bluuebunny/crossref_metadata_2025 huggingface dataset:
IBC Oxford University Oral Abstract 50 - Addressing leaks in one anastomosis gastric bypass: 2024 comprehensive systematic review and meta-analysis
Authors: Kermansaravi M , Shahmiri S Shahabi , Kassir R , Valizadeh R , Parmar C , Davarpanah Jazi A H , Benois M
Published: February 2025

Introduction

One-anastomosis gastric bypass (OAGB) complication, such as leakage, can be dangerous and should be managed properly, yet little data exist in the literature regarding the management of leaks after OAGB, and there are no guidelines to date.

Methods

The authors performed a systematic review and meta-analysis of the literature and 46 studies, examining 44 318 patients were included.

Results

There were 410 leaks reported in 44 318 patients of OAGB published in the literature, which represents a prevalence of 1% of leaks after OAGB. The surgical strategy was very variable among all the different studies; 62.1% of patients with leaks had to undergo another surgery due to the leak. The most commonly performed procedure was peritoneal washout and drainage (with or without T-tube placement) in 30.8% of patients, followed by conversion to Roux-en-Y gastric bypass in 9.6% of patients. Medical treatment with antibiotics, with or without total parenteral nutrition alone, was conducted in 13.6% of patients. Among the patients with the leak, the mortality rate related to the leak was 1.95%, and the mortality due to the leak in the population of OAGB was 0.02%.

Conclusion

The management of leaks following OAGB requires a multidisciplinary approach. OAGB is a safe operation with a low leak risk rate, and the leaks can be managed successfully if detected in a timely fashion. Keywords: bariatric, leak, one-anastomosis gastric bypass, weight loss.
IBC Oxford University Oral Abstract 51 - Comparison between low-molecular-weight heparin and apixaban for prophylaxis against venous thromboembolism after laparoscopic sleeve gastrectomy: a randomized controlled trial
Authors: Abdelsalam A
Published: February 2025

Background

Venous thromboembolism (VTE) is a possible complication after bariatric-metabolic surgery. Low-molecular-weight heparin (LMWH) is commonly used to prevent VTE, but there is limited data on the use of direct oral anticoagulants (DOACs). Apixaban, which is primarily absorbed in the proximal small bowel, may offer advantages over LMWH.

Objectives

This study aimed to assess the efficacy and safety of apixaban compared to LMWH for VTE prophylaxis after laparoscopic sleeve gastrectomy (LSG), by evaluating the incidence of VTE and bleeding.

Methods

This study was a randomized, single-blind, parallel-group (1:1) controlled clinical trial that enrolled 100 adult participants of both genders, aged 18 to 65 years who were scheduled for LSG at Cairo University Hospitals between August 2022 and January 2024. Subjects with severe obesity (BMI ≥ 40 kg/m² or ≥ 35 kg/m² with comorbidities), normal preoperative human coagulation factor Xa serum level, and normal preoperative mesenteric, portal, splenic, and lower limb venous duplex were recruited. Exclusion criteria for this study included a history of bariatric surgery other than LSG, VTE/pulmonary embolism, or heart valve replacement, as well as pregnancy, lactation, and missed follow-up duplex. Participants were randomly assigned to one of two groups (50 patients each) using a computer-generated random sample table. Group A received postoperative prophylaxis with LMWH (1 mg/kg/day, max 120 mg/day) from day 1 to day 15, while G to day 15. Assessment of VTE was conducted on postoperative day 15 via venous duple roup B received postoperative prophylaxis with apixaban (2.5 mg twice daily) from day 1x of the mesenteric, splenic, portal, and lower limb veins.

Results

No statistically significant differences were observed between groups in VTE (0% incidence) or major postoperative bleeding (2% incidence).

