Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations.

BACKGROUND: During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based "enhanced" perioperative protocol. METHODS: The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. RESULTS: Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials. CONCLUSIONS: A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.

Molecular identification in monophasic and nonmotile variants of Salmonella enterica serovar Typhimurium.

Variant strains of Salmonella enterica serovar Typhimurium, lacking one or both flagellar phases have been widely reported. The monophasic S.1,4,[5],12:i:- variant has emerged worldwide in the past few years and has become one of the most frequently encountered in many countries. In contrast, monophasic S.1,4,[5],12:-:1,2 and nonmotile S.1,4,[5],12:-:- strains are rarely described. This study investigated seven molecular markers to identify and delineate monophasic S.1,4,[5],12:i:- (n = 90), S.1,4,[5],12:-:1,2 (n = 25), nonmotile S.1,4,[5],12:-:- (n = 17) strains, and some serovar Typhimurium strains (n = 124) collected through the French Salmonella network between 2001 and 2010. Three markers were commonly detected in serovar Typhimurium and in all variant strains: STM2757, mdh and fliA-B. Monophasic S.1,4,[5],12:i:- were genotypically confirmed by the absence of the fljB, fljA, and hin genes. Nevertheless, 13 (14.5%) of them were positive for these last three genes, revealing monophasic strains named "inconsistent" as previously described. All nonmotile 1,4,[5],12:-:- strains had the fliC, fljA, fljB, and hin genes and the fliC gene was detected in 88% of monophasic S.1,4,[5],12:-:1,2 strains. The combination of the seven markers detection enables to recognize eight different genotypes within the S.1,4,[5],12:i:- collection, among which the Spanish and the U.S. clones previously described could be distinguished and assigned to a genotype. Based on this molecular approach, 71% of the French S.1,4,[5],12:i:- collection belonged to the Spanish clone, whereas only 2% were assigned to the U.S. clone. This study highlights the usefulness of these molecular markers and genotypes for identifying lineages, especially among the epidemiologically important monophasic S.1,4,[5],12:i:- variant.

P2Y purinergic potentiation of glucose-induced insulin secretion and pancreatic beta-cell metabolism.

Purine nucleotides and their analogs increase insulin secretion through activation of pancreatic beta-cell P2Y receptors. The present study aimed at determining the role of glucose metabolism in the response to P2Y agonists and whether ATP-activated K+ channels (KATP channels) are involved in this response. The experiments were performed in the rat isolated pancreas, perfused with a Krebs-bicarbonate buffer supplemented with 2 g/l bovine serum albumin under dynamic glucose conditions from 5 mmol/l baseline to 11 mmol/l. ADPbetaS (0.5 micromol/l) was selected as a stable and selective P2Y agonist. This compound, ineffective on the 5 mmol/l glucose background, induced a significant threefold increase in insulin release triggered by the glucose challenge. The effect of ADPbetaS was markedly reduced (P <0.001) in the presence of an inhibitor of glucose metabolism. In addition to glucose, the ADP analog also amplified the beta-cell insulin response to 15 mmol/l methyl pyruvate (P <0.05), but it was ineffective on the insulin response to 2.5 mmol/l methyl succinate. A nonmetabolic stimulus was applied using tolbutamide (185 micromol/l). Insulin secretion induced by the KATP channel blocker was strongly reinforced by ADPbetaS (P <0.001), which prompted us to check a possible interplay of KATP channels in the effect of ADPbetaS. In the presence of diazoxide 250 micromol/l and 21 mmol/l KCl, ADPbetaS still amplified the second phase of glucose-induced insulin secretion (P <0.001). We conclude that P2Y receptor activation is able to promote insulin secretion through a mechanism, involving beta-cell metabolism and a rise in intracellular calcium; this effect does not result from a direct inhibitory effect on KATP channels.

Most humoral non-responders to hepatitis B vaccines develop HBV-specific cellular immune responses.

About 10% of health care professionals vaccinated against hepatitis B virus (HBV) fail to develop protective antibodies. We tested the capacity of peripheral blood lymphocytes from 121 health care professionals, including 76 non-responders, to proliferate to four HBV vaccines, examined the proliferating cells' subset, production of IFN-gamma, IL-4 and IL-10, and for 22 subjects, the cytokine production genotype. Specific proliferative responses to at least one HBV antigen were noted in 75% humoral non-responders. These cells differed from the CD4+ strongly proliferating cells of responders. Non-responders frequently displayed a genotype of high TGF-beta and intermediate IL-10 secretion. Most humoral non-responders to HBV thus develop specific cellular immune responses, eventually liable to protect them against viral infection.

Liquid chromatography-electrospray mass spectrometry multi-residue determination of pesticides in apples and pears.

