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Kejser Patton posted an update a month ago
An exploration and summary of the current literature on indocyanine green (ICG) fluorescence in metabolic and bariatric surgery (MBS) is undertaken in this review, alongside an evaluation of its potential for enhancing patient safety.
Employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, the review was composed. During October 2022, independent screening of evidence was performed across PubMed, ScienceDirect, and Ovid MEDLINE databases. The primary data points emphasized the method of fluorescence application, its potential to improve patient well-being, and the rate of any adverse effects that arose. The secondary outcomes included details regarding the dye, the application procedure, and the utilized instruments.
Thirteen publications featured six prospective observational studies, along with five case reports and two retrospective cohort studies, collectively involving 424 patients. Fluorescence application methods were the criteria for the four-group categorization of the publications. Fluorescence was applied in 66 percent of LSG cases, 323 percent in RYGB cases, 12 percent in revisional surgeries, 2 percent in adjustable gastric band removal cases, and 2 percent in LSG combined with Rossetti fundoplication procedures. The majority of the studies employed ICG alone, but in one, it was used in combination with methylene blue. The protocols for the administration of ICG displayed a significant degree of variability. Three patients (0.71%) experienced complications; two exhibited leaks, and one patient needed a blood transfusion.
A prevalent application of this technique is intraoperative blood supply assessment. Utilizing ICG might decrease the risk of complications, with the potential advantages of detecting ischemia and leaks, finding bleeding in areas inaccessible to endoscopy, and evaluating non-invasive liver conditions.
The most used method is intraoperative evaluation of the blood supply’s condition. Potential benefits of employing ICG include a reduced risk of complications, improved capability for detecting ischemia and leaks, facilitating the search for bleeding in regions not accessible by endoscopy, and facilitating non-invasive assessment of hepatopathy.
Under various conditions of exposure, this study assessed how gypsum residue deposition affects the surrounding environment and the radiation exposure levels experienced by plant and animal life. A large gypsum storage facility, situated apart from the main Korean facility (adjacent to a waste stockyard and surrounded by mountains and the sea), was used for the slurry-form storage of phosphogypsum, a byproduct of phosphoric acid processes. For determining the risk associated with radiation’s impact on nonhuman environments in mineral processing and waste storage applications, the ERICA tool was employed. Despite the presence of a phosphogypsum stockyard, the environmental impact of radiation, with a screening dose of less than 10 Gy h-1, remained insignificant. In order to conservatively assess the environmental effect of rainfall and wind on the phosphogypsum stack, the soil at the interface of the stack, where plant growth was impossible, was considered. The calculated dose rate for nearby shrubs was determined to be 45 Gy per hour. The total internal exposure dose in biota, 95-100% of it, was attributed to the influence of the phosphogypsum stockyard on the surrounding environment. Radium, generally, was identified as the primary contributor to biota, with lead and polonium following as secondary contributors to the overall dose. The study’s results provide a deeper understanding of the radiological consequences for the environment and its living organisms (all routes of exposure) resulting from the facility’s stored and disposed waste, guiding the development of sustainable operations and pollution monitoring policies.
Commercial probiotic ingredients incorporating spore-forming Bacillus species are witnessing a surge in popularity. Although Bacillus species probiotics are insufficient, a greater necessity for secure Bacillus species exists. Traditional fermented foods and soil samples were collected from a range of more than ten Chinese provinces for the study, leading to the selection of 506 Bacillus strains from amongst 109 collected samples. The enhanced protocol enabled us to screen nine bacterial cultures, which demonstrated successful resistance to acid, alkali, bile salts, and trypsin. Results of drug sensitivity tests on nine bacterial isolates of Bacillus revealed that three isolates showed antibiotic sensitivity to more than 29 types of antibiotics. Based on the analysis of the 16S ribosomal RNA, recA, and gyrB genes, three antibiotic-sensitive strains were characterized. Two isolates, designated 38327 and 38328, are members of the Lysinibacillus capsici species, and the remaining isolate, 37326, belongs to the Bacillus halotolerans species. The safety of the three strains was established through animal experimentation, in addition. ro-3306 inhibitor L. capsici strains 38327 and 38328 displayed protective effects in a mouse model of Salmonella typhimurium infection, which resulted in reduced weight loss, diminished bacterial load, and enhanced antioxidant function. Our collected data consistently indicated that specific strains of L. capsici possess the potential to be novel probiotics beneficial for intestinal health.