Conclusion

Apixaban is as effective and safe as LMWH in preventing VTE after LSG, highlighting its potential role in this setting.
IBC Oxford University Poster Abstract 3 - Novel technique in reversal of RYGB leads to remission of postprandial hyperinsulinaemic
Authors: Shah K , Holmer H , Thörn S , Gislason H
Published: February 2025

Background and Aim

Postprandial hyperinsulinaemic hypoglycaemia is one of the complications occurring after Roux-en-Y gastric bypass. Nutritional and medical treatment are considered first line of treatment, but some cases are deemed intractable as to why surgical options are explored. Amongst these, a novel technique—Functional reversal—has been proposed as an alternative to anatomic reversal that elsewise carries a higher complication rate and is technically more demanding. In this case report the effect of functional reversal in alleviating intractable hypoglycaemia was assessed.

Case Presentation

We present the case of a 62-year-old Caucasian male who had undergone Roux-en-Y Gastric bypass for morbid obesity. Shortly after the procedure he started complaining of episodical hypoglycaemia that aggravated to daily symptoms consistent with Whipple’s Triad. Conservative treatment with Acarbose and Liraglutide along with dietary regulations proved futile and he underwent a functional reversal that entailed a laparoscopic construction of a gastro-gastric fistula thus enabling a passageway through the otherwise remnant stomach of his gastric bypass. Immediately after the procedure, serum-glucose levels normalized. Continuous glucose monitoring four months after surgery showed resolution of his postprandial hyperinsulinaemic hypoglycaemia. Eating and dietary habits returned to normal.

Conclusion

Functional reversal leads to resolution of intractable postprandial hyperinsulinaemic hypoglycaemia after RYGB. Prospective studies should evaluate the reproducibility of the treatment effect and could thus prove a safe and viable alternative to anatomic reversal.
IBC Oxford University Poster Abstract 4 - Cicatrized ulcer at the gastro-jejunostomy in OAGB case managed by conversion to RYGB
Authors: Abdelsalam A
Published: February 2025

Background

One Anastomosis Gastric Bypass (OAGB) has gained popularity over the years since introduced by Rutledge in 1997. It has been proposed as a simpler and efficient weight-reducing surgery. It offers improvement/cure for many parts of metabolic syndrome, especially diabetes and hypertension. Needless to mention its effects on sleep apnoea syndrome, osteoarthritis, and many other diseases related to obesity. However, it comes with many risks as well, starting from leakage and bleeding to long-term nutritional deficiencies. Biliary reflux is a fearful complication whose incidence is not accurately reported. There are few papers in the literature talking about stomal ulcers after OAGB, with some of them talking about perforated ulcers.

Case Presentation

We present here a case with the history of OAGB that was done two years before presentation with a weight of 117 kg and a height of 175 cm (BMI = 38.2 kg/m2). He came with a complicated stomal ulcer ending in fibrosis as diagnosed with upper endoscopy and 3D CT volumetry. This led to obstruction of the gastro-jejunostomy with severe vomiting and malnutrition. His BMI at presentation was 17 kg/m2. The patient tried medical treatment, but it failed because of the fibrosis at the level of GJ anastomosis. We went for exploratory laparoscopy aiming at resection of the fibrotic part and going for RYGB. The GJ was adherent to the stomach anteriorly and the remnant stomach posteriorly, so we had to do some sort of partial gastrectomy to be able to resect the fibrotic area and be able to create a pouch for RYGB. We did RYGB with 50 cm BP limb length and 50 cm for the alimentary limb aiming at relieving obstruction not for weight loss.

Results

The patient was admitted to the hospital for 5 days to monitor his vitals as well as his tolerance to fluids. He was discharged then and follow-ups after two weeks, 6 weeks then two months were unremarkable.

