Risk factors of perioperative morbimortality after laparoscopic sleeve gastrectomy: a club coelio multicenter study.

OBJECTIVES: Postoperative complications after Laparoscopic sleeve gastrectomy (LSG) can dramatically compromise patient's outcome. The aim of this study is to analyze the per- and postoperative short-term outcomes after LSG and to assess predictive risk factors of complications. METHODS: The study group consisted of 790 patients (610 women and 180 men) who underwent LSG In 2014. All interventions were performed by 18 experienced surgeons members of the Club Coelio. Data about preoperative work-up, surgical techniques, 30-days postoperative morbidity and mortality were collected. Endpoints were perioperative morbidity and mortality and assessment of potential risk factors for complications. RESULTS: Mean age and body mass index were respectively 39 years and 41.5kg/m2. Ninety-one patients (11.5%) had previous bariatric surgery. Morbidity rate was 4.7% (37/790) including 16 leaks (2.0%) and 9 bleedings (1.1%) and no deaths. Risk factors for leak were: previous adjustable banding (p = .0051), with no difference between removal of the banding and LSG in 1 or 2 steps, and type of endostapler (p = .0129). CONCLUSIONS: Leakage after Sleeve was rare but still observed even in experienced hands. The leak rate is particularly high when LSG is performed after adjustable gastric banding removal.

The C terminus of lettuce mosaic potyvirus cylindrical inclusion helicase interacts with the viral VPg and with lettuce translation eukaryotic initiation factor 4E.

Recessive resistance to lettuce mosaic virus (LMV) is conferred in lettuce by the mo1 gene, encoding the eukaryotic translation initiation factor 4E (eIF4E). The C terminus of the viral cylindrical inclusion helicase (CI-Cter), together with the VPg, is involved directly in overcoming mo1 resistance. In this study, recombinant LMV VPg and CI-Cter proteins from wild-type or resistance-breaking isolates were expressed and purified from Escherichia coli. The allelic forms of eIF4E from susceptible or resistant lettuce cultivars were produced similarly and these proteins were used in ELISA-based assays to demonstrate the in vitro binding of the various forms of LMV CI-Cter to both lettuce eIF4E and LMV VPg proteins. All combinations tested displayed significant and specific interactions, and the interaction between the C-terminal part of the LMV CI and eIF4E was confirmed in vivo in bimolecular fluorescence complementation assays. Higher interaction signals for both CI-eIF4E and CI-VPg were observed for LMV-E, indicating that the eIF4E interaction network involving CI and VPg appears to be stronger in the case of this resistance-breaking isolate. This could suggest the need for a minimal interaction threshold for infection success in resistant lettuce, but more precise measurement of the interaction parameters linking eIF4E, VPg and CI is needed in order to reinforce such a hypothesis.

Analysis of malpractice claims: The Franco-Belgian "Cœlio Club" experience.

Malpractice claims are a regularly increasing concern in gastrointestinal surgery. The goal of this study was to compare the current status of claims in two different French-speaking communities by a retrospective descriptive study of surgeons' experiences, from the beginning of their practice up until December 31 2014. Data included the number, the reasons, and the results of medicolegal claims and their jurisdictions. Forty-three surgeons participated in this study. Two hundred medicolegal claims were analyzed. The mean number was 5.8 per surgeon. Bariatric surgery, colorectal surgery and parietal surgery were the most exposed. Forty-six (23%) faults were noted, while no fault was pronounced in 139 (69.5%) cases. The main reasons for lodging complaints were nosocomial infections, anastomotic leaks, poor postoperative care, hollow organ perforation, peripheral neurologic complication, and insufficient preoperative information. Forty-four percent of the complaints were analyzed by the conciliation and compensation commissions and 43.5% by the High Court. In the French-speaking group, there were 13 complaints, two of which gave rise to compensation. French surgeons are highly exposed to complaints: in French law, clumsiness or technical maladdress is considered as a fault. The patient should be informed preoperatively of all possible severe risks of a medical procedure. In Belgium, complications are exceptional and are considered random therapeutic events. Adhering to the recommendations emanating from the French High Authority of Health and Learned Societies as well as accreditation issued by the same High Authority should allow to decrease the number of undesirable events related to care and malpractice.

Constitutive expression of stromal derived factor-1 by mucosal epithelia and its role in HIV transmission and propagation.

