Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding

AIM:To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass(RYGB)and laparoscopic adjustable gastric band(LAGB).METHODS:Data relating to changes in body mass index(BMI)and procedural complications after RYGB(1995-2009;n=609;116M:493F;42.4±0.4 years)or LAGB(2004-2009;n=686;131M:555F;37.2±0.4years)were extracted from prospective databases.RESULTS:Pre-operative BMI was higher in RYGB than LAGB patients(46.8±7.1 kg/m2vs 40.4±4.2 kg/m2,P<001);more patients with BMI<35 kg/m2underwent LAGB than RYGB(17.1%vs 4.1%,P<0.0001).BMI decrease was greater after RYGB.There were direct relationships between weight loss and pre-operative BMI(P<0.001).Although there was no difference in weight loss between genders during the first 3-year post-surgery,male LAGB patients had greater BMI reduction than females(-8.2±4.3 kg/m2vs-3.9±1.9kg/m2,P=0.02).Peri-operative complications occurred more frequently following RYGB than LAGB(8.0%vs0.5%,P<0.001);majority related to wound infection.LAGB had more long-term complications requiring corrective procedures than RYGB(8.9%vs 2.1%,P<0.001).Conversion to RYGB resulted in greater BMI reduction(-9.5±3.8 kg/m2)compared to removal and replacement of the band(-6.0±3.0 kg/m2).Twelve months post-surgery,fasting glucose,total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB patients.CONCLUSION:RYGB produces substantially greater weight loss than LAGB.Whilst peri-operative complications are greater after RYGB,long-term complication rate is higher following LAGB.

A retrospective comparative series comparing monarc and sparc suburethral slings

A Retrospective Comparative Series Comparing Monarc and Sparc Suburethral Slings. Introduction and Hypothesis: There are a number of suburethral slings used in current practice to treat female urinary incontinence. To date there has been a lack of larger comparative series. This paper aims to evaluate the effectiveness and complications of two types of suburethral sling. Methods: A retrospective comparative series comparing 113 consecutive Sparcsuburethral slings with 112 consecutive Monarc slings. Results: The success rate of SparcvsMonarc was similar at 6 weeks (96.1% vs 94.2%, NS) and at 6 months (96.0% vs 92.6%, NS). The Monarc procedure had less intraoperative bladder fenestrations & less postoperative urgency. Conclusions: Both procedures had a similar success rate, while the Monarc had less complications. Brief Summary: Both procedures had a similar success rate, while the Monarc had less complications of intraoperative bladder fenestration & postoperative urgency.

Correlation of High PIRADS Score on Three-Tesla Magnetic Resonance with In-Gantry Magnetic Resonance Guided Biopsy in Patients with Clinical Risk of Prostate Cancer

Introduction and Objective: Prostate cancer detection is a difficult process despite different modalities that are available. The current standard of practice is based on stratifying risk using Prostate Specific Antigen (PSA), digital rectal examination (DRE) and performing a transrectal ultrasound (TRUS) or transperineal (TP) guided biopsy. Recent advances in three-tesla multiparametric magnetic resonance imaging (MP-MRI) technology and the availability of in-gantry MRI guided biopsies (MRGB) have added another diagnostic tool in management of prostate cancer. We review MRGB performed on high Prostate Imaging Reporting and Data System (PIRADS) score lesions in a single centre retrospective study. Materials and Methods: There were 77 patients (mean age 63) with high PIRADS score (4 and 5) that underwent in-gantry MRGB. All the biopsies were performed utilizing dynacad prostate biopsy system on a three-tesla MRI scanner by an urologist with assistance of an experienced radiologist. Two to three samples were obtained from each lesion using an MRI compatible 18-gauge biopsy needle. Three experienced pathologists evaluated the samples and provided the results and Gleason score in each positive sample. Results: Out of the total 77 high PIRADS patients, 54 were PIRADS score 4 (70%) and 23 PIRADS score 5 (30%). There were 22 positive biopsies for adenocarcinoma of prostate with a Gleason score of 3 + 3 = 6 or higher. Out of the 54 PIRADS score 4 lesions, 13 were positive (24%) and out of 23 PIRADS 5 lesions, 9 were positive (39%). The remaining 55 biopsies were negative for prostate cancer. Conclusion: We present our series of MRGB in patients with a high PIRADS score for prostate cancer. While this diagnostic paradigm was in its infancy stages, MRGB was positive in 24% of PIRADS 4 and 39% of PIRADS 5 lesions in this series.

