SG Group Research Articles

Prospective Study Comparing the effect of Laparoscopic Mini Gastric Bypass and Laparoscopic Sleeve Gastrectomy on Blood Glucose Level in Type 2 Diabetes Mellitus Obese Patients

Abstract Background Type 2 diabetes mellitus (T2DM) is now a global health priority. The World Health Organization estimates that between 2000 and 2030, the number of diabetic patients will increase by 114%. T2DM and morbid obesity are conditions representing increasing public health threats. They are associated with significant morbidity and mortality, and despite lifestyle modifications and medical support, glycemic control remains difficult to achieve in obese diabetic patients. Objective To compare the effect of laproscopic mini gastric bypass and laproscopic sleeve gastrectomy in controlling type 2 DM obese patients. Patients and Methods Our study was conducted on 40 adult morbid obese patients with T2DM. Twenty patient underwent laparoscopic mini-gastric bypass and the other 20 patient underwent sleeve gastrectomy. All of these patients were followed up preoperative and postoperative at 1, 3, 6, 9 and 12 months by measuring BMI, EWL%, Fasting blood glucose level, 2 hours post prandial blood glucose level, HbA1C also postoperative gastrografin study to exclude complications. Results Our study demonstrated the superiority of MGB over SG in controlling T2DM along 1 year of follow up with lower 1 year HBA1C, FBG, 2HPP blood glucose level in bypass group in comparison with SG group. The results of our study regarding mini gastric bypass MGB patient group showed total remission rate (85%), the other 15% of patients achieved improvement of glycemic control, regarding antidiabetic treatment only 3 out of 20 needed postoperative treatment. The results of our study regarding sleeve gastrectomy patient group showed total remission rate (50%) the other 50% of patients achieved improvement of T2DM control, regarding antidiabetic treatment 9 out of 20 needed postoperative treatment. Conclusion late postoperative complications and long-term maintenance of glycemic control need to be determined by further studies on a larger scale of patients and bigger duration of follow up.

Propofol Causes Consciousness Loss by Affecting GABA-A Receptor in the Nucleus Basalis of Rats.

Objective Propofol is a classical anesthetic and induces consciousness loss, and gamma-aminobutyric-acid-type-A (GABA-A) receptor is its target. Righting reflex is associated with conscious response. The nucleus basalis (NB) acts as a major relay between the reticular activating system and the frontal cortex (FC). Propofol may mediate righting reflex by affecting GABA-A receptor in NB. Methods Fifty male SD rats (250-350 g) were divided into parts I and II. In part I, 20 male SD rats were randomly divided into control group (CG) and NB-lesion group (NG, ibotenic acid-induced NB lesion). In part II, 30 male SD rats were treated with saline (0.9% NaCl, SG group), muscimol (a GABA-A receptor agonist, MG group), and gabazine (a GABA-A receptor antagonist, GG group) in NB, respectively. Two weeks later, the activity of the rats was measured between CG and NG groups. The rats were intravenously injected with propofol (50 mg/kg/h) to test the time of loss of righting reflex (LORR) in all rats. When LORR occurred, the rats received single administration of propofol (12 mg/kg) to measure the time of return of righting reflex (RORR). Electroencephalogram (EEG) activity of the frontal cortex (FC) was recorded. Results The numbers of NB neurons were reduced by 44% in the NG group compared to the CG group (p < 0.05) whereas the activity of rats was reduced a little in the NG group when compared with the CG group, but the statistical difference was insignificant (p < 0.05) whereas the activity of rats was reduced a little in the NG group when compared with the CG group, but the statistical difference was insignificant (p < 0.05) whereas the activity of rats was reduced a little in the NG group when compared with the CG group, but the statistical difference was insignificant (p < 0.05) whereas the activity of rats was reduced a little in the NG group when compared with the CG group, but the statistical difference was insignificant (p < 0.05) whereas the activity of rats was reduced a little in the NG group when compared with the CG group, but the statistical difference was insignificant (p < 0.05) whereas the activity of rats was reduced a little in the NG group when compared with the CG group, but the statistical difference was insignificant (Conclusions The unilateral NB lesion increased the recovery time and FC delta power, and the NB region might be involved in the emergence after propofol administration. Propofol plays a crucial role for causing conscious loss by affecting GABA-A receptor in NB.

