A generalized laboratory software package—A prototype approach

A prototyped model of a generalized table-driven software package for laboratory testing and results registration is presented. The need to computerize dozens of laboratories performing hundreds of tests, called for a radical approach which would enable the quick addition of new laboratories to the system, as well as ease of maintenance. The generalized laboratory software package (GLAB) relies on a set of data tables, maintained by users, and a menu controlled environment interfacing GLAB with the rest of the hospital's systems.     

Estimation of noise level and signal to noise ratio of laplacian electrocardiogram during ventricular depolarization and repolarization

Body surface Laplacian ECG (LECG) has demonstrated its enhanced capability to localize cardiac electrical sources closest to the recording site. The aim of the present study was to evaluate the noise level and signal to noise ratio (SNR) in the LECG as compared to the potential ECG (PECG). Such evaluation is important to determine the applicability of the LECG to localizing and imaging of cardiac electrical activity in an experimental setting. Experimental studies were conducted in six healthy men. A 150-channel PECG was recorded from the anterolateral chest and the LECG was estimated using the finite difference algorithm. The noise level in the PECG and LECG was evaluated using multiple estimation protocols. The signal level during ventricular depolarization and repolarization was also estimated, and the corresponding SNR was calculated. Different filtering techniques were examined to evaluate their effects on the noise level and SNR of the LECG and PECG. The experimental results indicate that with basic signal processing techniques (baseline adjustment, three-point moving average filter, and Wiener spatial filter), the SNR of the LECG is about 30-40% of that of the PECG. Furthermore, the SNR estimated during ventricular depolarization is about three times that obtained during ventricular repolarization for the PECG and LECG. The present study indicates that the LECG derived from the PECG using a local finite difference estimation procedure has satisfactory SNR during the periods of ventricular depolarization and repolarization, and suggests the feasibility of estimating the LECG from the recorded PECG in human subjects in an experimental setting.     

Long-Term (over 10 Years) Retrospective Follow-up of Laparoscopic Adjustable Gastric Banding

Background

Laparoscopic adjustable gastric banding (LAGB) placements have progressively decreased in recent years. This is related to poor long-term weight loss outcomes and necessity for revision or removal of these bands. Long-term outcome results following LAGB are limited. The aim of our study was to determine the long-term outcome after LAGB at our institution.

Objectives

The aim of our study was to determine the long-term outcome after LAGB at our institution.

Setting

The setting of this is Academic Center, Israel.

Methods

Patients who underwent LAGB between 1999 and 2004 were reviewed. Patient comorbidities and weight loss parameters were collected preoperatively and at defined postoperative periods. Improvement in weight loss was defined as percent excess weight lost, and improvement in comorbidities was defined based on standardized reporting definitions.

Results

In total, 74 (80%) patients who underwent LAGB met inclusion criteria. The mean age at LAGB placement was 50.5 ± 9.6 years, and the mean body mass index (BMI) was 45.5 ± 4.8 kg/m². Preoperative comorbidities were diabetes mellitus (13.5%), hypertension (32%), hyperlipidemia (12.1%), obstructive sleep apnea (5.4%), joints disease (10.8%), mood disorders (5.4%), and gastro-esophageal reflux disease (GERD) symptoms (8.1%). The mean follow-up was 162.96 ± 13.9 months; 44 patients (59.4%) had their band removed, and 22 (30%) had another bariatric surgery. The follow-up BMI was 35.7 ± 6.9 (p < 0.001), and the % total weight loss was 21.0 ± 0.13. There was no improvement in any of the comorbidities. GERD symptoms worsened at long-term follow-up (p < 0.001). Undergoing another bariatric procedure was associated with a higher weight loss (OR 12.8; CI 95% 1.62–23.9; p = 0.02).

Conclusion

LAGB required removal in the majority of our patients and showed poor resolution of comorbidities with worsening of GERD-related symptoms. Patients who go on to have another bariatric procedure have more durable weight loss outcomes.

     

Structure and functional significance of the transverse vesical fold

The plica vesicalis transversa or transverse vesical fold (TVF) is a peritoneal fold extending from the lateral side of the bladder to the side of the lesser pelvis near the deep inguinal ring. It is an important landmark in laparoscopic surgery of the pelvis but is variably observed in the embalmed cadaver. We investigated the gross anatomy of this structure in the cadaver and confirmed that its medial portion corresponds to the location of the superior vesical artery(ies), thus supporting the idea that the TVF is "mesovesical." However, no large vessels were observed grossly in the lateral portion of the TVF. The hypothesis that the lateral TVF has a suspensory function was tested histologically by comparison with the suspensory ligament of the duodenum and the phrenicocolic ligament, both of which have smooth muscle contributing to their inferred suspensory function. Microscopic examination of prepared samples from 20 cadavers shows that the TVF evinces no smooth muscle in either its lateral or medial segments. The TVF is demonstrated to be a mesentery-like reflection of peritoneum raised by branches of the superior vesical artery which provides no demonstrable structural support for the bladder. Implications of these findings include avoidance of sectioning of medial TVF during laparoscopic surgery because of its vascular nature, and inadvisability of utilizing any portion of theTVF for an anchor in reconstruction of the anterior pelvic floor within the paravesical fossae.     