The initial conservative treatment for prolactinomas typically entails the use of dopamine agonists. However, the course of treatment is often a lifelong commitment, and this may result in considerable side effects. Surgical intervention for prolactinoma typically yields positive results with minimal complications, prompting a reconsideration of its earlier application in treatment protocols. The purpose of this study was to analyze post-operative outcomes of prolactinoma removal surgery at our institution, compare it to outcomes in other surgical and non-surgical cases, and discuss surgery’s role in modern prolactinoma therapies. A database of consecutively performed prolactinoma surgeries at a single institution was examined by the authors, who assessed resection extent, endocrine and neurological results, and adverse events. A study involving thirty patients was carried out. Patients’ ages ranged from 16 to 76 years, with a mean age of 372.155 years. This group comprised 17 females (56.7%) and 13 males (43.3%). Twenty-one patients (70%) did not benefit from medical therapy, with 11 (52.4%) experiencing intolerable side effects as the principal cause, and 10 (47.6%) exhibiting an inadequate therapeutic response. Among the nine patients (representing 30% of the sample), no prior medical treatment was administered before surgical intervention. Of these, five (556%) were operated on due to pituitary apoplexy; two (222%) due to acute visual deterioration; and two (222%) elected for surgical intervention as the initial treatment, bypassing medical intervention. Of the 30 surgically removed tumors, 567% (n=17) were microadenomas, 30% (n=9) were macroadenomas (10 mm in diameter), and a proportion of 133% (n=4) were giant adenomas (40 mm in size). In seventy-five percent (21 cases), the target result was achieved. Remarkably, remission was achieved in 633% of the study participants. A residual tumor was detected in seven patients (25%) by MRI, typically exhibiting invasive growth patterns. Postoperative cerebrospinal fluid leaks were absent. A considerable mean follow-up period of 349,603 months was recorded, encompassing a span of 0 to 246 months. Endocrine remission was established when the morning fasting basal PRL level, at the last available follow-up, registered a value less than 223 ng/mL. Postoperative prolactin measurements were unavailable for three patients. A highly selected dataset studied in our analysis exhibits a disproportionate prevalence of substantial, invasive tumors and emergency cases. Despite this, the outcomes are satisfactory and show a degree of similarity to previously published studies. Prolactinomas, especially the microprolactinoma type, have increasingly been treated surgically in recent years, thanks to the consistently positive results achieved through transphenoidal surgical interventions. The surgical timing for each case must be determined by a multidisciplinary team, with the aim of achieving the most favorable outcome possible.
Significant differences in post-bariatric fat-free mass loss (FFML) are frequently seen between individuals, potentially linked to variations in protein consumption and exercise regimens among patients. A six-month follow-up period after banded Roux-en-Y gastric bypass surgery was used to repeatedly assess protein consumption and physical activity, examining its relation to FFML.
In 28 patients (4 male, aged 42-12 years), pre-operative and postoperative (1, 3, and 6 months) assessments included bio-impedance analysis (FFML), protein intake (24-hour dietary recalls), and moderate-to-vigorous physical activity (MVPA) using activPAL. Mixed-model analysis was chosen to study the impact of protein intake and MVPA, while univariate regression was utilized for analyzing correlations with FFML.
In the six-month timeframe, the FFML exhibited a substantial drop, equivalent to -7336 kilograms. Protein consumption, at 8029 grams daily before surgery, decreased sharply to 4526 grams one month after the operation (P<0.0001), and this reduced level of intake, at 5121 grams per day, showed no sign of improvement afterward (P>0.005). At six months post-surgery, 25% of the seven participants consumed 60 grams of protein daily. Participants logged 73,942,420 daily steps through 5420 minutes of moderate-to-vigorous physical activity (MVPA); this remained unchanged from before to after surgery (P>0.005). Participants with a higher step count (B=-0002; 95%CI=; P=0048) and higher MVPA (B=-029; 95%CI=; P=0018) exhibited a lower FFML.
The observed decrease in post-surgery FFML was primarily due to greater MVPA levels, independent of protein intake. The low protein consumption overall, and the observation that a small number of patients were able to achieve a daily protein intake of 60 grams, may account for this.