Parietal cell distribution informs gastric bypass procedure

INTRODUCTION: Roux-en-Y Gastric Bypass (RYGB) is a common bariatric procedure that facilitates weight loss and reduces co-morbidities of obesity. A common complication is marginal ulceration, caused by an overproduction of hydrochloric acid from the gastric pouch, and acid insult to the unprotected jejunal mucosa. The exact distribution of parietal cells in the stomach is not agreed upon. We hypothesize that there are regions of low density of parietal cells, and that these areas can allude to the optimal dimensions of the gastric pouch to reduce acid production. METHODS: Seventeen cadaveric subjects were used in this study. A standardized schematic based on anatomical landmarks was created to examine nine operationally defined stomach segments of the cardiac and fundic stomach. Punch biopsies from the center of each of the stomach segments were collected and subsequently analyzed using immunohistochemistry. Sections were stained with Hydrogen Potassium ATPase Beta monoclonal antibody. Computational analysis was used to calculate the number of parietal nuclei per ROI area (?m2). Chi-Square Goodness of Fit analysis was performed to determine if there is a difference in parietal cell density between segments. RESULTS: Amongst all different stomach segments, the number of parietal nuclei per ROI area (?m2) is significantly different across all sections from the expected value of all sections being equal X2(8)=21.82, p=0.005. Trends in the data illustrated that the distal lesser curvature contains a high concentration of parietal cells. CONCLUSION: The analysis demonstrates that there is a difference in parietal cell density between various stomach segments, with some segments illustrating lower parietal cell density. These findings inform our recommendation of a horizontal gastric pouch, to include the proximal cardia and fundus adjacent to the gastroesophageal junction, in order to minimize the density of parietal cells in the gastric pouch and reduce the incidence of marginal ulceration following RYGB

Temporal evolution of living donor liver transplantation survival - A UNOS registry study.

Living donor liver transplantation (LDLT) is a curative treatment for various liver diseases, reducing waitlist times and associated mortality. We aimed to assess the overall survival (OS), identify predictors for mortality, and analyze differences in risk factors over time. Adult patients undergoing LDLT were selected from the United Network for Organ Sharing database from inception (1987) to 2023. The Kaplan-Meier method was used for analysis, and multivariable Cox proportional hazard models were conducted. 7,257 LDLT recipients with a median age of 54years (IQR:45,61), 54% male, 80% non-Hispanic White, BMI 26.3kg/m2 (IQR:23.2,30.0), and MELD 15 (IQR:11,19) were included. The median cold ischemic time was 1.6hours (IQR:1.0,2.3) with 88% right-lobe-grafts. The follow-up was 4.0years (IQR:1.0,9.2). The contemporary reached median overall survival was 17.0years (95%CI:16.1,18.1) with OS estimates: 1-year 95%, 3-years 89%, 5-years OS 84%, 10-years 72%, 15-years 56% and 20-years 43%. Nine independent factors associated with mortality were identified, with an independent improved OS in the recent time era (aHR 0.53; 95%CI:0.39,0.71). The median center-caseload per year was 5 (IQR:2,10) with observed center-specific improvement of OS. LDLT is a safe procedure with excellent OS. Its efficacy has improved despite an increase of risk parameters, suggesting its limits are yet to be met

Moving Forward After COVID‑19: New Directions for Teaching and Course Design in Higher Education

This study identifies course design practices and evaluation strategies that promote high-quality, equitable, and inclusive education in hybrid or online modalities, and that consider student well-being and mental health, for the post-pandemic era. Our data set consisted of an integrative literature review, interviews with instructors, and focus groups with teaching and learning centre representatives from five countries: Canada, the United States, the United Kingdom, France, and Lebanon. The study informs instructors’ professional development, recommends concrete course design elements that promote equitable education, and shares innovative pedagogical practices for digital contexts.Cette étude détermine les pratiques de conception de cours et les stratégies d’évaluation qui favorisent une éducation de haute qualité, équitable et inclusive dans des modalités hybrides ou en ligne, tout en considérant le bien-être et la santé mentale des groupes étudiants pour la période postmandémique. Nos données se composent d’une analyse documentaire, d’entretiens avec des groupes enseignants et de groupes de discussion avec des représentants des services de soutien à l’enseignement et à l’apprentissage de cinq pays, le Canada, les États-Unis, le Royaume-Uni, la France et le Liban. L’étude informe le développement professionnel du corps professoral, recommande des éléments concrets de conception de cours promouvant une éducation équitable et partage des pratiques pédagogiques innovantes pour les contextes numériques

Living Donor Availability Improves Patient Survival in a North American Center: An Intention-to-treat Analysis.

OBJECTIVE Assess the impact of having a living donor on waitlist outcomes and overall survival through an intention-to-treat analysis. BACKGROUND Living-donor liver transplantation (LDLT) offers an alternative to deceased donation in the face of organ shortage. An as-treated analysis revealed that undergoing LDLT, compared to staying on the waiting list, is associated with improved survival, even at Model for End-stage Liver Disease-sodium (MELD-Na) score of 11. METHODS Liver transplant candidates listed at the Ajmera Transplant Centre (2000-2021) were categorized as pLDLT (having a potential living donor) or pDDLT (without a living donor). Employing Cox proportional-hazard regression with time-dependent covariates, we evaluated pLDLT's impact on waitlist dropout and overall survival through a risk-adjusted analysis. RESULTS Of 4,124 candidates, 984 (24%) had potential living donors. The pLDLT group experienced significantly lower overall waitlist dropouts (5.2%vs. 34.4%, P<0.001) and mortality (3.8%vs. 24.4%, P<0.001) compared to the pDDLT group. Possessing a living donor correlated with a 26% decline in the risk of waitlist dropout (adjusted hazard ratio 0.74, 95%CI 0.55-0.99, P=0.042). The pLDLT group also demonstrated superior survival outcomes at 1- (84.9%vs. 80.1%), 5- (77.6%vs. 61.7%), and 10-year (65.6%vs.52.9%) from listing (log-rank P<0.001) with a 35% reduced risk of death (adjusted hazard ratio 0.65, 95%CI 0.56-0.76, P<0.001). Moreover, the predicted hazard ratios consistently remained below 1 across the MELD-Na range 11-26. CONCLUSIONS Having a potential living donor significantly improves survival in end-stage liver disease patients, even with MELD-Na scores as low as 11. This emphasizes the need to promote awareness and adoption of LDLT in liver transplant programs worldwide