This paper describes a rapid, specific and sensitive multi-residue method for the routine quantitative analysis of pesticides of several classes used for the treatment of apples and pears, down to their respective maximum residue limits (MRLs). It involves a rapid extraction procedure and liquid chromatography coupled to electrospray mass selective detection. Seven pesticides were extracted at pH 4.5 with a mixture of acetone-dichloromethane-hexane (50:20:30, v/v/v). Ionization was performed at atmospheric pressure in an electrospray-type source and detection was carried out using the selected ion monitoring (SIM) mode. Extraction recoveries were between 55 and 98% except for methylthiophanate (< 20%). Limits of detection (LODs) and limits of quantitation (LOQs) ranged, respectively, from 0.01 to 0.02 mg/kg and from 0.02 to 0.05 mg/kg, with relative standard deviation (R.S.D.) less than 19%. An excellent linearity was observed for LOQs up to 5 mg/kg. Intermediate ("inter-assay") precision and accuracy were satisfactory. The method was applied to many fruit samples intended for commercialization.

Multiresidue determination of pesticides in apples and pears by gas chromatography-mass spectrometry.

This paper describes a rapid, specific and sensitive multiresidue method for the routine analysis of several classes of pesticides used for the treatment of apples and pears, involving a rapid extraction procedure at pH 4.5 with a mixture of acetone-dichloromethane-hexane (50:20:30, v/v/v) and gas chromatography coupled to mass-selective detection, in order to achieve quantitative analysis down to their respective maximum residue limit. Extraction recoveries were between 55 and 98%. Limits of detection and limits of quantitation ranged respectively, from 0.01 to 0.05 mg/kg and from 0.02 to 0.1 mg/kg. Intra-assay relative standard deviation was less than 19% for all compounds. An excellent linearity was observed from these LOQs up to 500 mg/kg. Intermediate (inter-assay) precision and accuracy were satisfactory. The method has been applied to many fruit samples intended for commercialisation.

[Effect of an acidic sulfated polysaccharide on whole blood coagulability. In vivo study in rats]. / Action d'un polysaccharide sulfaté acide sur la coagulabilité globale du sang. Etude in vivo chez le rat.

Armatan, an acid sulphated polysaccharide isolated from a red marine seaweed Asparagopsis armata (Harv.), increases the coagulation time of the rat plasma in vivo assays. This property presents, with administration, time and dose, some variations. Among the three ways studied, subcutaneous injection gives more interesting results than the others. At high concentrations (10, 20 and 50 mg/kg), intravenous administration induces plasma and organic (liver-spleen) diseases.

[Effects of a fixed mixture of lactate, glucose and phosphate on the survival of human spermatozoa]. / Effet d'un mélange déterminé de lactate, glucose et phosphate sur la survie des spermatozoïdes humains.

It is admitted that selection of human motile spermatozoa improves chances of conception by homologous artificial insemination. Effect of media constituted by different concentrations of glucose, lactate and phosphate in the maintenance of vitality and forward motility (positively correlated with penetrating capacity) was studied in human spermatozoa after washing. Lactate optimal concentrations appear necessary in the maintenance of progressive motility. The vitality is little affected in the various media. To complete this minimum medium various substances known to improve spermatozoa survival should be added. This complete media should allow to dispose of suitable spermatozoa suspensions during several days permitting many inseminations by cycle.

[Survival of motile spermatozoa in a medium based on lactate, glucose and phosphate]. / Survie des spermatozoïdes mobiles dans un milieu à base de lactate, glucose et phosphate.

Suspensions of motile human spermatozoa, plasma seminal-free, were incubated several days into synthetic medium (C2) with lactate, glucose and phosphate as principal components. Maintenance of forward motility was compared in C2 medium and in known B2 I.N.R.A. medium. C2 medium entertain survival of motile spermatozoa during some days at 20 degrees C. This method of conservation should allow many homologous artificial inseminations by ovulatory cycle avoiding injurious effects of repeated ejaculations or low-temperature conservation.

[Characteristics of the action of an acidic sulfated polysaccharide on global blood coagulation in vitro. Preliminary study in various species of mammals and in man]. / Particularités de l'action d'un polysaccharide sulfaté acide sur la coagulation globale du sang in vitro. Etude préliminaire chez différentes espèces de Mammifères dont l'Homme.

An acid sulphated polysaccharide, isolated from a red marine seaweed, Asparagopsis armata ( Harv .), increases the coagulation time of the plasma in vitro studies. This property, compared with the anticoagulant activity of pentosan polysulphate and heparin, pr esents , with concentration and temperature, some variations in man and other mammals . The rat and human plasma seem to behave in the same way with this substance.