Completion gastrectomy with esophagojejunostomy for management of complications of benign foregut surgery

Background: With the worldwide epidemic of obesity, an increasing number of bariatric operations and antireflux fundoplications are being performed. Despite low morbidity of the primary foregut surgery, completion gastrectomy may be necessary as a definitive procedure for complications of prior foregut surgery; however, the literature evaluating outcomes after completion gastrectomy with esophagojejunostomy (EJ) for benign diseases is limited. We present our experience of completion gastrectomy with Roux-en-Y EJ in the setting of benign disease at a single tertiary center. Methods and Procedures: All patients who underwent total, proximal, or completion gastrectomy with EJ for complications of benign foregut surgery from January 2006 to December 2015 were retrospectively identified. All cancer operations were excluded. Results: There were 23 patients who underwent gastrectomy with EJ (13 laparoscopic EJ [LEJ] and 10 open EJ). The index operations included 12 antireflux, 9 bariatric, and 2 peptic ulcer disease surgeries. Seventy-eight percent of patients had surgical or endoscopic interventions before EJ, with a median of one prior intervention and a median interval from the index operation to EJ of 25 months (interquartile range 9–87). The 30-day perioperative complication rate was 30% with 17% classified being major (Clavien–Dindo ≥ III) and no 30-day perioperative mortality. Comparing laparoscopic and open approaches showed similar operative times, estimated blood loss, and overall complication rate. LEJ was associated with a shorter length of stay (LOS) (P < .001), fewer postoperative ICU days (P = .002), fewer 6-month complication rates (P < .007), and decreased readmission rate (P = .024). Conclusion: Our series demonstrates that EJ is a reasonable option for reoperative foregut surgery. The laparoscopic approach appears to be associated with decreased LOS and readmissions

Developing SOEPsurvey and SOEPservice: The (Near) Future of the German Socio-Economic Panel Study (SOEP)