Abstract P1-20-28: Intraoperative margin status in breast conserving surgery - A novel 3D evaluation using tomosynthesis

Abstract Background: Margin status remains a debatable issue in breast cancer surgery, accounting for a 10-40% re-excision rate. Accurate intraoperative assessment of margin status enables one step surgery, lowers re-excision rates and offers better surgical and cosmetic outcomes for the patient. We present a novel 3D intraoperative evaluation using Screen Vision and Computed Tomosynthesis. Methods: Our standard suture-guided orientations for a lumpectomy in 36 patients (SG group) undergoing BCS was compared to the new 3D orientation using the Screen Vision, a plastic box, with a two-dimensional axis system combined with three-dimensional tomosynthesis, in the first 26 patients operated with this technique (3D group). We defined clear margins as “no ink on tumor” for invasive carcinoma, and more than 2 mm distance for ductal carcinoma in situ. The margin status and the re-excision rates were recorded, for both benign and malignant lesions. Results: The margin-expansion rate in the first operation according to intra-operative margin status imaging, was 6/36 (16%) in the SG group compared to 9/26 (34%) in the 3D group. Additional margin-expansion according to clinical suspect in spite of negative imaging status was performed in 14/36 (28%) in the SG group and 8/26 (30%) in the 3D group. The re-lumpectomy rate was 4/36 (11%) in the SG group and 2/26 (7%) in the 3D group. Conclusions: This method of combined Screen Vision and computed tomosynthesis presents easier orientation of surgical specimens, with better intra-operative analysis of surgical margins. It might have a role in improving intra-operative margin status imaging, with subsequent lowering of re-lumpectomy rates. Citation Format: Bothaina Nakad, Ibrahim Matter, Paula Simovici, Daria Milevsky, Oksana Greg, Gideon Sroka, Asia Brodsky. Intraoperative margin status in breast conserving surgery - A novel 3D evaluation using tomosynthesis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-28.

The effect of desloratadine on ischemia reperfusion induced oxidative and inflammatory renal injury in rats

Purpose To examine the effect of desloratadine on kidney ischemia-reperfusion (I/R) injury in albino Wistar male rats using biochemical and histopathological methods. Methods The treated with ischemia–reperfusion + 5 mg/kg desloratadine (IRD) group (n–6) was given 5 mg/kg desloratadine by gavage orally, and applied renal ischemia-reperfusion (BIR) group (n–6) and control (SG) group undergoing Sham operation (n–6) rats were given distilled water as solvent one hour before ketamine anesthesia. During the anesthesia period, ischemia was induced for 2 h unilaterally in the left kidney of all rats followed by reperfusion for 6 h. The kidneys of the SG group had sham operation without any intervention. Results Our biochemical test results showed that malondialdehyde (MDA), nuclear factor kappa (NF-κB), tumor necrosis factor alpha (TNF-α), interleukin one beta (IL-1β), creatinine, and blood urea nitrogen (BUN) levels were significantly increased in the BIR group compared to the healthy control and IRD groups treated with desloratadine. Histopathological results were revealed tubular dilatation, tubular necrosis, loss of brushy margins, cast formation, and apoptotic bodies in tubular epithelial cells in the BIR group. There were no histopathological findings except for the swelling of tubule epithelial cells and the accumulation of proteinous material in some tubule lumens in renal tissue of desloratadine-treated rats. Conclusions Experimental results suggested that desloratadine may be useful in the treatment of renal I/R injury.

1441PD - A comprehensive model of genetic-features predicts outcome of personalized adjuvant treatment in resected EGFR-mutant stage II-IIIA NSCLC: Results from a phase III trial (CTONG 1104-ADJUVANT)

