Metabolic surgery: Quo Vadis?

The impact of bariatric surgery beyond its effect on weight loss has entailed a change in the way of regarding it. The term metabolic surgery has become more popular to designate those interventions that aim at resolving diseases that have been traditionally considered as of exclusive medical management, such as type 2 diabetes mellitus (T2D). Recommendations for metabolic surgery have been largely addressed and discussed in worldwide meetings, but no definitive consensus has been reached yet. Rates of diabetes remission after metabolic surgery have been one of the most debated hot topics, with heterogeneity being a current concern. This review aims to identify and clarify controversies regarding metabolic surgery, by focusing on a critical analysis of T2D remission rates achieved with different bariatric procedures, and using different criteria for its definition. Indications for metabolic surgery for patients with T2D who are not morbidly obese are also discussed.     

CGRP antagonists and capsaicin on celiac ganglia partly prevent postoperative gastric ileus

The role of capsaicin-sensitive pathways and CGRP in postoperative gastric ileus was investigated. Abdominal surgery was performed under enflurane anesthesia, and 5 min later, the 20-min rate of gastric emptying was measured by the phenol red method in conscious rats. Surgery inhibited gastric emptying by 76–83% compared with rats receiving anesthesia alone. Capsaicin on the celiac/mesenteric ganglia (10–21 days before) reduced gastric ileus by 33 ± 8%, whereas perivagal capsaicin had no effect. The IV CGRP-induced inhibition of gastric emptying was completely reversed by the CGRP antagonist, CGRP(8–37) (30 μg, IV); CGRP(8–37) (15, 30, or 60 μg) or CGRP monoclonal antibody #4901 (2 mg protein) decreased the inhibition of gastric emptying by 11 ± 7%, 51 ± 13%, 47 ± 3%, and 45 ± 17%, respectively. These results indicate that CGRP and splanchnic capsaicin-sensitive afferents are involved in mediating part of the gastric ileus observed immediately after abdominal surgery.     

Microbiological air analysis in dental surgeries: A comparison between two methods

The microbiological quality of indoor air is creating an increasing interest especially as far as places at risk such as hospitals, clinics, medical and odontological surgeries are concerned. Working with the odontologists of our province we have been carrying out a research aimed at preventing cross-infection in odontology. Data obtained from the microbiological analysis of the air in 36 surgeries using S.A.S were discussed during the V National Congress of Aerobiology. During that congress the need of setting a standardized technique of air sampling in indoor environments emerged and two routes have been identified: (1) the gravimetric technique on open plate exposed for an hour close to the dental unit and (2) the use of the volumetric sampler which gives qualitative data expressed as colonies forming units per cubic metre of air. However, both of these techniques present some problems: using the first a loss of micro-organisms has been noticed due to the variability of the air fluxes and the different weight of the biological particles; using the second one the bacterial charge is also undervalued, because of the stress suffered by the bacteria with the use of the volumetric sampler. In the light of these statements we decided to use both in dental surgeries to be able to compare the results obtained. Our project is expected to carry out at least one inspection and the relative sampling (indoor air, water of the dental unit, air of the syringe, disinfectant solution, surface tampons, biological test of sterility) in each dental surgery in the territory of our health Unit, located in Ferrara, Northern Italy.     

An intersegmental reflex between the copulatory swimmerets of the male squat lobster,Galathea strigosa

The structure of the sexually modified 1st 2 pairs of swimmerets of the male squat lobster Galathea strigosa are described, and a reflex involving these swimmerets is characterised. The endopodite of the 1st swimmeret forms a partially rolled lamina which hooks around the “bottle brush” end of the endopodite of the 2nd swimmeret. Mechanical stimulation of a sensitive region on the endopodite of each 1st swimmeret causes retraction of both 2nd swimmerets, inducing the “bottle brush” to push up within the endopodite of the 1st swimmeret. The reflex is thought to be involved in sperm transfer during copulation. Neural information travels between the 1st and 2nd swimmerets in the interganglionic connective ipsilateral to the stimulus.     

Intraoperative Biomechanical Registration of the Liver: Does the Heterogeneity of the Liver Matter?