Das Sozio-oekonomische Panel (SOEP) ist als multidisziplinäres Haushaltspanel, das Informationen zu allen Personen, die in einem Panel-Haushalt leben, erhebt und damit alle Altersjahrgänge abdeckt, nach 25 Jahren Laufzeit auch zu einer Kohorten- Studie geworden. Der zunehmende Erfolg der Forschungsinfrastruktur-Einrichtung SOEP speist sich in erster Linie daraus, dass die Analysekraft von Längsschnittstudien mit jedem weiteren Erhebungsjahr zunimmt. Hinzu kommen im Falle des SOEP seit Beginn an eine lange Reihe von Innovationen bei der Erhebung, Datenaufbereitung und Nutzer-Service. Deswegen gilt es zu überlegen, wie die wissenschaftliche Power des SOEP weiter gestärkt werden kann. Nicht zuletzt auch, da es für neue, spezialisierte Panel-Studien (wie das Nationale Bildungspanel oder das DFG-geförderte Familienpanel PAIRFAM) eine Referenz und ggf. Verankerung der Hochrechnung darstellt. Zudem kann das SOEP künftig eine größere Rolle als ,,Kontroll-Stichprobe" für Interventions-Studien spielen; etwa im Bereich der Kindheitsentwicklung. Auf diese neuen Rollen muss es vorbereitet sein. Die im SOEP in den letzten Jahren realisierten Erhebungsinnovationen wie z. B. die Inkorporation psychologischer Konzepte, physische Gesundheitsmessungen (Greifkraft), die Messung kognitiver Fähigkeiten und die Erprobung von Verhaltens- Experimenten werden in anderen Panel-Studien aufgegriffen und auf eine größere Stichprobenbasis gestellt. Im UK wird mit ,,Understanding Society" ein Haushaltspanel mit 40.000 Haushalten begonnen; in den Niederlanden wird mit MESS ein Haushaltspanel von über 5.000 Haushalten für innovative Messmethoden zur Verfügung gestellt. Die Erhebungsinhalte des SOEP werden von den Forschungs- und Politikberatungs-Communities unverändert stark nachgefragt. In UK hat ein für ,,Understanding Society" breit angelegter Konsultationsprozess keine grundsätzlich neuen Befragungsinhalte zu Tage gefördert, die das SOEP nicht bereits enthält oder die für das SOEP ohnehin im Gespräch sind. Wichtiger als die ,,Entdeckung" völlig neuer Erhebungsinhalte ist das thematische wie zeitliche ,,Zuschneiden" der Details von Befragungsinhalten auf (zugespitzte) neue (theoretische) Fragestellungen und dabei gleichzeitig bewährte sowie viel genutzte zentrale Befragungsinhalte und deren Befragungsrhythmen beizubehalten. Das ,,Maßschneidern" von Erhebungsinhalten wird in den nächsten Jahren die eigentliche Herausforderung für Infrastruktur- Erhebungen wie die PSID, ,,Understanding Society" und das SOEP sein. Bei den Erhebungsinhalten sollten die ,,Ränder" des Lebenslaufs eine größere Rolle spielen, da diese von Haushalts-Panels besonders gut erfasst werden können. Diese Verbesserungen der Erhebungen beziehen sich einerseits auf die fötale Phase von in das SOEP hineingeborenen Kindern und die (frühe) Kindheit, andererseits auf die letzte Lebensphase und das Sterben. In der Mitte des Lebenslaufs werden verbesserte Fragen zum Einkommen, Sparen und Vermögen sowie auch psychologische Konstrukte eine zentrale Rolle spielen, außerdem gezielte Fragen (event triggered questionnaires) in Verbindung mit zentralen Lebensereignissen wie z. B. Eheschließung, Scheidung, Eintritt in und Austritt aus Arbeitslosigkeit. Es wird die Etablierung einer SOEP-"Innovations-Stichprobe" vorbereitet, um theoriegeleitete Forschungsfragen gezielter unterstützen zu können. Dazu wird es auch notwendig sein, neue Messkonzepte zu erproben (z. B. die Erhebung von Biomarkern, qualitative Erhebungen, aber auch Experimente und gezielte Interventionsstudien). Um die Power von Längsschnittdaten von Anfang an für die Innovations-Stichprobe ausnutzen zu können, ist geplant, zwei kleinere Teilstichproben des SOEP, die seit 1998 bzw. 2006 laufen (Subsamples E und H), in die Innovationsstichprobe zu überführen. Um die statistische Power langlaufender Längsschnittdaten entscheidend zu verbessern, schätzen wir eine Mindestfallzahl von etwa 500 Personen pro Geburtsund Alterskohorte für ausreichend ein. Um dieses Ziel zu erreichen, muss die Fallzahl des SOEP-Standard-Samples erhöht werden. Als ,,Nebeneffekt" werden dadurch wesentlich bessere Analysen für relativ kleine Gruppen in der Bevölkerung möglich; etwa für allein Erziehende oder bestimme Immigrantengruppen. Außerdem verbessern sich als weiterer ,,Nebeneffekt" auch regionale Analysemöglichkeiten, z. B. für die meisten Bundesländer und in großen Bundesländern bis hin zu Regierungsbezirken (oder ähnlich abgegrenzten regionalen Einheiten). In letzter Zeit wird immer deutlicher, welche große Bedeutung das SOEP als ,,Referenz-Datensatz" für spezialisierte und vom SOEP völlig unabhängige Erhebungen hat (neben Beobachtungsstudien, wie etwa Zwillings-Studien, auch Labor- und Interventions-Studien). Zur Unterstützung dieser Funktion ist eine neue Art von Service, der in Deutschland bislang nicht vorgehalten wird, notwendig (Beratung von Spezial-Erhebungen; ggf. Datenaufbereitung von längsschnittlichen Spezial-Erhebungen), der auch in ein Datenservicezentrum eingebracht werden könnte. After 25 years as a multidisciplinary household panel containing information on all individuals residing in panel households and thus covering all age cohorts, the German Socio-Economic Panel (SOEP) has become a true cohort study as well. The increasing success of the SOEP research infrastructure comes above all from the increasing analytical power that longitudinal studies attain with each successive survey year. In the case of SOEP, a long series of innovations in surveying, data preparation, and user service have also played a major role. For this reason, it is important to consider how the scientific capacity of SOEP can be further enhanced-- not least of all since the SOEP can form a key point of reference (or "anchor") for new, specialized panel studies (such as the National Educational Panel and the family panel PAIRFAM, funded by the German Research Foundation). Furthermore SOEP can become a kind of "control sample" for intervention studies, for example, in the field of child development. The SOEP survey and its governance structures must be prepared for these new tasks. The numerous innovations introduced into SOEP in recent years--questions dealing with psychological concepts, physical health measures (grip strength), measures of cognitive capabilities, and behavioral experiments--have been incorporated into other panel studies as well, and thus provided with a larger sample base. In the UK, the "Understanding Society" household panel study was launched with 40,000 households; in the Netherlands, the MESS household panel study of over 5,000 households offered a new basis for testing innovative measurement methods. The results of the SOEP survey are in continuing high demand in the research and policy advisory community. From our point of view, the large-scale consultation process conducted to define the content of the UK survey "Understanding Society" failed to identify any fundamentally new survey content that the SOEP either did not already contain or that was not already being discussed for the SOEP. More important than "discovering" entirely new survey areas is "tailoring" the details of existing survey content to address new, more specific (theoretical) questions, and thus maintaining proven and widely used elements of survey content. The "tailoring" of survey content will be the real challenge facing infrastructure surveys like PSID, "Understanding Society," and the SOEP in the coming years. In the future, the "margins" of the life course should play a stronger role in survey content, since household panels are able to provide outstanding data of these life phases. The SOEP, and other household panel surveys, can be improved, on the one hand, by including the fetal phase of life and early childhood for children born into the panel, and on the other, by including late life and death. In the middle of the life course, improved questions on income, savings, and wealth as well as psychological constructs will play a central role, as will specific questions (in "eventtriggered" questionnaires) on central life occurrences such as marriage, divorce, and entry into and exit from unemployment. Current plans for SOEP foresee the addition of an "Innovation Sample" that will make it possible to better address theory-based research questions required for testing new measurement concepts (e.g., the surveying of biomarkers, qualitative surveys, but also experiments and targeted intervention studies). In order to exploit the power of longitudinal data from the outset, we plan to incorporate two smaller SOEP subsamples that have been running since 1998 and 2006 (Subsamples E and H, respectively) into the Innovation Sample. In order to decisively improve the statistical power of long-term longitudinal data, we believe that a minimum case number of about 500 persons per birth and age cohort is required. In order to reach this goal, the case number in the SOEP standard samples needs to be increased. A positive side-effect of this enlargement would be a significantly improved potential for analyses of relatively small groups within the population: for example, lone parents or specific immigrant groups. Another positive side-effect would be an improved potential for regional analyses: for example, for the majority of federal states. In recent times, the importance of SOEP as a "reference dataset" for specialized surveys which are independent from SOEP (observational studies such as twin studies, and laboratory and intervention studies) has become strikingly evident. To enhance this important function, new types of service are needed (advice on special surveys, possibly also data preparation for special surveys), which could become part of a Data Service Center.Household Panels, German Socio-Economic Panel Study, SOEP

