Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass?

Background: Consensus on the necessity of esophagogastroduodenoscopy (EGD) before bariatric surgery is lacking. Recommendations and practices vary by country and unit. Several reports have expressed concerns on gastroesophageal reflux disease (GERD) and its consequences after sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in the excluded stomach after Roux en -Y gastric bypass (RYGB). Objectives: We explored the number and types of clinically significant findings in preoperative EGDs and how they associate with preexisting GERD-symptoms (SG) and premalignant lesions (RYGB). We also studied how many reoperations were performed due to postoperative GERD in SG-patients. Setting: University hospital. Methods: We investigated preoperative EGD-findings and gastrointestinal symptoms before bariatric surgery in all patients with a primary bariatric operation in our unit between December 2007 and May 2016. Results: We performed 1474 operations: 1047 (71.0%) RYGB, 407 (27.6%) SG, and 20 (1.4%) others. One thousand two hundred seventy-five (86.5%) preoperative EGD reports were analyzed: 647 (50.7%) EGDs were completely normal. Altogether, 294 patients (23.0% of total) had a clinically significant finding that was relevant for SG (hiatal hernia, esophagitis, Barrett's esophagus, esophageal dysplasia), 144 (49.0%) of whom reported gastrointestinal symptoms. Twenty patients (1.6%) had a significant finding relevant for RYGB (peptic ulcer, atrophic gastritis, gastrointestinal stromal tumor), and 6 (30%) reported gastrointestinal symptoms. Thirteen (3.2%) SGs were converted into RYGB due to GERD. Conclusions: Preoperative EGD is indicated before SG but not before RYGB for asymptomatic patients without a risk for gastric pathology. (C) American Society for Metabolic and Bariatric Surgery. All rights reserved.Peer reviewe

Vacancy-Impurity Complexes in Highly Sb-Doped Si Grown by Molecular Beam Epitaxy

Positron annihilation measurements, supported by first-principles electron-structure calculations, identify vacancies and vacancy clusters decorated by 1–2 dopant impurities in highly Sb-doped Si. The concentration of vacancy defects increases with Sb doping and contributes significantly to the electrical compensation. Annealings at low temperatures of 400–500 K convert the defects to larger complexes where the open volume is neighbored by 2–3 Sb atoms. This behavior is attributed to the migration of vacancy-Sb pairs and demonstrates at atomic level the metastability of the material grown by epitaxy at low temperature.Peer reviewe

Identification of Vacancy-Impurity Complexes in Highly n-Type Si

We show that the detailed atomic structure of vacancy-impurity complexes in Si can be experimentally determined by combining positron lifetime and electron momentum distribution measurements. The vacancies complexed with a single impurity, V−P and V−As, are identified in electron irradiated Si. The formation of native vacancy defects is observed in highly As-doped Si at the doping level of 1020cm−3. The defects are identified as monovacancies surrounded by three As atoms. The formation of a V−As3 complex is consistent with the theoretical descriptions of As diffusion and electrical deactivation in highly As-doped Si.Peer reviewe

Bile Reflux is a Common Finding in the Gastric Pouch After One Anastomosis Gastric Bypass

INTRODUCTION: Data on postoperative bile reflux after one anastomosis gastric bypass (OAGB) is lacking. Bile reflux scintigraphy (BRS) has been shown to be a reliable non-invasive tool to assess bile reflux after OAGB. We set out to study bile reflux after OAGB with BRS and endoscopy in a prospective series (RYSA Trial). METHODS: Forty patients (29 women) underwent OAGB between November 2016 and December 2018. Symptoms were reported and upper gastrointestinal endoscopy (UGE) was done preoperatively. Six months after OAGB, bile reflux was assessed in UGE findings and as tracer activity found in gastric tube and esophagus in BRS (follow-up rate 95%). RESULTS: Twenty-six patients (68.4%) had no bile reflux in BRS. Twelve patients (31.6%) had bile reflux in the gastric pouch in BRS and one of them (2.6%) had bile reflux also in the esophagus 6 months postoperatively. Mean bile reflux activity in the gastric pouch was 5.2% (1-21%) of total activity. De novo findings suggestive of bile reflux (esophagitis, stomal ulcer, foveolar inflammation of gastric pouch) were found for 15 patients (39.5%) in postoperative UGE. BRS and UGE findings were significantly associated (P = 0.022). Eight patients experienced de novo reflux symptoms at 6 months, that were significantly associated with BRS and de novo UGE findings postoperatively (P = 0.033 and 0.0005, respectively). CONCLUSION: Postoperative bile reflux in the gastric pouch after OAGB is a common finding in scintigraphy and endoscopy. The long-term effects of bile exposure will be analyzed in future reports after a longer follow-up. TRIAL REGISTRATION: Clinical Trials Identifier NCT02882685.Peer reviewe

Identification of vacancy defects in compound semiconductors by core-electron annihilation: Application to InP

We show that the Doppler broadening of positron annihilation radiation can be used in the identification of vacancy defects in compound semiconductors. Annihilation of trapped positrons with surrounding core electrons reveals chemical information that becomes visible when the experimental backgorund is reduced by the coincidence technique. We also present a simple calculational scheme to predict the high-momentum part of the annihilation line. The utility of the method is demonstrated by providing results for vacancies in InP. In electron irradiated InP the isolated In and P vacancies are distinguished from each other by the magnitude of the core-electron annihilation. In heavily Zn-doped InP we detect a native vacancy defect and identify it to a P vacancy decorated by Zn atoms.Peer reviewe

Interdisciplinary team education promotes innovations in the home care of older people

This article describes a new type of team training that involves undergraduate students of medicine, students from the Aalto University (industrial engineering and management, architecture, information networks, collaborative and industrial design and bioinformation technology) and specialized home care nurses. During the course, the students learned interdisciplinary teamwork and created innovations in the care of older people. The 18 participants formed six microteams (three persons in each team: one specialized nurse, one medical student and one from Aalto University). The course consisted of two seminars and 3 full days of home visits to older people's homes. Participants were encouraged to make one innovation in each home visit that would improve the older person's well-being or streamline the processes of home care. During the course, the participants promptly formed tight teams. They valued the know-how of the other team members and learned openly from each other. They also created a number of practical innovations in home care which they presented to executives of older people's care in a final seminar. The course received very good feedback from the students. This course is an encouraging example of how gerontological interdisciplinary team training may be successfully applied. The article describes both the learning outcomes and the innovations the students produced during their home visits. It also discusses the learning theories behind effective interdisciplinary team learning.Peer reviewe