Predicting success of metabolic surgery: age,body mass index,C-peptide,and duration score

BackgroundSurgery is the most effective treatment of morbid obesity and leads to dramatic improvements in type 2 diabetes mellitus (T2DM). Gastrointestinal metabolic surgery has been proposed as a treatment option for T2DM. However, a grading system to categorize and predict the outcome of metabolic surgery is lacking. The study setting was a tertiary referral hospital (Taoyuan City, Taoyuan County, Taiwan).MethodsWe first evaluated 63 patients and identified 4 factors that predicted the success of T2DM remission after bariatric surgery in this cohort: body mass index, C-peptide level, T2DM duration, and patient age. We used these variables to construct the Diabetes Surgery Score, a multidimensional 10-point scale along which greater scores indicate a better chance of T2DM remission. We then validated the index in a prospective collected cohort of 176 patients, using remission of T2DM at 1 year after surgery as the outcome variable.ResultsA total of 48 T2DM remissions occurred among the 63 patients and 115 remissions (65.3%) in the validation cohort. Patients with T2DM remission after surgery had a greater Diabetes Surgery Score than those without (8 ± 4 versus 4 ± 4, P < .05). Patients with a greater Diabetes Surgery Score also had a greater rate of success with T2DM remission (from 33% at score 0 to 100% at score 10); A 1-point increase in the Diabetes Surgery Score translated to an absolute 6.7% in the success rate.ConclusionThe Diabetes Surgery Score is a simple multidimensional grading system that can predict the success of T2DM treatment using bariatric surgery among patients with inadequately controlled T2DM.     

Association of beta 2-adrenergic receptor polymorphism with the phenotype of aspirin-intolerant acute urticaria

The genetic mechanism of aspirin intolerant acute urticaria (AIAU) is unknown. To demonstrate an association between the beta 2 adrenergic receptor (ADRB2) polymorphism and the phenotype of AIAU, one hundred fourteen patients with AIAU, 110 patients with aspirin intolerant chronic urticaria (AICU), and 498 normal healthy controls (NC) based on a Korean population were enrolled. The genotype of ADRB2 at 46 A > G was analyzed using a direct sequencing method. The ADRB2 polymorphism at 46 A > G showed a significant difference between AIAU and NC; the frequency of the major genotype was significantly higher in the AIAU group (p= 0.017 in recessive model), while no differences were noted in allele and genotype frequencies between AICU and NC. In conclusion, the ADRB2 (46 A > G) gene polymorphism may contribute to the development of the phenotype of AIAU.     

Gasless endoscopic thyroidectomy via an anterior chest wall approach using a flap-lifting system

PURPOSE: Endoscopic thyroidectomy (ET) requires a proper working space for adequate visualization of anatomical structures and proper instrument manipulation. The purpose of this prospective study was to estimate the feasibility and safety of ET using an anterior chest wall approach without gas insufflation. MATERIALS AND METHODS: The working space was created under a direct and endoscopic view through a 3-cm incision on the anterior chest wall. A retracting device was then inserted to establish the working space, and subsequent procedures were performed endoscopically. All data were reviewed using a prospective database. RESULTS: We performed 30 ETs in patients with benign thyroid tumors from December 2003 to December 2005. The procedures were completed successfully in 29 patients (mean operative time: 160.6 min; range: 90-345 min). One patient with ET was converted to open thyroidectomy secondary to substernal extension of the tumor. None of the patients developed permanent postoperative hypocalcemia or recurrent laryngeal nerve paralysis. Three patients exhibited some degree of transient recurrent laryngeal nerve palsy. CONCLUSION: These data suggest that gasless ET using an anterior chest wall approach is safe and feasible in selected patients for treating benign thyroid tumors. This technique may offer good operative working space when performed by surgeons with relatively low-volume ET practices.     

Comparison of the MicroScan system and the agar dilution assay for Quinupristin/Dalfopristin susceptibility of Enterococcus faecium

We compared the results of Quinupristin/Dalfopristin (Q/D) susceptibility tests by the Positive Combo Panel (Type 11) of the MicroScan Walk Away 96 analyzer (Dade Behring, Inc.) with those obtained by the reference agar dilution method. From September 2003 to August 2004, a total of 410 E. faecium isolates were obtained from clinical samples. Of these, 65 (15.9%) strains were non-susceptible, and 345 (84.1%) strains were susceptible to Q/D. We collected consecutively 65 Q/D non-susceptible E. faecium isolates (42 resistant, 23 intermediate), and randomly selected 32 Q/D susceptible E. faecium isolates using the MicroScan system. The minimal inhibitory concentrations (MICs) of Q/D, vancomycin, and teicoplanin were determined by the agar dilution method according to CLSI guidelines. The agreement rates between the two methods were 100% for Q/D-susceptible strains, 85.7% for Q/D-resistant strains, and 26.1% for Q/D-intermediate strains of E. faecium. The major error rate (S-->R) was 11.9%, and the minor error rate (S-->I) was 13.0%. No very major errors were found. We conclude that for MicroScan 'non-susceptible' test results for Q/D, it is necessary to confirm the result using a reference method. The Q/D-resistance rate was higher in glycopeptide-susceptible (78.0% for vancomycin, 82.0% for teicoplanin) than glycopeptide-resistant E. faecium (22.0% for vancomycin, 16.0% for teicoplanin). Further studies are needed to determine whether Q/D use in hospitals or virginiamycin use in animals, or other factors, are responsible for the high rates of glycopeptide-susceptible and Q/D-resistant E. faecium strains in Korea.     

Identification of a novel HLA-B*58 allele, B*5813, by sequence-based typing of DNA from Korean baby cord blood

The novel HLA-B*5813 allele was identified in the cord blood of a Korean baby by sequence-based typing. This allele shows a sequence identical to that of HLA-B*5801, except for a nucleotide substitution that changes GAG to AAG at codon 128, resulting in an amino acid change from glutamic acid to lysine in the protein.