Slow and fast single photons from a quantum dot interacting with the excited state hyperfine structure of the Cesium D1-line

Hybrid interfaces between distinct quantum systems play a major role in the implementation of quantum networks. Quantum states have to be stored in memories to synchronize the photon arrival times for entanglement swapping by projective measurements in quantum repeaters or for entanglement purification. Here, we analyze the distortion of a single-photon wave packet propagating through a dispersive and absorptive medium with high spectral resolution. Single photons are generated from a single In(Ga)As quantum dot with its excitonic transition precisely set relative to the Cesium D1 transition. The delay of spectral components of the single-photon wave packet with almost Fourier-limited width is investigated in detail with a 200 MHz narrow-band monolithic Fabry-Pérot resonator. Reflecting the excited state hyperfine structure of Cesium, “slow light” and “fast light” behavior is observed. As a step towards room-temperature alkali vapor memories, quantum dot photons are delayed for 5 ns by strong dispersion between the two 1.17 GHz hyperfine-split excited state transitions. Based on optical pumping on the hyperfine-split ground states, we propose a simple, all-optically controllable delay for synchronization of heralded narrow-band photons in a quantum network

Interviewer BMI effects on under- and over-reporting of restrained eating: evidence from a national Dutch face-to-face survey and a postal follow-up

Contains fulltext : 102650pub.pdf (publisher's version ) (Open Access)Objectives To determine the effect of interviewer BMI on self-reported restrained eating in a face-to-face survey and to examine under- and over-reporting using the face-to face study and a postal follow-up. Methods A sample of 1,212 Dutch adults was assigned to 98 interviewers with different BMI who administered an eating questionnaire. To further evaluate misreporting a mail follow-up was conducted among 504 participants. Data were analyzed using two-level hierarchical models. Results Interviewer BMI had a positive effect on restrained eating. Normal weight and pre-obese interviewers obtained valid responses, underweight interviewers stimulated underreporting whereas obese interviewers triggered overreporting. Conclusion In face-to-face interviews self-reported dietary restraint is distorted by interviewer BMI. This result has implications for public health surveys, the more so given the expanding obesity epidemic.5 p