Conclusion

There are few papers about stomal ulcers after OAGB, and perforating cicatrized ulcers might not be mentioned in the literature to our knowledge.
IBC Oxford University Poster Abstract 11 - Accessing common bile duct stones after one anastomosis gastric bypass—same destination via different route
Authors: Bhambri A , Budhiraja S
Published: February 2025

Background

Laparoscopic Mini Gastric Bypass/One Anastomosis Gastric Bypass (MGB/OAGB) excludes the common bile duct (CBD) from traditional diagnostic and therapeutic treatment options with Endoscopic Retrograde Cholangiopancreatography (ERCP). Accessing CBD becomes limited and challenging due to altered MGB/OAGB anatomy. Due to the initial rapid weight loss, MGB/OAGB patients have an increased risk of developing cholelithiasis as well as choledocholithiasis.

Case Presentation

This technique demonstrates how to safely treat this rare problem by performing a combined laparoscopic and endoscopic approach—Trans-gastric ERCP. Methods A 53-year-old female with an initial BMI of 41 kg/m2 and an absolute weight of 134 kg, underwent MGB/OAGB 6 months ago. She had normal liver function tests (LFTs) and an ultrasound abdomen preoperatively. She lost 21 kgs of body weight over 5 months postoperatively. She had a history of laparoscopic cholecystectomy done 20 years ago, so she was not started on the Ursodeoxycholic-acid regimen post-operatively. She was admitted given the history of severe episodic epigastric pain for one week. There were no other complaints. Results She was evaluated and showed deranged LFTs including significantly raised serum alkaline phosphatase (ALP) and Gamma glutamyl transferase (GGT) levels, which raised suspicion of some biliary pathology. MRCP abdomen revealed dilated CBD of 24 mm with lower CBD calculus sized 9.8 mm, with sludge or a possible stricture. She underwent Laparoscopic Trans-gastric ERCP. Access was made by creating a gastrotomy in the remnant of the stomach for placement of an endoscope. Getting access to the remnant of the stomach was challenging due to dense adhesions from the previous two surgeries and smaller gastric remnants because of the long and loose gastric pouch of OAGB/MGB as compared to Roux-en-Y gastric bypass. Retrieval of stones and dilatation of lower CBD stricture area was done along with taking biliary stricture brush cytology. Complete clearance of CBD was done with multiple balloon sweeps and endoscopic papillary balloon dilatation was done up to 12 mm. The gastrotomy performed on the remnant of the stomach was closed. Post-surgery her LFTs become normal and biliary brush cytology reported negative for malignancy.

Conclusion

Treating the Bile duct pathology endoscopically after MGB/OAGB is technically challenging and requires multidisciplinary teams. It can be managed safely and effectively at centres with both high endoscopic and bariatric expertise.
IBC Oxford University Poster Abstract 15 - Unsuccess of metabolic and bariatric surgery—beyond the anthropometric criteria: a retrospective cohort study
Authors: Amorim-Cruz F , Santos-Sousa H , Nogueiro J , Vaz S , Vieira-Sousa1 P , Peleteiro B , Lemos J , Resende F , Costa-Pinho A , Preto J , Freitas P , Carneiro S , da-Costa E Lima
Published: February 2025

Background

Despite metabolic and bariatric surgery (MBS) being an effective treatment for clinically severe obesity, some patients experience insufficient weight loss (IWL) and weight regain (WR). MBS also has a significant impact on obesity-related comorbidities, perhaps not reflected in categorical definitions of IWL and WR. Therefore, MBS success should not only be measured by a percentage of weight change. Our study aims to investigate whether the definitions of anthropometric criteria used to determine unsuccessful weight loss have clinical significance for MBS unsuccess.

Methods

We conducted a single-centre retrospective cohort study with 1042 consecutive patients submitted to MBS between 2019 and 2021. In terms of anthropometric criteria, at 2 years of follow-up, unsuccessful weight loss was explored as IWL and WR, both as a dichotomous (IWL defined as percentage of total weight loss (%TWL) <20% and WR as an increase in excess weight loss (%EWL) >30% from nadir) and a continuous variable. MBS clinical unsuccess was defined as a composite endpoint including the worsened or unchanged comorbidities (hypertension, type 2 diabetes, dyslipidaemia, and OSA), need for revisional bariatric surgery and mortality at 90 days. Area under the Receiver Operating Characteristic (AUC-ROC) curve was computed to evaluate model performance.