Novel Anti-Cancer Peptides Comprising Three Amino Acids

Background: The NPxY motif common to all β integrin cytoplasmic domains forms part of a canonical recognition sequence for phosphotyrosine-binding domains which are protein modules present in a wide variety of signaling and cytoskeletal proteins. We have recently reported that a non-naturally occurring peptide, RSKAKNPLYR, derived from the β6 integrin cytoplasmic domain inhibits cancer cell growth in vitro and proposed that this may be due, at least in part, to the inhibition of c-Src activity [1]. In the present study we examined the role of the NPLY motif within RSKAKNPLYR in terms of its requirement for inhibition of cancer cell growth. Materials and Methods: The effects of peptide modifications to RSKAKNPLYR on in vitro proliferation of human cancer cell lines (colorectal HT29, prostate DU145, breast MCF-7 and ovarian A2780) were evaluated using the MTT cell growth assay. Passage of peptide across the plasma membrane was assessed by means of confocal microscopy using FITC-labelled peptide. The effect of peptide on kinase activity was assessed in cell-free in vitro kinase assays. Results: The NPLY motif within RSKAKNPLYR was found to be essential for the growth inhibitory effect of this peptide. However, modified forms of this peptide in which all amino acids except the charged residues arginine and lysine were replaced by single non-polar amino acids such as alanine or valine were equally effective at inhibiting cancer cell proliferation. Moreover, these peptides inhibited not only c-Src activity as seen for RSKAKNPLYR but also the activity of members of the PKB/Akt kinase family. Conclusion: Novel decapeptides comprising only three amino acids have anti-cancer effects without the requirement for an integrin-based NPLY motif. These peptides inhibit the activity of not only c-Src but also members of the Akt family of kinases and may be useful as potential anti-cancer agents when used either alone or in combination with compounds previously reported to inhibit c-Src kinase activity.

Early anticoagulation in patients with stroke and atrial fibrillation is associated with fewer ischaemic lesions at 1 month: the ATTUNE study

Background The optimal time to commence anticoagulation in patients with atrial fibrillation(AF)after ischaemic stroke or transient ischaemic attack(TIA)is unclear,with guidelines differing in recommendations.A limitation of previous studies is the focus on clinically overt stroke,rather than radiologically obvious diffusion-weighted imaging ischaemic lesions.We aimed to quantify silent ischaemic lesions and haemorrhages on MRI at 1month in patients commenced on early(<4days)vs late(≥4days)anticoagulation.We hypothesised that there would be fewer ischaemic lesions and more haemorrhages in the early anticoagulant group at 1-month MRI.Methods A prospective multicentre,observational cohort study was performed at 11 Australian stroke centres.Clinical and MRI data were collected at baseline and follow-up,with blinded imaging assessment performed by two authors.Timing of commencement of anticoagulation was at the discretion of the treating stroke physician.Results We recruited 276 patients of whom 208 met the eligibility criteria.The average age was 74.2 years(SD±10.63),and 79(38%)patients were female.Median National Institute of Health Stroke Scale score was 5(IQR 1–12).Median baseline ischaemic lesion volume was 5mL(IQR 2–17).There were a greater number of new ischaemic lesions on follow-up MRI in patients commenced on anticoagulation≥4days after index event(17%vs 8%,p=0.04),but no difference in haemorrhage rates(22%vs 32%,p=0.10).Baseline ischaemic lesion volume of≤5mL was less likely to have a new haemorrhage at 1month(p=0.02).There was no difference in haemorrhage rates in patients with an initial ischaemic lesion volume of>5mL,regardless of anticoagulation timing.Conclusion Commencing anticoagulation<4days after stroke or TIA is associated with fewer ischaemic lesions at 1month in AF patients.There is no increased rate of haemorrhage with early anticoagulation.These results suggest that early anticoagulation after mild-to-moderate acute ischaemic stroke associated with AF might be safe,but randomised controlled studies are needed to inform clinical practice.WHAT IS ALREADY KNOWN ON THIS TOPIC⇒Early anticoagulation after ischaemic stroke associ-ated with atrial fibrillation(AF)may reduce the rate of recurrent diffusion-weighted imaging ischaemic lesions and increase the rate of new haemorrhage.⇒It is unknown whether early anticoagulation also re-duces the rate of new silent ischaemic lesions.WHAT THIS STUDY ADDS⇒Early anticoagulation(<4days)after ischaemic stroke due to AF reduces the rate of new silent isch-aemic lesions at 1month without increasing the rate of new haemorrhage.HOW THIS STUDY MIGHT AFFECT RESEARCH,PRACTICE OR POLICY⇒Early anticoagulation after mild-to-moderate acute ischaemic stroke due to AF might be safe,howev-er,the results require further validation with ran-domised trials.