BackgroundResults of the ADJUVANT trial established adjuvant gefitinib as an optimal choice for EGFR-mutated stage II-IIIA NSCLC patients. However, clinical benefit varied among patients. To investigate this heterogeneity, we performed comprehensive tumor genomic analyses on these patients. Here, we report the predictive MEDUSA model (Multiple-biomarker Evaluation to Determine the Utilization of Specific Adjuvant therapy) that can guide clinical decision of adjuvant therapy. Methods171 baseline specimens from ADJUVANT (n=95, gefitinib arm; n=76, vinorelbine plus cisplatin [VP] arm) underwent targeted sequencing (Geneseeq 422-gene panel). Predictive biomarkers were identified by Cox regression with gene-by-treatment interactions, and a multi-gene composite score was developed to compare the benefits of these treatments. ResultsEGFR mutations were confirmed in all cases. TP53, NKX2-1, CDK4, MYC and RB1 were identified as predictive biomarkers. Specifically, gefitinib-favoring biomarkers include TP53 exon4/5 mutations (interaction HR [iHR] 0.33, 95% CI 0.12-0.93, p=0.035), and copy number gain of NKX2-1 (iHR 0.26, 95% CI 0.098-0.68, p=0.006), CDK4 (iHR 0.14, 95% CI 0.025-0.77, p=0.024) and MYC (iHR 0.10, 95% CI 0.011-0.98, p=0.048). RB1 alterations strongly favored VP (iHR 4.07, 95% CI 1.56-10.53, p=0.004). The MEDUSA model was developed based on the above, and stratified patients into 3 groups: Strong Gefitinib-favoring (SG, n=60), Moderate Gefitinib-favoring (MG, n=87), and VP-favoring (VP, n=24). Notably, the SG group demonstrated significant OS benefit with adjuvant gefitinib as well: HR of OS was 0.44 (95% CI 0.2-0.98, p=0.04).Table: 1441PDTable: 1441PDMEDUSA ScoremDFS (m)2y DFS(%)HR(95% CI)PSG≤-0.534.5 vs 9.170.3 vs 11.00.21 (0.1-0.43)<0.0001MG-0.5 to 0.532.8 vs 20.767.5 vs 41.00.61 (0.35-1.07)0.08VP≥0.519.3 vs 34.241.6 vs 69.23.07 (0.98-9.52)0.04 ConclusionsIncorporating alterations in TP53, NKX2-1, CDK4, MYC and RB1, MEDUSA score could guide personalized adjuvant therapy for resected stage II-IIIA EGFR-mutant NSCLC patients. Clinical trial identificationNCT01405079; Release at July 29. 2011. Legal entity responsible for the studyChinese Thoracic Oncology Group (CTONG). FundingAstraZeneca Roche. DisclosureY. Wu: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): AstraZeneca; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Roche; Honoraria (self): Eli Lilly; Honoraria (self): Pfizer; Honoraria (self): MSD; Honoraria (self): BMS; Honoraria (self), Advisory / Consultancy: Boehringer Ingelheim. H. Bao: Full / Part-time employment: Geneseeq Technology Inc. Toronto. Y. Chen: Full / Part-time employment: Geneseeq Technology Inc. Nanjing. Y.W. Shao: Full / Part-time employment: Geneseeq Technology Inc. Nanjing. All other authors have declared no conflicts of interest.

Nutritional Assistance by Software Improves Surgical Outcomes of Elective Colorectal Surgery

Objective The present study analyzes nutrition support in a group of patients undergoing colorectal surgery managed by nutritional requirement software compared to a group of consecutive patients undergoing colorectal surgery with conventional nutrition Materials and Methods A total of 485 patients were treated between January 2000 and January 2013 with colorectal resection. Outcomes (mortality, morbidity according to Clavien classification, length of hospital stay, type of colorectal disease) in a group of patients who received nutrition support through software (SG) were compared to those in a previous series, control group (CG) with conventional nutrition support Results Of the patients, 59.6% were men and the median age of the population was 68.2 years (range, 19–95 years), with no difference between the 2 groups. There were significantly more malnourished patients in the SG group (SG 63.8% versus 45.2% CG; P &amp;lt; 0.0001). The overall mortality was 2.1% lower in the SG group, but without a significant difference (SG 0.7% versus 2.7% CG). There were more severe stage III to IV complications according to Clavien classification in the SG group (SG 10.7 GC versus 17% NS), with significantly greater collections (SG 8% versus 16.9% CG; P = 0.015) and greater anastomotic leaks (SG 4% versus 13.9% CG; P &amp;lt; 0.001). The median hospital stay was lower in the SG group (SG 12 days versus 15 days CG; P = 0.049). Conclusion The proposed software could contribute to optimizing the strategy of nutritional support in hospitalized patients.

Disordered eating and weight loss after bariatric surgery.

Aberrant eating patterns are frequently observed in bariatric patients. Since bariatric operations produce alterations in food transit and in appetite/satiety balance, postoperative eating behavior changes are not surprising. 88 consecutive obese patients undergoing Roux-en-Y gastric bypass (RYGBP, 50 cases) and Sleeve Gastrectomy (SG, 38 cases) were retrospectively evaluated. Beside anthropometric data measurement, eating behavior was assessed by direct interview prior to the operation and at the first and second postoperative years: patients were considered as eating disordered (ED) when referred habitual occurrence of binge eating and nibbling/grazing. Weight loss was assessed by percent of BMI loss (% Δ BMI). Together with standard follow-up, patients received additional behavioral/dietetic support upon request. Postoperative ED patients showed lower % Δ BMI than the not ED ones at one (30.7% ± 8,5 vs. 26.8% ± 10, p < 0.02) and two (32% ± 10.3 vs. 27.4% ± 12.9, p < 0.05) years after operation, the follow-up rate being 82% and 76%, respectively, without differences between RYGBP and SG group. After RYGBP, an improvement of eating behavior was observed (ED patients from 75 to 28% at 1 year and to 27% at 2 years), while no changes were observed after SG. In SG patients, the number of additional behavioral/dietetic support sessions throughout the follow-up was positively associated with % Δ BMI. The postoperative normalization of eating pattern has a role in weight loss after bariatric surgery. Behavioral/dietetic support is indicated in all SG patient, while after RYGBP is useful only when weight loss is unsatisfactory. III: retrospective cohort study.

