Laparoscopic Sleeve Gastrectomy: Our First 100 Patients

Laparoscopic sleeve gastrectomy appears to be a safe, reproducible method to manage morbidly obese patients

A survey of fertility preservation options available to cancer patients around the globe

Purpose: Oncofertility focuses on providing fertility and endocrine-sparing options to patients who undergo life-preserving but gonadotoxic cancer treatment. The resources needed to meet patient demand often are fragmented along disciplinary lines. We quantify assets and gaps in oncofertility care on a global scale. Methods: Survey-based questionnaires were provided to 191 members of the Oncofertility Consortium Global Partners Network, a National Institutes of Health–funded organization. Responses were analyzed to measure trends and regional subtleties about patient oncofertility experiences and to analyze barriers to care at sites that provide oncofertility services. Results: Sixty-three responses were received (response rate, 25%), and 40 were analyzed from oncofertility centers in 28 countries. Thirty of 40 survey results (75%) showed that formal referral processes and psychological care are provided to patients at the majority of sites. Fourteen of 23 respondents (61%) stated that some fertility preservation services are not offered because of cultural and legal barriers. The growth of oncofertility and its capacity to improve the lives of cancer survivors around the globe relies on concentrated efforts to increase awareness, promote collaboration, share best practices, and advocate for research funding. Conclusion: This survey reveals global and regional successes and challenges and provides insight into what is needed to advance the field and make the discussion of fertility preservation and endocrine health a standard component of the cancer treatment plan. As the field of oncofertility continues to develop around the globe, regular assessment of both international and regional barriers to quality care must continue to guide process improvements

Atrial fibrillation genetic risk differentiates cardioembolic stroke from other stroke subtypes

AbstractObjectiveWe sought to assess whether genetic risk factors for atrial fibrillation can explain cardioembolic stroke risk.MethodsWe evaluated genetic correlations between a prior genetic study of AF and AF in the presence of cardioembolic stroke using genome-wide genotypes from the Stroke Genetics Network (N = 3,190 AF cases, 3,000 cardioembolic stroke cases, and 28,026 referents). We tested whether a previously-validated AF polygenic risk score (PRS) associated with cardioembolic and other stroke subtypes after accounting for AF clinical risk factors.ResultsWe observed strong correlation between previously reported genetic risk for AF, AF in the presence of stroke, and cardioembolic stroke (Pearson’s r=0.77 and 0.76, respectively, across SNPs with p &lt; 4.4 × 10−4 in the prior AF meta-analysis). An AF PRS, adjusted for clinical AF risk factors, was associated with cardioembolic stroke (odds ratio (OR) per standard deviation (sd) = 1.40, p = 1.45×10−48), explaining ∼20% of the heritable component of cardioembolic stroke risk. The AF PRS was also associated with stroke of undetermined cause (OR per sd = 1.07, p = 0.004), but no other primary stroke subtypes (all p &gt; 0.1).ConclusionsGenetic risk for AF is associated with cardioembolic stroke, independent of clinical risk factors. Studies are warranted to determine whether AF genetic risk can serve as a biomarker for strokes caused by AF.</jats:sec

Failed restrictive surgery: is sleeve gastrectomy a good revisional procedure?

The aim of this study is to evaluate the safety and efficacy of converting failed restrictive procedures such as laparoscopic adjustable gastric banding (LAGB), non-adjustable gastric banding (NAGB), and vertical banded gastroplasty (VBG) to laparoscopic sleeve gastrectomy (LSG). A prospective database was maintained of 32 patients who failed restrictive procedures. Twenty-six patients failed LAGB, three patients failed NAGB, one of which was performed open, and three patients failed VBG. These patients were converted to LSG between January 2006 and May 2010. Post-conversion outcomes, BMI, and excess weight loss (EWL) were recorded. Four patients were excluded from the weight loss statistical data secondary to short follow-up (less than 6 months since conversion); however, these patients were included in the overall number of cases and in the discussion of complications. Causes of failed restrictive procedures in our series include inadequate weight loss, 15 (47%); weight gain, six (19%); slippage, five (16%); esophageal dilatation, one (3%); unhappy with device, one (3%); tear of silastic ring, one (3%); infection, one (3%), gastrogastric fistula with VBG and weight gain, one (3%); and intractable nausea and vomiting, one (3%). The average hospital stay was 1.5 days (range, 1-3). The average length of follow-up was 26 months. The mean pre-conversion BMI was 42.69, post-conversion to SG mean BMI was 33.3, mean EWL pre-conversion was 10%, and post-conversion mean EWL was 60%. There was no mortality, no conversion to open, and there was one complication, a contained leak resolved by antibiotic treatment. Conversion to LSG from a prior restrictive procedure may be a feasible and acceptable alternative for patients. Average EWL was 60% at an average of 26 months

