Targeting the translationally controlled tumor protein by a monoclonal antibody improves allergic airway inflammation in mice.

Secretion of translationally controlled tumor protein (TCTP) was found in body fluids during the late phase of allergic reactions, implicating TCTP in allergic diseases. Furthermore, blocking TCTP has been shown to be helpful in treating asthma and allergies in animal models. The objectives of this study were to produce anti-TCTP monoclonal antibodies (mAbs), test their ability to inhibit the cytokine-like function of dimeric TCTP (dTCTP) in vitro and to assess their therapeutic effects in a murine model of ovalbumin (OVA)-induced airway inflammation. We first verified the inhibitory effects of 4 anti-TCTP mAbs on dTCTP-induced secretion of IL-8 in BEAS-2B cells. To investigate the anti-inflammatory effect of anti-TCTP mAbs on allergic airway inflammation, we treated OVA-sensitized mice with anti-TCTP mAbs before OVA challenge. The changes in bronchoalveolar lavage fluid (BALF) cells, IL-4, IL-5, and IL-13 levels in both BALF and lung homogenates, plasma levels of OVA-specific IgE, and lung tissues were analyzed. We found that JEW-M449 anti-TCTP mAb bound to the flexible loop of TCTP and significantly inhibited dTCTP-induced IL-8 release, making it the most effective inhibitor in our study. We also found that treatment with JEW-M449 significantly reduced the infiltration of inflammatory cells and suppressed the OVA-induced upregulation of type 2 cytokines in both BALF and lung homogenates in a dose-dependent manner. In addition, JEW-M449 significantly attenuated the degree of goblet cell hyperplasia and mucus secretion. Our results demonstrate that specific targeting of the flexible loop of TCTP is a potent strategy for treating airway inflammatory diseases.

Living Suzuki-Miyaura Catalyst-Transfer Polymerization for Precision Synthesis of Length-Controlled Armchair Graphene Nanoribbons and Their Block Copolymers.

The bottom-up synthesis of graphene nanoribbons (GNRs) offers a promising approach for designing atomically precise GNRs with tuneable photophysical properties, but controlling their length remains a challenge. Herein, we report an efficient synthetic protocol for producing length-controlled armchair GNRs (AGNRs) through living Suzuki-Miyaura catalyst-transfer polymerization (SCTP) using RuPhos-Pd catalyst and mild graphitization methods. Initially, SCTP of a dialkynylphenylene monomer was optimized by modifying boronates and halide moieties on the monomers, affording poly(2,5-dialkynyl-p-phenylene) (PDAPP) with controlled molecular weight (Mn up to 29.8k) and narrow dispersity (D = 1.14-1.39) in excellent yield (>85%). Subsequently, we successfully obtained N = 5 AGNRs by employing a mild alkyne benzannulation reaction on the PDAPP precursor and confirmed their length retention by size-exclusion chromatography. In addition, photophysical characterization revealed that a molar absorptivity was directly proportional to the length of the AGNR, while its highest occupied molecular orbital (HOMO) energy level remained constant within the given AGNR length. Furthermore, we prepared, for the very first time, N = 5 AGNR block copolymers with widely used donor or acceptor-conjugated polymers by taking advantage of the living SCTP. Finally, we achieved the lateral extension of AGNRs from N = 5 to 11 by oxidative cyclodehydrogenation in solution and confirmed their chemical structure and low band gap by various spectroscopic analyses.

Transferability of Alzheimer Disease Polygenic Risk Score Across Populations and Its Association With Alzheimer Disease-Related Phenotypes.