Cultural divides in acceptance and continuance of learning management system use: a longitudinal study of teenagers

Drawing on the technology acceptance model, the theory of reasoned action, and the expectation-confirmation model, an integrated model was proposed to explore teenagers’ learning management system (LMS) acceptance and continuance. Based on the data collected from a longitudinal survey of 1182 junior secondary students in Hong Kong, the results of structural equation modelling (SEM) supported the hypothesised model. Key findings were peer and teacher influences and perceived ease of use demonstrated significant effects; whereas parental influence and perceived usefulness had no effect, on behavioural intention over time. Multi-group SEM was used to test whether the paths in the hypothesized model varied across teenagers with different immigrant backgrounds. The sample was classified into three cultural groups: 203 first-generation immigrant students (FG), 354 second-generation immigrant students (FG), and 521 non-immigrant student (Native). The results showed that cultural divides existed in the relations of the proposed model across the FG, SG, and Native groups. The FG group, who were Mainland China born immigrants, were significantly different from the Native group in terms of the effects of perceptions, use experience, parental influence, and peer influence on their learning satisfaction and behavioural intention. The SG and Native groups, students who were born in Hong Kong, were the least noticeable in significant path differences. To highlight, peer influence demonstrated significantly stronger relationships with the FG group’s intention at the initial use stage, and peer influence only had a significant relationship with satisfaction for the FG and SG group. Discussion and implications of the findings are presented.

Effect of Using a Simulation Device for Ostomy Self-care Teaching in Iran: A Pilot, Randomized Clinical Trial

The aim of this pilot study was to determine the effects of simulation in ostomy self-care training on self-efficacy and adjustment. A randomized clinical trial was conducted among patients at 2 public medical center surgical units in eastern Iran from April 2015 to December 2015 using consecutive sampling. Patients who spoke Persian, were 18 to 65 years of age, had a temporary or permanent intestinal stoma, and did not have comorbidities that might interfere with self-care teaching were invited to participate and randomly allocated to the simulation (SG) or the control group (CG). Both groups were provided 4 training sessions; the first and fourth session was the same for each group, but in sessions 2 and 3, the SG group used a wearable stoma simulator, whereas the CG group used the demonstration-return method. Demographic and stoma variables were collected, and the Stoma Self-Efficacy Scale (SSES) and Ostomy Adjustment Inventory-23 (OAI-23) were administered at baseline (following surgery), after 4 instructional sessions, and 45 days following the last education session. Descriptive statistics and chi-squared, Fisher's exact, Mann-Whitney U, repeated measure, and least significant difference tests were used to analyze the data. Of the 53 patients enrolled, 46 (23 in each group) completed the study. Mean age for SG and CG patients was 45.91 ± 10.40 and 53.78 ± 9.15, respectively (P = .009). The majority of patients were female (SG: 11 [47.8%]; CG: 14 [60.9%]), married (SG: 20 [87.0%]; CG: 19 [82.6%]), and had a diagnosis of cancer (SG: 20 [87.0%]; CG: 21 [91.3%]). The mean SSES score for stoma self-efficacy was 103.82 ± 15.81 in the SG and 89.91 ± 13.41 in the CG after the fourth session. Results indicated an improvement in self-efficacy in both groups from baseline to final follow-up visit (P <.0001). SSES in the SG was significantly different from baseline to final follow-up visit during the study (F = 3.183, P = .008). Mean OAI-23 scores were 51.04 ± 13.37 in the SG and 50.82 ± 13.84 in the CG at baseline and after the intervention (fourth session) were 60.56 ± 16.41 in the SG and 53.95 ± 13.22 in the CG group. The repeated measure test results indicated significant increases in adjustment scores from baseline to final follow-up visit in both groups (P = .000). The results of this pilot study suggest that using simulation to teach ostomy self-care improves self-efficacy after 3 and 9 weeks. Further randomized controlled trials that expand the sample size and demographic should be conducted.