A GATA4-regulated secretory program suppresses tumors through recruitment of cytotoxic CD8 T cells

AbstractThe GATA4 transcription factor acts as a master regulator of development of multiple tissues. GATA4 also acts in a distinct capacity to control a stress-inducible pro-inflammatory secretory program that is associated with senescence, a potent tumor suppression mechanism, but also operates in non-senescent contexts such as tumorigenesis. This secretory pathway is composed of chemokines, cytokines, growth factors, and proteases. Since GATA4 is deleted or epigenetically silenced in cancer, here we examine the role of GATA4 in tumorigenesis in mouse models through both loss-of-function and overexpression experiments. We find that GATA4 promotes non-cell autonomous tumor suppression in multiple model systems. Mechanistically, we show that Gata4-dependent tumor suppression requires cytotoxic CD8 T cells and partially requires the secreted chemokine CCL2. Analysis of transcriptome data in human tumors reveals reduced lymphocyte infiltration in GATA4-deficient tumors, consistent with our murine data. Notably, activation of the GATA4-dependent secretory program combined with an anti-PD-1 antibody robustly abrogates tumor growth in vivo.</jats:p

The Cultural Ecohydrogeology of Mediterranean-Climate Springs: A Global Review with Case Studies

Cultures in Mediterranean climate zones (MCZs) around the world have long been reliant on groundwater and springs as freshwater sources. While their ecology and cultural sustainability are recognized as critically important, inter-relationships between springs and culture in MCZs have received less attention. Here we augmented a global literature review with case studies in MCZ cultural landscapes to examine the diversity and intensity of cultural and socio-economic relationships on spring ecohydrogeology. MCZs are often oriented on western and southern coasts in tectonically active landscapes which control aquifer structure, the prevalence of westerly winds, and aridity, and generally expose associated habitats and cultures to harsh afternoon sunlight. Cultural appreciation and appropriation of springs ranges widely, from their use as subsistence water supplies to their roles in profound traditions such as Greco-Roman nymphalea as well as Asian and Abrahamic spiritual cleansing and baptism. The abandonment of traditional ways of life, such as rural livestock production, for urban ones has shifted impacts on aquifers from local to regional groundwater exploitation. The commoditization of water resources for regional agricultural, industrial (e.g., mining, water bottling, geothermal resorts), and urban uses is placing ever-increasing unsustainable demands on aquifers and spring ecosystems. When the regional economic value of springs approaches or exceeds local cultural values, these irreplaceable aquatic ecosystems are often degraded, over-looked, and lost. Sustainable stewardship of springs and the aquifers that support them is a poorly recognized but central conservation challenge for modern Mediterranean societies as they face impending impacts of global climate change. Solutions to this crisis require education, societal dialogue, and improved policy and implementation

The Cultural ecohydrogeology of Mediterranean-climate cprings : a global review with case studies

Cultures in Mediterranean climate zones (MCZs) around the world have long been reliant on groundwater and springs as freshwater sources. While their ecology and cultural sustainability are recognized as critically important, inter-relationships between springs and culture in MCZs has received little attention. Here we augmented a global literature review with case studies in MCZ cultural landscapes to examine the intensity of cultural and socio-economic impacts on springs ecohydrogeology. MCZs are often oriented on the west and southern coasts in tectonically active landscapes, which control aquifer structure, the prevalence of westerly winds, and aridity, and generally expose associated habitats to harsh, afternoon sunlight. Cultural appreciation and appropriation of springs ranges widely, from their use as subsitence supplies to profound traditions, such as Greco-Roman nymphs, and Asian and Abrahamic spiritual cleansing and baptism. Commoditization of water resources for agriculture, industry (e.g., mining, water bottling, geothermal resorts), and urban needs is placing ever-increasing, non-sustainable demands on aquifers and springs. When economic values approach or exceed cultural values, these irreplaceable aquatic resources are degraded and lost. Sustainable stewardship of springs and the aquifers that support them are a little-recognized, but central conservation challenge for modern society facing global climate changes