Importance: Polygenic risk scores (PRSs), which aggregate the genetic effects of single-nucleotide variants identified in genome-wide association studies (GWASs), can help distinguish individuals at a high genetic risk for Alzheimer disease (AD). However, genetic studies have predominantly focused on populations of European ancestry. Objective: To evaluate the transferability of a PRS for AD in the Korean population using summary statistics from a prior GWAS of European populations. Design, Setting, and Participants: This cohort study developed a PRS based on the summary statistics of a large-scale GWAS of a European population (the International Genomics of Alzheimer Project; 21 982 AD cases and 41 944 controls). This PRS was tested for an association with AD dementia and its related phenotypes in 1634 Korean individuals, who were recruited from 2013 to 2019. The association of a PRS based on a GWAS of a Japanese population (the National Center for Geriatrics and Gerontology; 3962 AD cases and 4074 controls) and a transancestry meta-analysis of European and Japanese GWASs was also evaluated. Data were analyzed from December 2020 to June 2021. Main Outcomes and Measures: Risk of AD dementia, amnestic mild cognitive impairment (aMCI), earlier symptom onset, and amyloid ß deposition (Aß). Results: A total of 1634 Korean patients (969 women [59.3%]), including 716 individuals (43.6%) with AD dementia, 222 (13.6%) with aMCI, and 699 (42.8%) cognitively unimpaired controls, were analyzed in this study. The mean (SD) age of the participants was 71.6 (9.0) years. Higher PRS was associated with a higher risk of AD dementia independent of APOE ɛ4 status in the Korean population (OR, 1.95; 95% CI, 1.40-2.72; P < .001). Furthermore, PRS was associated with aMCI, earlier symptom onset, and Aß deposition independent of APOE ɛ4 status. The PRS based on a transancestry meta-analysis of data sets comprising 2 distinct ancestries showed a slightly improved accuracy. Conclusions and Relevance: In this cohort study, a PRS derived from a European GWAS identified individuals at a high risk for AD dementia in the Korean population. These findings emphasize the transancestry transferability and clinical value of PRSs and suggest the importance of enriching diversity in genetic studies of AD.

Precision Synthesis of Various Low-Bandgap Donor-Acceptor Alternating Conjugated Polymers via Living Suzuki-Miyaura Catalyst-Transfer Polymerization.

Herein, we demonstrate that living Suzuki-Miyaura catalyst-transfer polymerization (SCTP) using a RuPhos Pd G3 precatalyst is a versatile method for the precision synthesis of various donor-acceptor alternating conjugated polymers (DA ACPs). First, the living SCTP of biaryl monomers with combinations of both medium to strong A and D were optimized to produce DA ACPs with controlled number average molecular weight (Mn ), narrow dispersity (Ð, 1.05-1.29), and high yield (>87 %). Moreover, its expansion to controlled polymerization (Mn =9.2-40.0 kg mol-1 ) of an A1 -D-A2 -D quateraryl monomer containing diketopyrrolopyrrole (DPP; strong A) was successful. The living SCTP also enabled the efficient one-pot synthesis of various diblock and triblock copolymers. Lastly, the DA ACPs showed tunable optical band gap (Eg opt , from 1.29 to 1.77 eV) and highest occupied molecular orbital (HOMO) level (from -5.57 to -4.75 eV), while their block copolymers exhibited broad absorption ranges and promising visible light-harvesting properties.

Pulsed Electrical Stimulation Enhances Consistency of Directional Migration of Adipose-Derived Stem Cells.

Electrical stimulation is a well-known strategy for regulating cell behavior, both in pathological and physiological processes such as wound healing, tissue regeneration, and embryonic development. Electrotaxis is the directional migration of cells toward the cathode or anode when subjected to electrical stimulation. In this study, we investigated the conditions for enhanced directional migration of electrically stimulated adipose-derived stem cells (ADSCs) during prolonged culture, using a customized agar-salt electrotaxis chamber. Exposure of ADSCs to a 1200 µA electric current for 3 h, followed by cessation of stimulation for 6 h and resumed stimulation for a further 3 h, increased directional cell migration toward the anode without inducing cell death. Moreover, Golgi polarization maintained the direction of polarity parallel to the direction of cell movement. Herein, we demonstrated that a pulsed electric current is sufficient to trigger directional migration of ADSCs in long-term culture while maintaining cell viability.