Bioavailability of Iron Supplement Formulations by Bariatric Surgery Type: A Pilot Study (P23-013-19)

ObjectivesOur previous research demonstrated that ferrous sulfate, the gold standard iron supplement treats iron deficiency in bariatric surgery patients but wasn’t well tolerated. We also found that the bioavailability of iron supplements, assessed by a serum iron absorption test, predicts treatment response. The objective of the current study is to determine whether bariatric surgery type (gastric bypass [GB] and sleeve gastrectomy [SG]) or iron formulation type (inorganic ferrous sulfate versus and an organic, slow-release form of iron, called AspironTM) predicts iron supplement bioavailability. MethodsIron-deficient GB and SG females, ages 18–65 years, who had surgery at least 6 months previously, participated in an 8-hour iron absorption test. Participants were considered iron deficient if two of the following values were abnormal: serum transferrin receptor greater than 2012 mcg/L, ferritin below 30 mcg/L, total iron binding capacity above 370 mcg/dL, and a serum transferrin receptor: ferritin ratio greater than 500. Participants received a low-iron breakfast with a 65 mg iron supplement. We assessed serum iron every 30 minutes for 8 hours following the supplementation using a calorimetric assay (South Bend Medical Foundation, South Bend, IN). ResultsWe report our preliminary findings to date; the study is ongoing. Out of the 10 participants, 8 had GB and 2 had SG. Six of the GB patients and both SG patients received AspironTM, and two of the GB patients received ferrous sulfate. In GB participants, following ferrous sulfate, serum iron increased 80.5 ± 6.4 mcg/dL compared to baseline, whereas following AspironTM, serum iron increased 6.7 ± 4.6 mcg/dL compared to baseline (P = 0.000). Compared to the GB group, serum iron increased 58.5 ± 57.3 mcg/dL in the SG group following AspironTM supplementation (P = 0.037). ConclusionsOur preliminary findings suggest that AspironTM is not as bioavailable as ferrous sulfate in GB patients. AspironTM may be better absorbed in SG patients, indicating that it could be an effective treatment to reverse iron deficiency in the SG population. Funding SourcesCura Global Health Inc.

Effects of pycnogenol on ischemia/reperfusion-induced inflammatory and oxidative brain injury in rats

BackgroundIschemia/reperfusion (I/R) injury results from the onset of re-circulation following a perfusion deterioration period in the tissues, resulting in more damage than that caused by perfusion deterioration. This study aimed to determine the effects of pycnogenol on I/R injury in rat brain tissues. MethodsEighteen albino Wistar rats were divided into three groups: I/R injury (IR, n = 6) group; I/R injury + pycnogenol (IR + P, n = 6) group; and sham group (SG, n = 6). After 30 min of transient ischemia, 24 h of reperfusion was achieved in the IR and IR + P groups. Surgical dissection, except for transient ischemia, was performed in SG. Next, histopathological and biochemical investigations were performed on brain tissues. Malondialdehyde (MDA), reduced glutathione (GSH), and glutathione peroxidase (GPO) were analyzed as oxidative stress markers; IL-1β and TNF-α were analyzed as inflammatory stress markers in biochemical tests. ResultsHistopathological examination revealed normal morphology in SG and diffuse cortex damage with edema, vasopathology, and inflammatory cell infiltration in the IR group. The IR + P group showed less cortex damage, edema, and vasopathology than the IR group. The MDA, IL-1β, and TNF-α levels were significantly higher in the IR group than those in the SG group. The values of same markers for the IR + P group were significantly lower than the IR group. The GSH and GPO levels were significantly decreased with IR damage, but PYC treatment showed significant improvement in the levels. ConclusionThis study showed that the administration of pycnogenol ameliorated brain damage after I/R injury by reducing oxidative and inflammatory damage in the rat brain.

Validation of new Japanese classification system for esophageal achalasia

BackgroundThe fourth edition of New Japanese classification system for esophageal achalasia was revised after a long interval of 30 years in 2012. In this new system, achalasia is morphologically classified into 3 types, based on its X-ray findings. However, the system has been limitedly used in Japan and has not been fully validated in terms of its predictive capability of postoperative outcomes. The purpose of this study was to clarify the validity of new Japanese classification system for esophageal achalasia, as an index of patient characteristics and as a predictor of operative and mid/long-term postoperative outcomes.Patients and methodsFifty-nine cases of achalasia underwent laparoscopic Heller–Dor surgery between 2005 and 2018. We evaluated retrospectively patient characteristics, intraoperative findings, esophageal manometry, 24-h pH monitoring and postoperative course.ResultsThere were 34 St and 25 Sg/aSg cases. Age of St group was lower than Sg group. Preoperative duration of disease of St group was shorter than Sg. There were no differences in the results of surgical outcomes and prognoses.ConclusionThe new Japanese classification system may give additional insight and information in understanding epidemiology of esophageal achalasia; however, our study failed to demonstrate “inter-disease type” differences in surgical outcomes and prognoses.