HIV particles that use the chemokine receptor CXCR4 as a coreceptor for entry into cells (X4-HIV) inefficiently transmit infection across mucosal surfaces [1], despite their presence in seminal fluid and mucosal secretions from infected individuals [2] [3] [4]. In addition, although intestinal lymphocytes are susceptible to infection with either X4-HIV particles or particles that use the chemokine receptor CCR5 for viral entry (R5-HIV) during ex vivo culture [5], only systemic inoculation of R5-chimeric simian-HIV (S-HIV) results in a rapid loss of CD4(+) intestinal lymphocytes in macaques [6]. The mechanisms underlying the inefficient capacity of X4-HIV to transmit infection across mucosal surfaces and to infect intestinal lymphocytes in vivo have remained elusive. The CCR5 ligands RANTES, MIP-1alpha and MIP-1beta suppress infection by R5-HIV-1 particles via induction of CCR5 internalization, and individuals whose peripheral blood lymphocytes produce high levels of these chemokines are relatively resistant to infection [7] [8] [9]. Here, we show that the CXCR4 ligand stromal derived factor-1 (SDF-1) is constitutively expressed by mucosal epithelial cells at sites of HIV transmission and propagation. Furthermore, CXCR4 is selectively downmodulated on intestinal lymphocytes within the setting of prominent SDF-1 expression. We postulate that mucosally derived SDF-1 continuously downmodulates CXCR4 on resident HIV target cells, thereby reducing the transmission and propagation of X4-HIV at mucosal sites. Moreover, such a mechanism could contribute to the delayed emergence of X4 isolates, which predominantly occurs during the later stages of the HIV infection.

[Calcium, modulator of the expression of gonadoliberin at the intracellular level]. / Le calcium, modulateur de l'expression du message de la gonadoliberine au niveau intracellulaire.

GnRH has been entrapped in liposomes. Chromatographic studies and enzymatic peptidase treatments, show the efficiency of the encapsulation. A purification method on G75 Sephadex of the entrapped GnRH is described. This method prevents any dilution of the liposome fraction. A free GnRH contamination, lower than 0.4 per cent, has been observed. Superfused hypophyses respond to the message of the internalized GnRH only when calcium is present in the extracellular medium. The intensity of the answer depends on the duration of the entrapped GnRH infusion. The decrease observed in the response intensity after a long stay of the GnRH in the cytoplasm allows us to say that GnRH controls its own expression: The binding of GnRH to the membrane receptor during the early phase induces a calcium uptake necessary to the expression of the internalized GnRH, this being the late phase in LH release. A too low calcium concentration does not allow GnRH expression. As a consequence, GnRH is enzymatically degradated by the cytoplasmic peptidases. The LH release during the late phase is the result of a combined action of calcium and cytoplasmic peptidases. To support this idea we show: 1- that an extracellular calcium concentration around 0.5 or 0.6 mM is the best condition for the expression of the internalized GnRH. 2- that a GnRH agonist (D-Ala6-GnRH) known to be peptidase resistent induces a higher LH release in our experimental conditions.

Rat (and mouse) monoclonal antibodies. VIII. ELISA measurement of Ig production in mouse hybridoma culture supernatants.

We describe a rat monoclonal antibody (MAb)-based solid-phase immunoenzymometric assay for the quantification of mouse hybridoma culture supernatant immunoglobulins (Igs). This assay involves the use of two rat MAbs, LO-MK-1 and LO-MK-2, which bind distinct mouse kappa light chain epitopes expressed by all murine kappa Igs. The assay permits reliable measurement of all murine kappa IgG subclasses in the 2-120 ng/ml range and murine kappa IgM class in the 2-30 ng/ml range. The intra- and interassay coefficients of variation in the measurement of Ig in mouse hybridoma culture supernatants averaged 7.5% and 5% respectively. The assay is simple, reproducible, rapid and does not require specific equipment. It is of potential value to all laboratories engaged in hybridoma technology.

Monoclonal antibody-mediated inhibition of RNA binding and annealing activities of HIV type 1 nucleocapsid protein.

Retroviral nucleocapsid (NC) proteins are highly basic, with one or two zinc fingers, and are required for virion formation, genomic RNA dimerization and packaging, and replication primer tRNA annealing to the viral RNA. We report here the first characterization of monoclonal antibodies directed against a retroviral nucleocapsid protein and their use to study the structure-function relationships of the nucleocapsid protein NCp7 of HIV-1. Four anti-NCp7 monoclonal antibodies (MAbs) have been generated by using NCp7 of HIV-1. The epitope targets of these MAbs were mapped using ELISA and BIAcore techniques. Whereas three of them are specific for epitopes located in the N and C termini of NCp7, the fourth one appears to be conformation specific. Interestingly, only two of these MAbs, the conformation-specific one and the MAb recognizing an N-terminal epitope are able to inhibit the RNA-binding and annealing activities of NCp7 as well as strong-stop DNA synthesis in vitro. The binding of the two other MAbs onto NCp7 either has no effect or enhances the NCp7-RNA interactions. These MAbs also display a differential recognition of the Gag polyprotein precursor, which makes them useful tools for studying NC protein maturation in the course of virion morphogenesis.

