperative body mass index (BMI) of 44.8. ALL and BPLL were respectively fixed at 150 and 75 cm. A systematic intraoperative measurement of CLL was performed.

Results

As expected, we found a great variation of the jejuno-ileal length and also of the CLL. We created three subgroups of patients: one with the entire population, one excluding the super-obese patients (BMI?>?50) and the third one excluding the revisions. There was no statistically significant correlation between CLL and excess BMI loss (EBMIL) at 1, 3, 6 and 12 months of follow-up in each group. We also found a linear correlation between the jejuno-ileal length and the height of individuals.

Conclusion

With a fixed 150-cm ALL and a 75-cm BPLL, there is no evidence that the anatomical variations of CLL could influence weight loss after classical RYGBP.

     

Automatic analysis of single-channel sleep EEG: validation in healthy individuals

STUDY OBJECTIVE: To assess the performance of automatic sleep scoring software (ASEEGA) based on a single EEG channel comparatively with manual scoring (2 experts) of conventional full polysomnograms. DESIGN: Polysomnograms from 15 healthy individuals were scored by 2 independent experts using conventional R&K rules. The results were compared to those of ASEEGA scoring on an epoch-by-epoch basis. SETTING: Sleep laboratory in the physiology department of a teaching hospital. PARTICIPANTS: Fifteen healthy volunteers. MEASUREMENTS AND RESULTS: The epoch-by-epoch comparison was based on classifying into 2 states (wake/sleep), 3 states (wake/REM/ NREM), 4 states (wake/REM/stages 1-2/SWS), or 5 states (wake/REM/ stage 1/stage 2/SWS). The obtained overall agreements, as quantified by the kappa coefficient, were 0.82, 0.81, 0.75, and 0.72, respectively. Furthermore, obtained agreements between ASEEGA and the expert consensual scoring were 96.0%, 92.1%, 84.9%, and 82.9%, respectively. Finally, when classifying into 5 states, the sensitivity and positive predictive value of ASEEGA regarding wakefulness were 82.5% and 89.7%, respectively. Similarly, sensitivity and positive predictive value regarding REM state were 83.0% and 89.1%. CONCLUSIONS: Our results establish the face validity and convergent validity of ASEEGA for single-channel sleep analysis in healthy individuals. ASEEGA appears as a good candidate for diagnostic aid and automatic ambulant scoring.     

Comparison of hydrogenated vegetable shortening and nutritionally complete high-fat diet on limited access-binge behavior in rats

Previous studies have suggested that intermittent exposure to hydrogenated vegetable shortening yields a binge/compensate pattern of feeding in rats. The present study was designed to assess whether rats would exhibit similar patterns of intake when given intermittent access to a nutritionally complete high-fat diet. Four groups of rats received varying exposure to either hydrogenated vegetable shortening or high-fat diet for 8 consecutive weeks. Animals were given daily and intermittent access to determine if the binge/compensate pattern of feeding was frequency dependent. At the conclusion of the study, body composition and plasma leptin levels were assessed to determine effects of diet and binge/compensate intake on endocrine alterations. As predicted, animals receiving intermittent access to high-fat diet displayed the binge/compensate pattern of feeding and appeared to compensate as a result of the caloric overload accompanying a particular binge episode. In addition, exposure to either shortening or high-fat diet led to alterations in body composition, while only exposure to shortening altered plasma leptin levels. These results suggest that binge-intake behavior occurs on a nutritionally complete high-fat diet and that this regimen is capable of altering both body composition and endocrine profile.     

Pesticide exposure exacerbates alpha-synucleinopathy in an A53T transgenic mouse model

The factors initiating or contributing to the pathogenesis of Parkinson's disease and related neurodegenerative synucleinopathies are still largely unclear, but environmental factors such as pesticides have been implicated. In this study, A53T mutant human alpha-synuclein transgenic mice (M83), which develop alpha-synuclein neuropathology, were treated with the pesticides paraquat and maneb (either singly or together), and their effects were analyzed. Immunohistochemical and biochemical analyses showed that chronic treatment of M83 transgenic mice with both pesticides (but not with either pesticide alone) drastically increased neuronal alpha-synuclein pathology throughout the central nervous system including the hippocampus, cerebellum, and sensory and auditory cortices. alpha-Synuclein-associated mitochondrial degeneration was observed in M83 but not in wild-type alpha-synuclein transgenic mice. Because alpha-synuclein inclusions accumulated in pesticide-exposed M83 transgenic mice without a motor phenotype, we conclude that alpha-synuclein aggregate formation precedes disease onset. These studies support the notion that environmental factors causing nitrative damage are closely linked to mechanisms underlying the formation of alpha-synuclein pathologies and the onset of Parkinson's-like neurodegeneration.