Antecedent Administration of Glutamine Benefits the Homeostasis of CD4+ T Cells and Attenuates Lung Injury in Mice With Gut‐Derived Polymicrobial Sepsis

Sepsis is a syndrome with CD4+ T-cell dysfunction and dysregulation of T helper (Th) and regulatory T (Treg) cells. Glutamine (Gln) is a nutrient with immunomodulatory properties. This study investigated the effects of dietary Gln pretreatment on Th and Treg cell homeostasis and lung injury in mice with gut-derived polymicrobial sepsis. Mice were randomly assigned to 4 groups with 2 control (C and G) and 2 sepsis groups (SC and SG). The C and SC groups were fed a common semipurified diet, whereas the G and SG groups received an identical diet except that part of the casein was replaced by Gln. Mice were administered these diets for 2 weeks. Then mice in the control groups underwent a sham operation, whereas operations in the sepsis groups were performed with cecal ligation and puncture. Mice were killed 24 hours after the surgery. Blood, spleens, and lungs were collected for further examination. Sepsis resulted in a decreased blood T-lymphocyte percentage, whereas percentages of interferon-γ-expressing, interleukin (IL)-4-expressing, and IL-17-expressing CD4+ T cells were upregulated. Compared with the SC group, Gln administration before sepsis reduced blood Th1, Th2, and Th17 but increased Treg percentages. Also, percentages of CD69-expressing CD4+ and CD8+ cells in the spleen increased. Concomitant with the decreased plasma IL-6 and keratinocyte-derived chemokine levels, the SG group exhibited a lower injury score of the lungs. Pretreatment with Gln may elicit more balanced Th polarization, alleviate inflammatory response, and attenuate lung injury induced by polymicrobial sepsis.

Effectiveness of posterior structures in the development of proximal junctional kyphosis following posterior instrumentation: A biomechanical study in a sheep spine model

IntroductionProximal junctional kyphosis – PJK has been defined by a 10 or greater increase in kyphosis at the proximal junction as measured by the Cobb angle from the caudal endplate of the uppermost instrumented vertebrae (UIV) to the cephalad endplate of the vertebrae 1 segments cranial to the UIV. In this biomechanical study, it is aimed to evaluate effects of interspinosus ligament complex distruption and facet joint degeneration on PJK development. Materials and methodsPosterior instrumentation applied between T2 – T7 vertebrae using pedicle screws to randomly selected 21 sheeps, divided into 3 groups. First group selected as control group (CG), of which posterior soft tissue and facet joints are protected. In second group (spinosus group, SG) interspinosus ligament complex which 1 segment cranial to UIV has been transected, and third group (faset group-FG) was applied facet joint excision. 25 N, 50 N, 100 N, 150 N and 200 N forces applied at frequency of 5 Hertz as 100 cycles axial to the samples. Then, 250 N, 275 N and 300 N forces applied static axially. Interspinosus distance, kyphosis angle and discus heights was measured in radiological evaluation. Abnormal PJK was defined by a proximal junctional angle greater than 100 and at least 100 greater than the corresponding preoperative measurement. ResultsIn CG group, average interspinosus distance was 6,6 ± 1.54 mm and kyphosis angle was 2,2 ± 0.46° before biomechanical testing, and they were measured as 9,4 ± 1.21 mm and 3,3 ±0.44° respectively after forces applied to samples. In SG group, average interspinosus distance was 6,2 ± 1.72 mm and kyphosis angle was 2,7 ± 1.01° before experiment, and they were measured as 20,8 ± 5.66 mm and 15,1 ± 2.34° respectively after forces applied to samples. In FG group, average interspinosus distance was 4,8 ± 1.15 mm and kyphosis angle was −1 ± 4.14° before experiment, and they were measured as 11,1 ±1.96mm and 11 ± 2.87° respectively after forces applied to samples. In comparison to group CG, statistically significant junctional kyphosis was seen on both FG and SG group after statistical analysis. (p < 0.05). PJK was seen statistically significant more on SG group than FG group. (p < 0.05). Not any statistically significant difference was seen on measurement of disk distances among three groups. (p > 0.05) ConclusionsProtecting interspinosus ligament complex and facet joint unity during posterior surgical treatment for spine deformation is vital to prevent PJK development. Based on our literature review, this is the first biomechanical study that reveals interspinosus ligament complex are more effective on preventing PJK development than facet joints.

Ten-year outcomes after Roux-en-Y gastric bypass and sleeve gastrectomy: an observational nonrandomized cohort study