Induction of DEAD Box helicase 5 in early adipogenesis is regulated by Ten-eleven translocation 2.

Dead box helicase 5 (DDX5) is an RNA helicase that is has cellular function on RNA splicing and transcriptional regulation. It has been reported to be involved in cell differentiation including adipogenesis. However, it is not clear how DDX5 is regulated during adipogenesis. Our previous report demonstrated that the Ten-eleven translocation methyl-cytosine dioxygenase 2 (TET2) is required for adipogenesis. This study was aimed to investigate DDX5 as a direct target of TET2 upon adipogenic induction of 3T3-L1 preadipocyte. Microarray-based screening of differentially expressed genes upon TET2 knockdown identified genes involved in cell cycle, DNA replication, and ribosome biology as major targets of TET2 in the initial step of adipogenic induction. The Ddx5 gene was identified and validated as the target. TET2-mediated epigenetic regulation of the Ddx5 gene was measured by two independent methods including immunoprecipitation against 5-hydroxymethylcytosine (5hmC) and 5-methylcytosine (5mC) as well as EpiMark 5hmC and 5mC analysis. Ddx5 expression was downregulated upon TET2 knockdown, coincided with a significant decrease of 5hmC at the Ddx5 locus. DDX5 knockdown significantly suppressed adipogenesis, while DDX5 overexpression promoted it. Importantly, DDX5 overexpression, when co-transfected, rescued the process of adipogenesis, which was hindered by TET2 siRNA treatment. The findings suggest TET2-mediated regulation of the Ddx5 gene is required for an initial step of adipogenesis.

Brain-stiffness-mimicking tilapia collagen gel promotes the induction of dorsal cortical neurons from human pluripotent stem cells.

The mechanical properties of the extracellular microenvironment, including its stiffness, play a crucial role in stem cell fate determination. Although previous studies have demonstrated that the developing brain exhibits spatiotemporal diversity in stiffness, it remains unclear how stiffness regulates stem cell fate towards specific neural lineages. Here, we established a culture substrate that reproduces the stiffness of brain tissue using tilapia collagen for in vitro reconstitution assays. By adding crosslinkers, we obtained gels that are similar in stiffness to living brain tissue (150-1500 Pa). We further examined the capability of the gels serving as a substrate for stem cell culture and the effect of stiffness on neural lineage differentiation using human iPS cells. Surprisingly, exposure to gels with a stiffness of approximately 1500 Pa during the early period of neural induction promoted the production of dorsal cortical neurons. These findings suggest that brain-stiffness-mimicking gel has the potential to determine the terminal neural subtype. Taken together, the crosslinked tilapia collagen gel is expected to be useful in various reconstitution assays that can be used to explore the role of stiffness in neurogenesis and neural functions. The enhanced production of dorsal cortical neurons may also provide considerable advantages for neural regenerative applications.

An Extremely Inexpensive, Simple, and Flexible Carbon Fiber Electrode for Tunable Elastomeric Piezo-Resistive Sensors and Devices Realized by LSTM RNN.

Here, we describe the utility of a carbon fiber (CF) electrode that is inexpensive, simple, and flexible and can be embedded with elastomeric nanocomposite piezo-resistive sensors fabricated from silicone rubber (Ecoflex) blended with carbon nanotubes (CNTs) and various wt % of silicone thinner to tune the sensitivity and softness range. The performance of the CF electrode was evaluated on the basis of piezo-resistive responses from the sensors subjected to dynamic sinusoidal compressive strains at different levels and frequencies. The responses were positive-pressure effects with rate-dependent asymmetric nonlinear hysteresis characteristics. Developing a mathematical model to describe the rate-dependent asymmetric nonlinear hysteresis behavior is technically impossible; therefore, we employed artificial intelligence-based hysteresis modeling, long short-term memory recurrent neural network, to describe the hysteresis nonlinearity. The debonding strength of the CF electrode was determined in the pull-off testing and was found to be much higher than that of a copper wire electrode. The debonding mechanism was further elucidated via an in situ resistance profile. The importance of a robust conductive interface between a CF electrode and a nanocomposite was experimentally demonstrated. It was found that the inherent piezo-resistance of the CF was negligible compared with the piezo-resistance of the sensor; therefore, the signals from the sensor were free of interference. We believe CF-embedded tunable piezo-resistive sensors could be used in biomedical devices, artificial e-skins, robotic touch applications, and flexible keyboards where the required stretchability of the electrode can be introduced via an appropriate geometrical design.