Generation of monoclonal antibodies specifically directed against the proximal zinc finger of HIV type 1 NCp7.

The HIV-1 NCp7 contains two spatially close zinc fingers, required for the production of infectious particles. To investigate in more detail the function of the zinc finger domain, monoclonal antibodies were generated with a cyclic analog of the NCp7 proximal zinc finger. This analog was shown to bind zinc ions and to preserve the highly folded structure of the native peptide (Dong C-Z et al.: J Am Chem Soc 1995;117:2726-2731). We report here two monoclonal antibodies (2B10 and 4D3), which are the first monoclonal antibodies directed against CCHC NCp7 zinc fingers. Dot-blot experiments revealed that a few nanograms of synthetic NCp7 can be detected on a nitrocellulose membrane. Whereas 2B10 appears specific for an epitope located in sequence 19-27 of NCp7, 4D3 appears to be structurally specific. Immunocomplex affinities were evaluated, using BIAcore technology, to be up to 1 and 10 nM, respectively, for 2B10 and 4D3 in 100 mM NaCl. These antibodies were able to recognize NCp7 in the Gag polyprotein precursor and were shown to immunoprecipitate NCp7 from a cell supernatant. Moreover, NCp7-Vpr interaction mediated by the zinc fingers is inhibited by 2B10, emphasizing the role of these domains in the protein-protein complex. These results indicate that 2B10 and 4D3 behave as useful tools for studying both NC protein functions during the course of virion morphogenesis and the role played by its zinc finger domain at various steps in the retroviral life cycle.

["Natural history" of arterial surgical restoration below the inguinal region]. / "Histoire naturelle" des restaurations artérielles chirurgicales à l'étage sous-inguinal.

Infra-inguinal endarterectomy and by-pass (PSI) are the oldest and more frequently done restorative arterial operations. Here are described the evolution of patients, limbs and PSI and the factors that could interfere with them from the facts gathered since 30 years in literature. Prognosis is serious.

[Leiomyosarcoma of the inferior vena cava. Report of 3 cases]. / Les léiomyosarcomes de la veine cave inférieure. A propos de trois cas.

Three cases of leiomyosarcoma of the inferior vena cava are reported. With the help of a review of the literature, the value of ultrasonography, computed tomography and cavography is recalled. Surgical possibilities and results are described together with the necessity of adjuvant treatments.

[Cysts of the parathyroid glands. Apropos of 6 cases]. / Les kystes des parathyroïdes. A propos de six cas.

Parathyroid cysts are rare lesions. Pathological examination distinguishes the "true" parathyroid cysts (non functional) most often present and cystic degeneration of a parathyroid adenoma (rare) with clinical or biochemical evidence of hyperparathyroidism. With the increased use of ultrasound and fine needle aspiration biopsies, the diagnosis of these cysts can be confirmed by an elevated parathyroid hormone (PTH) assay. The non-functioning parathyroid cysts can be successfully treated by total aspiration of the cyst fluid. Surgical exploration of all parathyroid glands is the treatment of choice for hyperparathyroidism. The different proposed etiologies for parathyroid cysts are discussed.

[Severe lower gastrointestinal tract hemorrhage in adults. Apropos of 38 cases]. / Les hémorragies digestives basses graves de l'adulte. A propos de 38 observations.

Retrospective study of 38 cases of serious intestinal or rectal hemorrhage in the adult occurring between 1974 and 1987 demonstrated a wide variety of lesions responsible. Malignant tumours (21%) and ischemic lesions (13%) were most often implicated. Colonic diverticulosis and angiodysplasia were each responsible for 8% of cases. The most effective means of exploration were rectosigmoidoscopy and coelio-mesenteric arteriography together with per-operative endoscopy. The diagnosis remained uncertain in only 8% of cases. Treatment was essentially surgical (32 patients). Post-operative mortality (26%) was high, in keeping with the severity of the lesion responsible for the hemorrhage. Serious lower intestinal hemorrhage requires a two-fold management: the institution of intensive care resuscitation and as soon as the patient state permits, etiological investigation. After recto-sigmoidoscopy, which generally allows lower intestinal hemorrhage to be eliminated, arteriography and per-operative colonoscopy have in our experience a high diagnostic yield in cases of persistent hemorrhage. Where bleeding stops spontaneously, colonoscopic examination, after suitable preparation, remains a worthwhile investigation.