BackgroundSleeve gastrectomy (SG) has replaced Roux-en-Y gastric bypass (RYGB) as the most commonly performed bariatric surgery procedure. Data on the long-term (up to 10 yr) outcomes after SG is scarce. No previous study has compared the long-term outcomes between RYGB and SG. ObjectiveTo compare 10-year weight lost and 10-year remission rates of type 2 diabetes, hypertension, and dyslipidemia between RYGB and SG. SettingUniversity hospital, Spain. MethodsNonrandomized cohort study including all patients that underwent RYGB or SG at our institution between January 2005 and March 2008. Participants were followed yearly after bariatric surgery. Data obtained at the 10-year evaluation after RYGB or SG (between January 2015 and March 2018) was analyzed. Main study outcomes were 10-year percentage of total weight lost and percentage of excess weight lost. Secondary outcomes included 10-year remission rates of type 2 diabetes, hypertension, and dyslipidemia. Between-groups differences in 10-year percentage of total weight lost and percentage of excess weight lost were evaluated using analysis of covariance. Association between type of surgery and remission rates of obesity-related co-morbidities were evaluated using logistic regression analyses. ResultsFive hundred four patients were included in the study, 390 underwent RYGB and 134 SG. Follow-up rate was 84.5%. Mean 10-year percentage of total weight lost and percentage of excess weight lost were 25.3 ± 11.2% and 56.0 ± 25.6% in the RYGB group, and 27.5 ± 13.5% and 53.2 ± 25.1% in the SG group (P = .853 and P = .746, respectively). In logistic regression analyses RYGB was superior to SG in achieving 10-year hypertension and dyslipidemia remission. ConclusionsThis study suggested comparable effectiveness between SG and RYGB on weight loss.

Comparison of Radial Artery Occlusion Following Transradial Access for Percutaneous Coronary Intervention Using Sheath-based versus Sheathless Technique

We compared the risk of radial artery occlusion (RAO) in patients undergoing coronary intervention with introducer sheath (SG) or without introducer sheath (SLG). 1251 consecutive patients, from 2 tertiary care center in Pennsylvania, USA, undergoing percutaneous coronary interventions (PCI) between 2008–2013 formed the study cohort (SLG: 161 patients, SG: 1090 patients). Radial artery patency was assessed using plethysmography. The association between sheath use and RAO was assessed using unadjusted, adjusted and propensity macthed logistic regression analyses. Mean age: 65 years, men: 63%, diabetics: 37%. SG was associated with lower RAO at band removal [unadjusted (OR: 0.31, 95% CI: 0.21–0.46), adjusted (OR: 0.10, 95% CI: 0.05–0.20) and propensity matched (OR: 0.20, 95% CI: 0.13–0.32)], at 24 hours [unadjusted (OR: 0.20, 95% CI: 0.12–0.34), adjusted (OR: 0.12, 95% CI: 0.06–0.24) and propensity matched (OR: 0.13, 95% CI: 0.07–0.25)] and 30 days [unadjusted (OR: 0.28, 95% CI: 0.14–0.54), adjusted (OR: 0.22, 95% CI: 0.10–0.50) and propensity matched (OR: 0.18, 95% CI: 0.10–0.40)], compared to SLG. Sheath use during radial access for PCI is associated with less RAO. It is unclear if use of introducer sheath during radial access for PCI reduces incidence of RAO. In this prospective cohort study involving 1251 concecutive patients undergoing PCI via radial access between 2008–2013, we assessed the difference in incidence of RAO between the SG (n = 1090) and the SLG (n = 161 patients) groups. SG group experienced lower incidence of RAO at band removal, 24 hours and 30 days post PCI in the unadjusted, adjusted, and propensity matched analyses compared to the SLG group. In conclusion sheath use during radial access for PCI is associated with less RAO.

Synbiotic meal decreases uremic toxins in hemodialysis individuals: A placebo-controlled trial

Generation of uremic toxins p-cresylsulfate (p-CS), indoxyl sulfate (IS) and indole 3-acetic acid (IAA) in hemodialysis (HD) individuals may be associated with the gut flora and recognized markers of disease progression. This study investigated the effect of synbiotic meal on uremic toxins in HD individuals. We conducted randomized singleblind and placebo-controlled intervention study with 58 HD subjects (20F/38M, 63.1 ± 10.9-old) who were randomly allocated in synbiotic group (SG, 40 g of extruded sorghum plus 100 mL of unfermented probiotic milk) or control group (CG, 40 g of extruded corn plus 100 mL of pasteurized milk), during 7-wk Metabolic markers and uremic toxins, fecal concentration of short chain fatty acid and pH value was determined. The SG group had decreased serum p-CS and IS, as well as decreased urea concentration (p < .05) compared to CG. SG showed higher fecal butyric acid and lower pH compared to baseline and SC (p < .05). In addition, serum p-CS and fecal pH were positively correlated to urea concentration in SG participants at the endpoint. The consumption of the synbiotic meal during 7-wk reduced colonic pH, and reduced serum uremic (p-CS and IS) toxins and urea in HD subjects.