Deep-Learning Technique To Convert a Crude Piezoresistive Carbon Nanotube-Ecoflex Composite Sheet into a Smart, Portable, Disposable, and Extremely Flexible Keypad.

An extremely simple bulk sheet made of a piezoresistive carbon nanotube (CNT)-Ecoflex composite can act as a smart keypad that is portable, disposable, and flexible enough to be carried crushed inside the pocket of a pair of trousers. Both a rigid-button-imbedded, rollable (or foldable) pad and a patterned flexible pad have been introduced for use as portable keyboards. Herein, we suggest a bare, bulk, macroscale piezoresistive sheet as a replacement for these complex devices that are achievable only through high-cost fabrication processes such as patterning-based coating, printing, deposition, and mounting. A deep-learning technique based on deep neural networks (DNN) enables this extremely simple bulk sheet to play the role of a smart keypad without the use of complicated fabrication processes. To develop this keypad, instantaneous electrical resistance change was recorded at several locations on the edge of the sheet along with the exact information on the touch position and pressure for a huge number of random touches. The recorded data were used for training a DNN model that could eventually act as a brain for a simple sheet-type keypad. This simple sheet-type keypad worked perfectly and outperformed all of the existing portable keypads in terms of functionality, flexibility, disposability, and cost.

An extremely simple macroscale electronic skin realized by deep machine learning.

Complicated structures consisting of multi-layers with a multi-modal array of device components, i.e., so-called patterned multi-layers, and their corresponding circuit designs for signal readout and addressing are used to achieve a macroscale electronic skin (e-skin). In contrast to this common approach, we realized an extremely simple macroscale e-skin only by employing a single-layered piezoresistive MWCNT-PDMS composite film with neither nano-, micro-, nor macro-patterns. It is the deep machine learning that made it possible to let such a simple bulky material play the role of a smart sensory device. A deep neural network (DNN) enabled us to process electrical resistance change induced by applied pressure and thereby to instantaneously evaluate the pressure level and the exact position under pressure. The great potential of this revolutionary concept for the attainment of pressure-distribution sensing on a macroscale area could expand its use to not only e-skin applications but to other high-end applications such as touch panels, portable flexible keyboard, sign language interpreting globes, safety diagnosis of social infrastructures, and the diagnosis of motility and peristalsis disorders in the gastrointestinal tract.

Multi-functionalized herringbone carbon nanofiber for anodes of lithium ion batteries.

Herringbone carbon nanofibers (HCNFs) are prepared for use as anode materials in lithium-ion batteries (LIBs). HCNFs are prepared using a Ni-Fe catalyst and subsequently multi-functionalized with oxygen using the Hummers' method, and then with both oxygen and nitrogen-containing 2-ureido-4[1H]pyrimidinone (UHP) moieties, which endow the HCNFs with the ability to form quadruple hydrogen bonds (QHBs). The as-prepared HCNFs are, on average, 13 µm in length and 100 nm in diameter, with a highly graphitic structure. The oxidized HCNFs (Ox-HCNFs) obtained by Hummers' method are partially exfoliated, having double-bladed saw-like structures that extend in the direction of the graphite planes. QHBs are formed between the HCNFs after functionalization with the UHP moieties. The final surface-modified HCNFs (N-Ox-HCNFs) have more electrochemical sites, shorter Li+ diffusion lengths, and additional electron pathways compared with the as-prepared HCNF and Ox-HCNF. The introduction of oxygen- and nitrogen-containing functional groups improves the performance of LIBs: a high charge capacity of 763 mA h g-1 at 0.1 A g-1, excellent rate capability (a capacity of 402 mA h g-1 at 3 A g-1), and near 100% capacity retention after 300 cycles are reported.