Comparative outcomes of bariatric surgery in patients with impaired mobility and ambulatory population

Purpose: This study aims to characterize complications, metabolic improvement, and change in ambulation status for patients with impaired mobility undergoing bariatric surgery. Material and methods: Individuals undergoing primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from February 2008 to December 2015 were included. Impaired mobility (WC) was defined as using a wheelchair or motorized scooter for at least part of a typical day. The WC group was propensity score matched to ambulatory patients (1:5 ratio). Comparisons were made for 30-day morbidity and mortality and 1-year improvement in weight-related comorbidities. Results: There were 93 patients in the WC group matched to 465 ambulatory controls. The median operative time (180 vs 159 min, p = 0.003) and postoperative length of stay (4 vs 3 days, p ≤ 0.001) was higher in the WC group. There were no differences in readmission or all-cause morbidity within 30 days. The median percent excess weight loss (%EWL) at 1 year was similar (WC group, 65% available, 53% EWL vs AMB group, 73% available, 54% EWL); however, patients with impaired mobility were less likely to experience improvement in diabetes (76 vs 90%, p = 0.046), hypertension (63 vs 82%, p < 0.005), and obstructive sleep apnea (53 vs 71%, p < 0.001). Within the WC group, 62% had improvement in their mobility status, eliminating dependence on wheelchair or scooter assistance. Conclusion: Patients with both obesity and impaired mobility experience similar rates of perioperative morbidity and weight loss at 1 year compared to ambulatory controls. However, improvement in weight-related comorbidities may be less likely with impaired mobility

The World Register of Marine Species (WoRMS) through the looking glass: insights from the data management team in light of the crystal anniversary of WoRMS

The World Register of Marine Species (WoRMS) started in 2007 with the question “how many species live in our oceans?”. Now, a little over 15 years later, WoRMS is able to answer several questions related to marine species discovery rates and provides a dynamic number of existing marine species, based on the information provided by hundreds of taxonomic experts worldwide, who have proven to be diverse and dynamic. We present basic statistics on marine species discovery rates based on the currently available content of WoRMS, as well as insights in the day-to-day activities and dynamics of our editorial board and the progress made so far on the content priorities as defined by the WoRMS Steering Committee. As for all dynamic systems, WoRMS is not complete and faces challenges. As an endorsed project of the UN Ocean Decade, WoRMS aims to tackle a number of these challenges and knowledge-gaps by 2030, including detailed documentation of authorships and original descriptions, and will provide continuous support to all marine initiatives, programs and projects that rely on WoRMS as an authoritative classification and catalogue of marine names

Down-regulation of the myo-inositol oxygenase gene family has no effect on cell wall composition in Arabidopsis

The enzyme myo-inositol oxygenase (MIOX; E.C. 1.13.99.1) catalyzes the ring-opening four-electron oxidation of myo-inositol into glucuronic acid, which is subsequently activated to UDP-glucuronic acid (UDP-GlcA) and serves as a precursor for plant cell wall polysaccharides. Starting from single T-DNA insertion lines in different MIOX-genes a quadruple knockdown (miox1/2/4/5-mutant) was obtained by crossing, which exhibits greater than 90% down-regulation of all four functional MIOX genes. Miox1/2/4/5-mutant shows no visible phenotype and produces viable pollen. The alternative pathway to UDP-glucuronic acid via UDP-glucose is upregulated in the miox1/2/4/5-mutant as a compensatory mechanism. Miox1/2/4/5-mutant is impaired in the utilization of myo-inositol for seedling growth. The incorporation of myo-inositol derived sugars into cell walls is strongly (>90%) inhibited. Instead, myo-inositol and metabolites produced from myo-inositol such as galactinol accumulate in the miox1/2/4/5-mutant. The increase in galactinol and raffinose family oligosaccharides does not enhance stress tolerance. The ascorbic acid levels are the same in mutant and wild type plants

Cooperative Regulation of the Activity of Factor Xa within Prothrombinase by Discrete Amino Acid Regions from Factor Va Heavy Chain†

ABSTRACT: The prothrombinase complex catalyzes the activation of prothrombin to R-thrombin. We have repetitively shown that amino acid region 695DYDY698 from the COOH terminus of the heavy chain of factor Va regulates the rate of cleavage of prothrombin at Arg271 by prothrombinase. We have also recently demonstrated that amino acid region 334DY335 is required for the optimal activity of prothrombinase. To assess the effect of these six amino acid residues on cofactor activity, we created recombinant factor Va molecules combining mutations at amino acid regions 334–335 an