Mechanism Research on the Influence of Large Scale Wind Power Integration on Power System Angle Stability

Base on the equivalent external characteristics of doubly-fed induction generator (DFIG) during the period of the fault and the power characteristic equation of delivery system, a novel method of eliminating equivalent mutual impedance is proposed to research the influence mechanism of different wind power penetration rate, the SG dispatch pattern and siting of wind farms on system transient power angle stability (TPAS) under fault condition are researched. The results show that system power angle characteristics are improved with the increase of the wind power scale. However, when the wind power scale reaches a certain level, the power angle stability promptly deteriorates. The distance of wind farms siting away from a SG group with leading power angle, as well as the generation reduction of the SG group, plays an important role in the improvement of TPAS. The effectiveness of the proposed method is verified by the numerical simulations of the two-machine power system.

Effects of Different Types of Oral Glucose-Lowering Drugs on Hepatic Fat Accumulation and Liver Function in Japanese Subjects with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease—A Randomized, Open-Label, 3-Arm Active-Control Study

Objective: In this study, we compared the effects of different types of oral hypoglycemic agents on NAFLD in subjects with T2DM. Methods: We conducted a randomized, open-label, 3-arm active-control trial in subjects with T2DM and NAFLD. A total of 98 subjects were randomly allocated either to dapagliflozin (SG, n=32), pioglitazone (TZ, n=33) or glimepiride (SU, n=33) group, and the subjects took these drugs for 28 weeks. The primary endpoint was a change of liver-to-spleen (L/S) ratio on CT. Results: Baseline characteristics in the three groups were similar in various clinical parameters. SG, TZ and SU ameliorated glycemic control similarly. Body weight and visceral fat area (VFA) were significantly decreased only in SG group. Serum adiponectin level was increased in TZ group compared to other two groups. SG and TZ, but not SU, significantly increased L/S ratio and decreased ALT level, and the effects of SG and TZ on those parameters were comparable. In simple correlation analysis with all subjects, change of L/S ratio was negatively correlated with alteration of BMI, VFA, HbA1c and serum insulin, and positively associated with change of adiponectin level. Multiple linear regression analysis revealed that the decrease in VFA and the increase in adiponectin level contributed to improve NAFLD in subjects with T2DM. In addition, the common factor which improved NAFLD in all groups was reduced VFA. On the other hand, there were also some differences among three groups about which factors were correlated with the change of L/S ratio. Conclusions: The present study showed the decreased VFA and increased adiponectin independently contributed to improve NAFLD in patients with T2DM. Furthermore, dapagliflozin and pioglitazone, exerted equivalent beneficial effects on NAFLD in subjects with T2DM, although the two drugs have different mechanism of action. Disclosure T. Kinoshita: None. M. Shimoda: Speaker's Bureau; Self; AstraZeneca. Research Support; Self; Taisho Pharmaceutical Co., Ltd. S. Nakanishi: Speaker's Bureau; Self; Sanofi. T. Mune: None. K. Kaku: Speaker's Bureau; Self; AstraZeneca. Advisory Panel; Self; Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Mitsubishi Tanabe Pharma Corporation, MSD K.K.. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd.. Advisory Panel; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Speaker's Bureau; Self; Taisho Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceuticals, Japan Inc., Kowa Pharmaceuticals, Japan Inc.. Advisory Panel; Self; Astellas, Japan Inc. H. Kaneto: Research Support; Self; Sanofi, Novo Nordisk Inc., Eli Lilly and Company, Boehringer Ingelheim Pharmaceuticals, Inc., MSD K.K., Takeda Pharmaceuticals U.S.A., Inc., Ono Pharmaceutical Co., Ltd., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Astellas Pharma US, Inc..

The effect of rutin on ovarian ischemia-reperfusion injury in a rat model

The effect of rutin on ovarian ischemia-reperfusion (I/R) injury was investigated in this experimental study. Eighteen Wistar albino female rats were divided into three groups as follows: I/R group (IRG; n = 6), 50 mg/kg rutin + I/R group (RG; n = 6), and a healthy control group scheduled for a sham operation (SG; n = 6). 2 h of ischemia and following 2 h of reperfusion were created in the IRG and RG by using a torsion model involving atraumatic vascular clips. Rutin, a flavonoid glycoside, was injected intraperitoneally at the dose of 50 mg/kg to RG group 1 h before reperfusion. Then, rats were euthanized and their ovaries were removed for biochemical and histopathological examination and also assessment of the gene expressions. IRG group had a significant increase in malondialdehyde (MDA) levels, in the expressions of tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β), and also in the activity of cyclooxygenase 2 (COX-2) unlike the significant decrease in total glutathione (tGSH) levels and the activity of COX-1 when compared to the SG group. However, rutin significantly decreased MDA levels, the expressions of TNF-α and IL-1β, and also the activity of COX-2 while it increased significantly tGSH levels and the activity of COX-1 in the RG group in comparison with the IRG group. Rutin ameliorated the I/R-induced ovarian injury in rats via its possible antioxidative and anti-inflammatory effects.