Trileucine residues in a ligand-CPP-based siRNA delivery platform improve endosomal escape of siRNA.

siRNA entrapment within endosomes is a significant problem encountered with siRNA delivery platforms that co-opt receptor-mediated entry pathways. Attachment of a cell-penetrating peptide (CPP), such as nona-arginine (9R) to a cell receptor-binding ligand like the Rabies virus glycoprotein, RVG, allows effective siRNA delivery to the cytoplasm by non-endocytic pathways, but a significant amount of siRNA complexes also enters the cell by ligand-induced receptor endocytosis and remain localized in endosomes. Here, we report that the incorporation of trileucine (3 Leu) residues as an endo-osmolytic moiety in the peptide improves endosomal escape and intracellular delivery of siRNA. The trileucine motif did not affect early non-endosomal mechanism of cytoplasmic siRNA delivery but enhanced target gene silencing by >20% only beyond 24 h of transfection when siRNA delivery is mostly through the endocytic route and siRNA trapped in the endosomes at later stages were subject to release into cytoplasm. The mechanism may involve endosomal membrane disruption as trileucine residues lysed RBCs selectively under endosomal pH conditions. Interestingly <3 Leu or >3 Leu residues were not as effective, suggesting that 3 Leu residues are useful for enhancing cytoplasmic delivery of siRNA routed through endosomes.

Hysteresis compensation of photoluminescence in ZnS:Cu for noncontact shaft torque sensing.

This paper presents a preliminary investigation of loading rate-dependent hysteresis of photoluminescence (PL) by phosphorescence quenching of copper-doped zinc sulfide (ZnS:Cu) microparticles in response to dynamic torsional loading. Precision sinusoidal torque waveforms in the frequency range of 0.5-3 Hz are used to identify the loading rate-dependent (i.e., frequency-dependent) nonlinear hysteresis phenomenon. The potential of the application of PL is demonstrated by successfully measuring the sinusoidal torque applied to a rotational shaft by evaluating the loading rate-dependent PL intensity signature using a photomultiplier tube. In addition, the potential of noncontact shaft torque sensing is demonstrated successfully by the simple compensation derived from ad hoc heuristic characterization.

Three-dimensional analysis of the tooth movement and arch dimension changes in Class I malocclusions treated with first premolar extractions: a guideline for virtual treatment planning.

INTRODUCTION: Our objective was to analyze patterns of tooth movement and changes of arch dimension by superimposing 3-dimensional (3D) virtual models. METHODS: The sample consisted of 24 Korean adults with Class I malocclusion and minimal crowding, treated by first premolar extractions, sliding mechanics (0.022-in MBT brackets [3M Unitek, Monrovia, Calif] with 0.019 × 0.025-in stainless steel wire) and moderate anchorage. The 3D virtual maxillary casts at pretreatment and posttreatment were superimposed with the best-fit method. Linear and angular variables were measured with 3Txer program (Orapix, Seoul, Korea). Wilcoxon signed rank and Mann-Whitney tests were used for statistical analysis. RESULTS: There was no significant difference in the individual tooth movement between the right and left sides (P > 0.05). For the movement of each tooth, the maxillary central incisors (U1), lateral incisors (U2), and canines (U3) were significantly inclined lingually, extruded, and moved posteriorly and laterally. The maxillary second premolar (U5), first molar (U6), and second molar (U7) had significant mesial inward rotation, anterior movement, and contracted toward the midsagittal plane. The ratio of anteroposterior movement between the maxillary anterior and posterior teeth was 5:1. The amounts of contraction in U5, U6, and U7 were 1.4, 1.3, and 1.2 mm, respectively. When the amount of change between the adjacent teeth were compared, the linguoversion in U1 was significantly greater than that of U2. U3 and U5 showed significant opposite movements in all variables. There were differences only in angulation and vertical displacement between U6 and U7. CONCLUSIONS: Superimposition of 3D virtual models could be a guideline for precise virtual treatment planning.