[Repeated subinguinal bypass. Report of 85 cases]. / Pontages sous-inguinaux itératifs. A propos de 85 cas.

From 1975 to 1987, 68 patients were operated with repeated subinguinal bypass (SIB) following early or late thrombosis os an initial bypass graft; 10 were operated with a third SIB, 4 with a fourth SIB. The indication for the second SIB was acute ischemia in 15 cases and chronic ischemia in 53. The graft material used was venous in 21 cases, prosthetic in 29 cases and mixed in 53. The distal anastomosis was performed on the upper popliteal artery in 12 cases, the lower popliteal artery in 34 cases or an artery in leg in 22 cases. The actuarial permeability rate of 84 repeated SIBs, whatever the material, was 21.7% at 1 year (50.2% for venous grafts and 13.6% for prosthetic grafts). The limb preservation rate was 47.9% at 5 years. Operative mortality was about 1%. The analysis of the results suggests that the repeated SIB should be performed only: for limb salvage, if the downstream arterial bed is in good condition, with usable venous material. The risk of having to perform a thigh amputation rather than a leg amputation when attempting repeated SIB is of 13.9% only.

Wood elastic characterization from a single sample by resonant ultrasound spectroscopy.

The goal of this paper is to propose an experimental method allowing the identification of the complete elastic tensor of anisotropic biological materials such as wood using only one sample. To do so, two complementary methods are used. First, the wood eigen-directions are defined from a sample of spherical shape that is then cut into a cube in a way to perform resonant ultrasound spectroscopy (RUS). The method is successfully applied on a reference beech sample with known orthotropic directions. A comparison of the identified elastic constants with those from the literature and some inferred from ultrasonic transmission measurements is given.

Central domain of a potyvirus VPg is involved in the interaction with the host translation initiation factor eIF4E and the viral protein HcPro.

Using recombinant proteins produced in bacteria or in infected plants, interactions between the VPg and HcPro of Lettuce mosaic potyvirus (LMV) and between LMV VPg and the lettuce translation initiation factor 4E, the cap-binding protein (eIF4E), were demonstrated in vitro. Interaction with eIF4E and HcPro both involved the same VPg central domain. The structure of this domain in the VPg context was predicted to include an amphiphilic alpha-helix, with the amino acids related to biological functions in various potyviruses exposed at the hydrophilic side.

[Comparative effect of a new calcium antagonist, BRL 40015, and verapamil on LH secretion from cultured pituitary cells]. / Action comparée d'un nouvel antagoniste calcique, le BRL 40015 A, et du vérapamil sur la sécrétion de LH à partir de cellules hypophysaires en culture.

Effects of the new calcium antagonist with antianginal properties BRL 40015 A (-1-(4-diethoxyphenyl) methyl-3,4-(dihydro-6,7 bis (methylethoxy)-isoquinoline, hydrochloride) on luteinizing hormone (LH) release from cultured rat pituitary cells were investigated and compared with those of verapamil. BRL 40015 A provoked a dose-dependent inhibition of LHRH-stimulated LH release; IC50 (50% inhibition) was found to be 2 X 10(-6)M whereas it was ten times greater with verapamil (2 X 10(-5)M). Inhibition was reversible, partially at least, when BRL 40015 A was removed from the incubation medium. Contrarily to what occurred with verapamil, an increase in extracellular Ca2+ concentration (5mM) provoked the disappearance of BRL 40015 A--induced inhibition. Such effects of BRL 40015 A were observed in absence of cytotoxicity. Thus, while confirming that Ca2+ mobilization plays an essential role in LH release, results suggest that the mechanism of action of BRL 40015 A on calcium channels is however different from that of verapamil.

[Encapsulation of GnRH in liposomes: effects on the release of hypophyseal LH]. / Encapsulation du GnRH dans les liposomes: effets sur la libération de la LH hypophysaire.

The GnRH has been entrapped in liposomes. The infusion of this trapped GnRH in a pituitary superfusion system allows us to show that it mimics only the phase II of the GnRH stimulated LH release. We show that cycloheximide seems to interact at the level of the natural GnRH penetration mechanism in the cytoplasm. One of the places where calcium is suspected to be potent has been located at the expression level of the message transmitted to the cytoplasm by the trapped GnRH.

Purification and immunological studies of the cross-reaction between the 65-kilodalton gonococcal parietal lectin and an antigen common to a wide range of bacteria.

The 65-kDa gonococcal parietal lectin (GPL) has been purified and found to have a lectinlike activity exhibiting both structural and immunological similarities to the common antigen family. Ultrastructural localization of GPL was done by using anti-GPL monoclonal antibodies: GPL is a major component of the outer membrane and is also present in blebs formed by gonococci.