Background: Preoperative images such as computed tomography scans or magnetic resonance imaging contain lots of valuable information that are not easily available for surgeons during an operation. To help the clinicians better target the structures of interest during an intervention, many registration methods that align preoperative images onto the intraoperative view of the organs have been developed. For important organ deformation, biomechanically-based registration has proven to be a method of choice.Method: Using an existing biomechanically-based registration algorithm for laparoscopic liver surgery we investigate in this paper the influence of the heterogeneity of the liver on the registration result.Results: No statistical difference in the results was found between the registration performed with the homogeneous model and the one carried out with the heterogeneous model.Conclusion: As the use of an heterogeneous model does not improve significantly the registration result and increase the computation time we recommend to perform the type of registration task described in the paper with a simplified homogeneous model.     

Glycocalyx damage biomarkers in healthy controls,abdominal surgery,and sepsis: a scoping review

Abstract

Objective

Despite wide interest in glycocalyx biomarkers, their values in healthy individuals, patients after abdominal surgery, and septic patients have been poorly understood.     

A multiparametric approach to discriminate the impacts of different degrees of invasiveness of surgical procedures in sheep

Traumatic situations in animals induce responses including pain, expressed through behavioural and physiological pathways such as inflammation, oxidative stress, hypothalamic–pituitary–adrenal (HPA) axis and autonomic nervous system. As some of these systems can also be activated during excitement and situations with a positive valence, their use as a means to assess pain response is difficult. We explored (i) how these five aforementioned pathways change in sheep exposed to various degrees of invasiveness of surgical procedures despite a therapeutic regimen and (ii) whether a multiparametric analysis that combines information from these five pathways enhances the discrimination between these situations, and estimates the relative importance of these pathways in the response. We used 24 adult sheep split into four treatments: Control (C; no fasting, no anaesthesia, no surgery), Sham (S; fasting, anaesthesia, no surgery), Rumen Canulation (R; fasting, anaesthesia, rumen cannulation) and Rumen–Duodenal–Ileum cannulation (RDI; fasting, anaesthesia, cannulation of the rumen, duodenum and ileum). Sheep’ responses were measured for 5 days after surgery. When considering each behavioural or physiological pathway independently, discrimination between treatments was acceptable, its sensitivity (Se) ranging from 0% to 100%, and its specificity (Sp) ranging from 62% to 100%. The multiparametric analysis gathering information from the five pathways enhanced the effectiveness of discrimination between treatments (Se, 50% to 100%; Sp, 82% to 100%), and gave additional information on the relative contribution of each pathway to the global sheep response. Sheep global response was higher when exposed to a surgery, and increased with the surgery invasiveness. This response relied mostly on inflammation (absolute correlation for haptoglobin, 0.89), HPA (cortisol, 0.85) and behaviour (antalgic postures, 0.85). The multiparametric approach seems to be a promising tool to discriminate between different degrees of invasiveness of surgical procedures.     

Effects of femoral component placement on the balancing of a total knee at surgery

Misalignment and soft-tissue imbalance in total knee arthroplasty (TKA) can cause discomfort, pain, inadequate motion and instability that may require revision surgery. Balancing can be defined as equal collateral ligament tensions or equal medial and lateral compartmental forces during the flexion range. Our goal was to study the effects on balancing of linear femoral component misplacements (proximal, distal, anterior, posterior); and different component rotations in mechanical alignment compared to kinematic alignment throughout the flexion path. A test rig was constructed such that the position of a standard femoral component could be adjusted to simulate the linear and rotational positions. With the knee in neutral reference values of the collateral tensions were adjusted to give anatomic contact force patterns, measured with an instrumented tibial trial. The deviations in the forces for each femoral component position were then determined. Compartmental forces were significantly influenced by 2 mm linear errors in the femoral component placement. However, the errors were least for a distal error, equivalent to undercutting the distal femur. The largest errors mainly increase the lateral condyle force, occurred for proximal and posterior component errors. There were only small contact force differences between kinematic and mechanical alignment. Based on these results, surgeons should avoid overcutting the distal femur and undercutting the posterior femur. However, the 2–3 degrees varus slope of the joint line as in kinematic alignment did not have much effect on balancing, so mechanical or kinematic alignment were equivalent.