Laparoscopic placement of a gastric stimulator for the treatment of gastroparesis: a pilot study technique and results.

AIM: To evaluate the safety and outcomes of laparoscopic placement of a gastric stimulator for patients with gastroparesis. MATERIALS AND METHODS: Data of all patients who underwent laparoscopic placement of a gastric stimulator between 2003 and 2005 was retrospectively reviewed. Data included; demographics, perioperative course, and outcomes. A telephone follow-up questionnaire was conducted for all patients. Patient's satisfaction of their life after the procedure was evaluated on a scale from 0 to 10. RESULTS: Seven patients underwent the procedure. There were no conversions, no perioperative complications; all patients were discharged on the first postoperative day. There were no postoperative complications or mortality. Only 5 patients were available for a telephone interview. All patients indicated reduction of symptoms, 4 patients decreased or discontinued their drug therapy. Four patients indicated that they were tolerating regular diet. Three patients indicated an improvement in their general life satisfaction. CONCLUSIONS: Gastric electrical stimulator may improve gastrointestinal symptoms, reduce the use of drug therapy, and offer subsequent improvement in patients' general life satisfaction. This procedure is relatively safe for patients with refractory gastroparesis. Further studies are required to confirm these results.

Laparoscopic resection of a retroperitoneal degenerative schwannoma: a case report and review of the literature.

Degenerative schwannomas are rare benign tumors. The patient presented in this case report complained of a dull left upper quadrant pain for several months. A computed tomography scan revealed a low-density lesion at the level of T12. The lesion was laparoscopically resected and pathologic examination revealed a degenerative schwannoma.

Emergency room visits after laparoscopic Roux-en-Y gastric bypass for morbid obesity.

BACKGROUND: Patients can be symptomatic after laparoscopic Roux-en-Y gastric bypass because of either surgical complications or physiologic changes and adjustment to the new anatomy. The aim of this study was to evaluate the factors that could influence the rate of postoperative emergency room admissions (ERAs) and the clinical implication of these visits for patients who have undergone laparoscopic Roux-en-Y gastric bypass. METHODS: The medical records of patients who underwent laparoscopic Roux-en-Y gastric bypass for morbid obesity from 2001 to 2004 were retrospectively reviewed. The data of patients with a history of an ERA after surgery was compared with the data of patients without a history of ERAs. The data collected included demographics, weight, body mass index, operative time, and more. The ERAs were subdivided into early ERAs and late ERAs, and the data were analyzed further. RESULTS: Of 733 patients, 228 (31.1%) had a history of ERAs. Patients with early postoperative complication (<7 days after the procedure) had a greater rate of ERAs (60.9% versus 30.1%, P <.05). The operative time was significantly longer in the ERA group (91.4 versus 86.5 min). The most frequent complaint in the emergency room was abdominal pain (61.4%) followed by vomiting (35.5%). Gastric outlet obstruction was the most frequent cause of an ERA within 2 weeks after surgery. Most patients were treated conservatively. CONCLUSION: Our results suggest that the rate of potential ERAs should not be disregarded. A prolonged operative time and early postoperative complications were significant predictors for late ERAs. Abdominal pain with or without vomiting was the most common presenting symptom. Most patients can be treated conservatively.

Laparoscopic remnant gastrectomy: a novel approach to gastrogastric fistula after Roux-en-Y gastric bypass for morbid obesity.

