The impact of Aprepitant on Nausea and Vomiting following Laparoscopic Sleeve Gastrectomy: A Blinded Randomized Controlled Trial.

INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is associated with postoperative nausea and vomiting (PONV). We aimed to compare the effects of aprepitant on the incidence of PONV after LSG. METHODS: In this double-blind, randomized controlled trial, the case group received the standard care regimen for PONV (dexamethasone 10 mg, ondansetron 4 mg, and metoclopramide 10 mg) plus prophylactic oral aprepitant 80 mg 1 h preoperatively. The control group received standard care plus a placebo. Comparative analyses using the Rhodes index were performed at 0, 6, 12, and 24 h postoperatively. RESULTS: A total of 400 patients (201 in the aprepitant group and 199 in the placebo group) underwent LSG. The groups were homogeneous. The aprepitant group experienced less PONV: early, 69 (34.3%) vs. 103 (51.7%), p ≤ 0.001; 6 h, 67 (33.3%) vs. 131 (65.8%), p ≤ 0.001; 12 h, 41 (20.4%) vs. 115 (57.8%), p ≤ 0.001; and 24 h, 22 (10.9%) vs. 67 (33.7%), p ≤ 0.001. Fewer patients in the aprepitant group vomited: early, 3 (1.5%) vs. 5 (2.5%), p = 0.020; 6 h, 6 (3%) vs. 18 (9%), p = 0.020; 12 h, 2 (1%) vs. 17 (8.5%), p = 0.006; and 24 h, 1 (0.5%) vs. 6 (3%), p = 0.040. Patients in the aprepitant group required less additional PONV medication: early, 61 (30.3%) vs. 86 (43.2), p = 0.008; 6 h, 7 (3.5%) vs. 34 (17%), p = 0.001; 12 h, 6 (3%) vs. 31 (15.6%), p ≤ 0.001; and 24 h, 5 (2.5%) vs. 11 (5.5%), p ≤ 0.001. CONCLUSIONS: Prophylactic aprepitant improved PONV between 0 h (early) and 24 h postoperatively in patients undergoing LSG.

Endoscopic sleeve gastroplasty as an early tool against obesity: a multicenter international study on an overweight population.

BACKGROUND AND AIMS: Endoscopic sleeve gastroplasty (ESG) is an effective, minimally invasive gastric remodeling procedure to treat mild and moderate obesity. Early adoption of ESG may be desirable to try to halt progression of obesity, but there are few data on its efficacy and safety for overweight patients. METHODS: This was a multicenter, international, analytical case series. Six U.S., 1 Brazilian, 1 Mexican, and 1 Indian center were included. Overweight patients according to local practice undergoing ESG were considered eligible for the study. The end points were percent total weight loss (%TWL), body mass index (BMI) reduction, rate of BMI normalization, and rate of adverse events. RESULTS: One hundred eighty-nine patients with a mean age of 42.6 ± 14.1 years and a mean BMI of 27.79 ± 1.17 kg/m2 were included. All procedures were successfully accomplished, and there were 3 intraprocedural adverse events (1.5%). The mean %TWL was 12.28% ± 3.21%, 15.03% ± 5.30%, 15.27% ± 5.28%, and 14.91% ± 5.62% at 6, 12, 24, and 36 months, respectively. At 12 and 24 months, 76% and 86% of patients achieved normal BMI, with a mean BMI reduction of 4.13 ± 1.46 kg/m2 and 4.25 ± 1.58 kg/m2. There was no difference in mean %TWL in the first quartile versus the fourth quartile of BMI in any of the time points. However, the BMI normalization rate was statistically higher in the first group at 6 and 12 months (6 months, 100% vs 48.5% [P < .01]; 12 months, 86.2% vs 50% [P < .01]; 24 months, 84.6% vs 76.1% [P = .47]; 36 months, 86.3% vs 66.6% [P = .26]). CONCLUSIONS: ESG is safe and effective in treating overweight patients with high BMI normalization rates. It could help halt or delay the progression to obesity.

Flavonoid, Nitrate and Glucosinolate Concentrations in Brassica Species Are Differentially Affected by Photosynthetically Active Radiation, Phosphate and Phosphite.