Direct activation of mTOR in B lymphocytes confers impairment in B-cell maturation andloss of marginal zone B cells

The tuberous sclerosis complex (TSC), composed of TSC1/TSC2 heterodimers, is inhibitory to the mammalian target of rapamycin (mTOR). Deletion of either TSC1 or TSC2 renders mTOR constitutively active. To directly explore the impact of mTOR activation on B-cell development, we conditionally deleted TSC1 in murine B cells. This led to impairment in B-cell maturation. Unexpectedly, and in contrast to Akt activation, marginal zone (MZ) B cells were significantly reduced. Administration of rapamycin partially corrected the MZ defect, indicating a direct role for mTOR in controlling MZ development. When challenged with a T-cell-dependent antigen, TSC1 KO mice responded less efficiently. Consistent with the MZ defects, TSC1 KO mice did not respond at all to T-independent antigens. Because activation of Akt upstream of TSC and mTOR yields the reverse phenotype with respect to MZ development, we conclude that, physiologically, Akt simultaneously emits two opposing signals that counterbalance each other in the control of B-cell differentiation.     

Monotherapy of lamotrigine versus carbamazepine in patients with poststroke seizure

OBJECTIVES: The incidence of seizures is known to be high in the elderly. The most common cause of an unprovoked seizure in the elderly population is stroke. These patients require effective and well-tolerated antiepileptic treatment because they frequently experience other medical conditions and use other medications that can interact with the antiepileptic treatment. The aim of the study was to analyze the tolerability and efficacy of lamotrigine (LTG) versus sustained-release carbamazepine (CBZ) treatment in newly diagnosed symptomatic poststroke seizure. METHODS: Sixty-four patients with a first post episode of seizures were randomized in a 1:1 ratio to either LTG or CBZ treatment and were followed up prospectively for up to 12 months for efficacy and tolerability of the drugs. RESULTS: More patients in the LTG group were seizure-free (72%) versus those in the CBZ group (44%; P = 0.06), but the numbers did not reach statistical significance because of a relative small number of study patients. The number of patients who withdraw from the study because of adverse events was statistically significantly less in the LTG group (3%) compared with the CBZ group (31%; P = 0.02). CONCLUSIONS: The LTG treatment in poststroke seizures versus CBZ treatment is a relatively better-tolerated drug and can be acceptable as initial treatment in this specific group of patients.     

Predictors of failed colonoscopy in nonagenarians: a single-center experience

BACKGROUND AND STUDY AIMS: Data on the yield of conventional colonoscopy in very old patients remain limited. The aim of the study was to evaluate the outcome of colonoscopy in nonagenarian patients. PATIENTS AND METHODS: The safety, success rate to complete colonoscopy and findings of colonoscopies performed during the last 5 years in our center were compared between 41 nonagenarians (group 1) and 2 control groups: 50 consecutive patients aged 70 to 79 years (group 2) and 50 consecutive patients aged 50 to 59 years (group 3). Serum hemoglobin, albumin, patients' source, indications for and colonoscopies findings were retrieved for the total study cohort and comorbidities, mental and functional states for group 1 only. Reasons for colonoscopy failure and predictive factors for failed colonoscopy were analyzed. Chi-square test was used to detect differences in categorical variables by failure or age group. Failure was modeled using logistic regression analyses, and odds ratios with 95% confidence intervals were calculated. All tests were 2-sided and considered significant at P<0.05. RESULTS: Failed colonoscopy was significantly more prevalent in group 1. The main reason for it was bad preparation. Malignant tumors were significantly more frequently observed in the elderly (groups 1 and 2) than in the younger age group. No complications during and 48 hours postcolonoscopy were observed in all study participants. In univariate analyses in group 1 mental and functional states were inversely and low serum hemoglobin and albumin levels were positively, significantly associated with failure to complete colonoscopy. In multivariate logistic regression analyses, only functional state retained significance as a predictor of failed colonoscopy (odds ratio 5.6, 95% confidence interval 1.5-21.06, P=0.01). CONCLUSIONS: Colonoscopy in nonagenarians is a safe procedure; however, it carries a significantly higher failure rate. Functional decline was found to be a significant predictive factor for failed colonoscopy.     

Treatment of hypertension with thiazides: benefit or damage-effect of low- and high-dose thiazide diuretics on arterial elasticity and metabolic parameters in hypertensive patients with and without glucose intolerance

Thiazide diuretics may cause multiple metabolic abnormalities. The authors investigated the effects of varying doses of hydrochlorothiazide (HCTZ) on arterial elasticity and metabolic parameters in patients with hypertension (HTN), HTN and impaired fasting glucose (HTN+IFG), and HTN and type 2 diabetes mellitus (HTN+DM). The patients received low and high doses of HCTZ. Systolic and diastolic blood pressures declined significantly during the first 3 months in all patients, but no additional decrease was seen following the increase in HCTZ dose. In HTN, large artery elasticity index and small artery elasticity increased during the study. In HTN+IFG, large artery elasticity index increased without improvement in small artery elasticity index. In HTN+DM, both large artery elasticity index and small artery elasticity index did not improve during follow-up. Low-dose HCTZ improves arterial elasticity in hypertensive patients, but this effect is diminished with concomitant DM or IFG. The HCTZ dose increase worsened parameters of glucose metabolism and did not further decrease blood pressure or improve arterial elasticity.