BACKGROUND: Gastrogastric fistula (GGF) is a relatively rare and devastating complication after divided Roux-en-Y gastric bypass (RYGB) for morbid obesity. The aim of this study was to review laparoscopic remnant gastrectomy (LRG) as a novel treatment option for this complication. STUDY DESIGN: After IRB approval, we retrospectively reviewed data from all patients who underwent bariatric surgery at Cleveland Clinic Florida and from all patients who were diagnosed with GGF as a complication of RYGB, between January 2000 and March 2005. Data collected included demographics, body weight, symptoms, initial diagnostic method, indications for LRG, and postoperative complications. RESULTS: Of 1,400 patients who had undergone RYGB in our institution during the study period, 21 patients (1.5%) were diagnosed with GGF; 4 more patients who were admitted with GGF after RYGB underwent the initial operation at another institution. Of these, 15 patients underwent LRG. Indications for surgical treatment were intractable epigastric pain (10 of 15), upper gastrointestinal bleeding (2 of 15), intolerance of soft diet (2 of 15), and weight regain (1 of 15). Mean hospital length of stay after the procedure was 4.7 days. There was no mortality, and there was no recurrence of GGF during the followup period. CONCLUSIONS: LRG appears to be a safe and effective surgical procedure for selective patients with GGF after RYGB.

Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic adjustable gastric banding (LAGB) are the most commonly performed surgical procedures for weight reduction in the United States. Currently, laparoscopic sleeve gastrectomy (LSG) is being explored. The aim of this study was to assess the safety and short-term efficacy of LSG as a treatment option for weight reduction. METHODS: Data of all patients who underwent LSG for treatment of morbid obesity between November 2004 and March 2006 and completed the 3- and 6-month follow-up visits at the time of the study, were retrospectively reviewed. Data collected included demographics, operative time, length of stay, postoperative complications, and degree of weight reduction. RESULTS: Of the 62 patients who underwent LSG performed by two surgeons, the data of 30 patients (7 males and 23 females) were further analyzed. Mean preoperative BMI was 41.4 (33-59) kg/m(2). Mean operative time was 80 min (range 65-130). Mean hospital stay was 3.2 days (range 2 to 25). Mean weight loss at 3 and 6 months following the procedure was 22.7 kg and 30.5 kg respectively, and mean % excess weight loss (EWL) was 40.7 and 52.8, respectively. Three patients were considered to have mild complications, and one patient had a major complication that necessitated surgical intervention. There was no mortality. CONCLUSIONS: In the short-term, LSG is a safe and effective treatment option.

Frequency and management of internal hernias after laparoscopic antecolic antegastric Roux-en-Y gastric bypass without division of the small bowel mesentery or closure of mesenteric defects: review of 1400 consecutive cases.

BACKGROUND: It is common practice to close mesenteric defects in abdominal surgery to prevent postoperative herniation and subsequent closed-loop obstruction. The aim of this study was to review our experience with antecolic antegastric laparoscopic Roux-en-Y gastric bypass (AA-LRYGBP) without division of the small bowel mesentery or closure of potential mesenteric defects. METHODS: Data for 1400 patients who underwent AA-LRYGBP between January 2001 and December 2004 was prospectively collected and retrospectively analyzed for the incidence of internal hernias. In all cases, an antecolic antegastric approach was performed without division of the small bowel mesentery or closure of potential hernia defects. RESULTS: Three patients (0.2%) developed a symptomatic internal hernia. Two of these patients had a 200-cm-long Roux limb, and the other had a 100-cm-long Roux limb. All three patients exhibited mild symptoms of partial small bowel obstruction. In all three cases the internal hernia was clinically manifested more than 10 months after the original AA- LRYGBP. Exploration revealed that the hernia site was between the transverse colon and the mesentery of the alimentary limb at the level of the jejunojejunostomy (Petersen's defect) in all three cases. All three patients underwent successful laparoscopic revision, hernia reduction, and mesenteric defect closure. CONCLUSIONS: AA-LRYGBP without division of the small bowel mesentery or closure of mesenteric defects does not result in an increased incidence of internal hernias. The laparoscopic approach for reexploration appears to be an effective and safe option.