We evaluated the effects of phosphate (Pi-deficiency: 0.1 mM; Pi-sufficiency: 0.5 mM), phosphite (low-Phi: 0.1 mM; medium-Phi: 0.5 mM; and high-Phi: 2.5 mM), and two mean daily photosynthetically active radiations (lower PAR: 22.2 mol ⋅ m-2 ⋅ d-1; higher PAR: 29.7 mol ⋅ m-2 ⋅ d-1), as well as their interactions, on flavonoid, nitrate and glucosinolate (GL) concentrations and growth characteristics in hydroponically grown Brassica campestris cv. Mibuna Early and Brassica juncea cv. Red Giant. As expected, higher PAR increased dry matter and contrariwise decreased number of leaves but only in B. campestris. Total flavonoid and individual flavonoid compounds increased with the higher PAR value in B. campestris. Pi-sufficiency resulted in a lower quercetin concentration in both species, the isorhamnetin and total flavonoid concentrations in B. campestris, and the cyanidin concentration in B. juncea, in comparison to Pi-deficiency. Similarly, Pi-sufficient plants exhibited lower GL concentration, especially alkyl-GLs in B. campestris and alkenyl-GLs and an aryl-GL in B. juncea. Pi did not affect the nitrate concentration in either species, and nor did Phi influence the flavonoid concentrations in either species. In B. campestris, medium Phi (0.5 mM) increased the 1-methoxyindol-3-ylmethyl GL concentration by 28.3%, as compared to that observed at low Phi. In B. juncea, high Phi level increased the but-3-enyl-GL concentration by 18.9%, in comparison to values recorded at medium Phi. B. campestris plants exposed to higher PAR increased total flavonoids concentration. In both Brassica species, higher PAR stimulated the alkyl-, alkenyl-, and indole-GLs. The interaction of lower PAR and increasing Phi significantly decreased flavonoid concentration in B. juncea, whereas increasing Phi at higher PAR increased such concentration in this species. The same combination reduced the concentration of 2-phenylethyl- and indol-3-ylmethyl-GL in B. juncea. The highest indol-3-ylmethyl-GL concentration was observed when Pi was deficient combined with medium Phi in B. juncea. Thus, PAR, Pi and Phi may modulate flavonoid, GL and nitrate concentrations in Brassica species, which may be a useful tool to improve the nutraceutical quality of these leafy vegetables if properly managed.

[Ectopic pregnancy in an in vitro fertilization program]. / Embarazo ectópico en un programa de fertilización in vitro.

The ectopic pregnancy rate in 171 patients of our IVF program in the last two years is 2.58%, this is quite similar to the previously reported in the general population. However, the information available from other IVF programs; even with the small numbers, and the association is high for multiple causes of tubal disease; our rate still good.

Embarazo ectópico en un programa de fertilización in vitro / Ectopic pregnancy in an in vitro fertilization program

Se analizó la incidencia de embarazo ectópico durante dos años en el programa de la clínica de fertilización in vitro del Grupo de Reproducción y Genética de AGN y Asociados y se observó que se presentó en 2.58 por ciento de los casos. Se concluye que la tasa de embarazo ectópico se mantiene similar a la de la población general, se tiene como riesgo más importante el factor tubario, pero permanecen las demás características iguales a las presentadas por la población abierta, a pesar de que las cifras publicadas sean más elevadas para la fertilización in vitro.

[Comparison of 2 artificial insemination technics. (Sperm tubal perfusion and intrauterine insemination)]. / Comparación de dos técnicas de inseminación artificial. (Perfusión tubárica de esperma e inseminación intrauterina).

In 1991 Kahn et al, described a method of intrauterine Insemination called Fallopian Tube Sperm Perfusion (FSP) using 4.0 ml for the insemination volume, unlike the classic Intrauterine Insemination (IIU) in which insemination volume is 0.5 ml. The aim of this study is to compare pregnancy rate per cycle in both technics. Between August 1993 and January 1994, 60 couples with infertility were studied, 131 ovarian stimulation cycles were done, 95 with IIU and 36 with PTE. 18 clinical pregnancies occurred, 11 with IIU and 7 with PTE, for a pregnancy rate per cycle of 11.5% for IIU and 19.4% for PTE. This result confirms the reports by Kahn. PTE represents a new possibility for the treatment of different etiology infertility.

Comparación de dos técnicas de inseminación artificial. (Perfusión tubárica de esperma e inseminación intrauterina) / Comparison of two artificial insemination techniques-Sperm tubal perfusion and intrauterine insemination

En 1991 Kahn y col. describieron un método de inseminación intrauterina llamado Perfusión Tubárica de Esperma (PTE) utilizando un volumen inseminado de 4.0 ml, a diferencia de la Inseminación Intrauterina (IIU) clásica en la que el volumen inseminado es de 0.5 ml. El objetivo del estudio es comparar la tasa de embarazos de ambas técnicas. Durante un período comprendido entre agosto de 1993 a enero de 1994 se atendieron 60 pacientes con infertilidad se realizaron 131 ciclos de inducción de ovulación e inseminación intrauterina, 95 fueron con IIU y 36 con PTE. Se obtuvieron 18 embarazos clínicos, 11 con IIU y 7 con PTE, representando una tasa de éxito de 11.5 por ciento para la primera y de 19.4 por ciento para la segunda técnica. Estos resultados confirman los obtenidos por Kahn. La PTE representa una nueva posibilidad para el tratamiento de la infertilidad de diversas etiologías