Standardization of the Fully Stapled Laparoscopic Roux-en-Y Gastric Bypass for Obesity Reduces Early Immediate Postoperative Morbidity and Mortality: A Single Center Study on 2606 Patients

Various techniques of laparoscopic Roux-en-Y gastric bypass have been described. We completely standardized this procedure to minimize its sometimes substantial morbidity and mortality. This study describes our experience with the standardized fully stapled laparoscopic Roux-en-Y gastric bypass (FS-LRYGB) and its influence on the 30-day morbidity and mortality.status: publishe

TLR1/2 Activation during Heterologous Prime-Boost Vaccination (DNA-MVA) Enhances CD8+ T Cell Responses Providing Protection against Leishmania (Viannia)

Leishmania (Viannia) are the predominant agents of leishmaniasis in Latin America. Given the fact that leishmaniasis is a zoonosis, eradication is unlikely; a vaccine could provide effective prevention of disease. However, these parasites present a challenge and we do not fully understand what elements of the host immune defense prevent disease. We examined the ability of vaccination to protect against L. (Viannia) infection using the highly immunogenic heterologous prime-boost (DNA-modified vaccinia virus) modality and a single Leishmania antigen (TRYP). Although this mode of vaccination can induce protection against other leishmaniases (cutaneous, visceral), no protection was observed against L. (V.) panamensis. However, we found that if the vaccination was modified and the innate immune response was activated through Toll-like receptor1/2(TLR1/2) during the DNA priming, vaccinated mice were protected. Protection was dependent on CD8 T cells. Vaccinated mice had higher CD8 T cell responses and decreased levels of cytokines known to promote infection. Given the long-term persistence of CD8 T cell memory, these findings are encouraging for vaccine development. Further, these results suggest that modulation of TLR1/2 signaling could improve the efficacy of DNA-based vaccines, especially where CD8 T cell activation is critical, thereby contributing to effective and affordable anti parasitic vaccines

End-result of routine ultrasound screening for congenital anomaties : the Belgian Multicentric Study 1984-92

Five ultrasound laboratories from Obstetrics and Gynecology departments of Belgian university hospitals or affiliated institutions conducted a prospective study from 1984 to 1992 in which the results of prenatal ultrasound examinations were compared to examination reports of the neonates. The results of the period 1984-89 (PI) have been published previously, and those of the period 1990-92 (PII) ave presented here. Some very minor congenital anomalies, as listed and defined in the EUROCAT Register, were excluded Of 26 147 pregnant women at normal risk for congenital anomalies, 25 046 had at least one ultrasound scan (96%). A total of 616 fetuses were structurally abnormal (prevalence 2.42%), and 685 abnormalities were recorded The sensitivity of the ultrasound test was 40.4% in PI and 51.1% in Pll for abnormal fetuses (p < 0.05), and 45% (PI) and 64% (PII) for abnormalities (p < 0.01). The specificity was 99.9% and the positive and negative predictive values were 94.2% and 98.6% respectively; these values did not differ significantly between the two periods. The sensitivity for the detection of anomalies before 23 weeks increased from 21% in PI to 41% in PII, indicating an improvement in the early detection of fetal abnormalities

Sensitivity and specificity of routine antenatal screening for congenital anomalies by ultrasound : the Belgian multicentric trial

United States and European consensus views differ on the place of routine ultrasound scans during pregnancy and the validity of such scans as screening tests for fetal malformations in the general population is still under debate. Four ultrasound laboratories from Obstetric and Gynecology departments of Belgian University hospitals and affiliated hospitals have conducted a prospective study from 1984 to 1989 to compare the anomalies discovered in ultrasonic screening of the fetus with the anomalies of the neonates. Of 16 370 pregnant women at normal risk for congenital anomalies attending the antenatal clinics of these hospitals, 16 072 have had at least one ultrasound screening for congenital anomalies (98.5%). Congenital anomalies, single or multiple and 'minor' or 'major', were clearly defined in order to allow comparisons. The excluded congenital anomalies were listed as defined in the Eurocat Register. A total of 381 fetuses (2.3%) were structurally abnormal. Of the 381, 154 were correctly detected by ultrasound (sensitivity 40.4%). Altogether 15 972 fetuses were true negatives (specificity 99.9%). Eight (0.05%) were false positive for congenital anomalies. The positive predictive value was 95.1% and the negative predictive value was 98.6%. Ultrasound diagnoses were correctly achieved before 23 weeks of gestation for 21% of the anomalies. The gestational age, operator and technical dependence of ultrasound screening for congenital anomalies is discussed

A 3D-CT scan study of the humeral and glenoid planes in 150 normal shoulders

The purpose of the study was to determine the normal three-dimensional relationship between the humeral and the glenoid plane of the individual patient. We measured the three-dimensional angle between the glenoid plane and the humeral plane (glenohumeral angle, A degrees GH) and the angle between the plane of the scapula and the plane of the glenoid (glenoscapular angle, A degrees GS) with the patient in a standardized position to the CT scan gantry. We hypothesized that a normal distribution with a small variation would exist for both angles. A total of 150 conventional CT scans of normal shoulders from patients aged between 18 and 80 years were examined and three-dimensional reconstructions were derived from it. The descriptive statistics and the variability of A degrees GH and A degrees GS were determined. The mean A degrees GH was 57.9A degrees, and the mean A degrees GS was -3.77A degrees. The overall reliability of the measurement was good. Descriptive statistics of this study confirm the normal distribution and a narrow variation of both parameters. This is the first study to determine the normal 3D relationship between the humerus and the glenoid (A degrees GH). This new three-dimensional anatomical information of the normal glenohumeral relationship and glenoid can be used to distinguish normal from pathological anatomy, as well as alternative surgical guidance especially in bony deficient glenoids

Current status of multiple antigen-presenting peptide vaccine systems: Application of organic and inorganic nanoparticles

<p>Abstract</p> <p>Many studies are currently investigating the development of safe and effective vaccines to prevent various infectious diseases. Multiple antigen-presenting peptide vaccine systems have been developed to avoid the adverse effects associated with conventional vaccines (<it>i.e</it>., live-attenuated, killed or inactivated pathogens), carrier proteins and cytotoxic adjuvants. Recently, two main approaches have been used to develop multiple antigen-presenting peptide vaccine systems: (1) the addition of functional components, <it>e.g</it>., T-cell epitopes, cell-penetrating peptides, and lipophilic moieties; and (2) synthetic approaches using size-defined nanomaterials, <it>e.g</it>., self-assembling peptides, non-peptidic dendrimers, and gold nanoparticles, as antigen-displaying platforms. This review summarizes the recent experimental studies directed to the development of multiple antigen-presenting peptide vaccine systems.</p