Results and Discussion

At 2 years of follow-up, for dichotomous definitions (defining anthropometric unsuccessful weight loss), AUC-ROC showed that any anthropometric criteria weren’t good enough to predict unsuccess of bariatric surgery, although IWR was significantly superior to WR [Fig. 1, AUC IWL 0.54 (95%c.i.: 0.52–0.56); AUC WR 0.51 (95% c.i.: 0.49–0.52), P = 0.001]. For continuous variables (Fig. 2), AUC-ROC for TWL was 0.62 (95% c.i.: 0.58–0.66) and for EWL was 0.58 (95% c.i.: 0.54–0.62), suggesting that for the definition of anthropometric criteria (both IWL and WR) a new cut-off could improve prediction of MBS clinical unsuccess.

Conclusion

The present study shows how different definitions of IWL and WR could not reflect the outcomes of MBS, since no single anthropometric criteria can reliably predict the unsuccess of metabolic bariatric surgery (remission of comorbidities, need for revisional surgery, and mortality).
IBC Oxford University Poster Abstract 17 - Early postoperative complications after bariatric surgery in Misurata, Libya: a single centre analysis
Authors: Elzowawi F , Shenaisheh S , Algubbi M , Rmali S , Alhubge M , Shikshaka B
Published: February 2025

Introduction

Bariatric surgery is the most effective treatment for morbid obesity and associated medical co morbidities. Bariatric procedures are generally safe and effective but can be associated with complications. Early complications may include bleeding, leakage, venous thromboembolic events (VTE), wound infection, abdominal wall hematoma, and dehydration required admission.

Aim

The aim of this study is to assess the incidence, clinical presentation, risk factors, and management of early postoperative complication within 30 days.

Materials and Methods

This single centre retrospective cohort study of collected data for all patients who underwent one of Bariatric Surgical operations: Sleeve gastrectomy, One anastomosis gastric bypass, Roux-en-Y gastric bypass (RNYGB), Single anastomosis sleeve ileal (SASI) in the period between January 2018 September 2023.

Results

The total number of patients who underwent bariatric surgeries were 861, of them 562 (65.3%) were females 299 (34.7%) were males. Body mass index (BMI) for the patients ranged from 35 to 65ٍ kg/m2 with mean 46.2 kg/m2. The most common procedures done was sleeve gastrectomy 554 (64.3%), followed by bypass surgery 292(33.9%), and 15(1.8%) were revisional procedures. The most common early complications was abdominal wall hematoma which occurred in 27 (3.1%) patients, followed by dehydration in 21 (2.4%), post operative bleeding (POB) which occurred in 16 (1.9%) patients of them 12 (1.4%) patients extra-luminal bleeding (ELB) and 4 (0.5%) patients Intraluminal bleeding (ILB), followed by wound infection in 11 (1.3%) patients, VTE as well as leakage occurred in 5 (0.6%) patients, and prolonged ileus in 2 (0.25%) patients. Noticeably, the leakage was strongly related to higher BMI (P < 0.01), while bleeding was strongly associated with hypertensive patients (P < 0.05).

Conclusion

The incidence of early complications after bariatric surgery remains within the acceptable range in comparison with the other published studies. Most of the early complication could be managed conservatively while surgical treatment might be required for some patients especially with hemodynamic instability.
IBC Oxford University Poster Abstract 22 - Definition and predictors of weight regain after metabolic and bariatric surgery: a retrospective cohort study
Authors: Amorim-Cruz F , Santos-Sousa H , Nogueiro J , Vaz S , Vieira-Sousa J P , Lemos J , Peleteiro B , Resende F , Costa-Pinho A , Preto J , Freitas P , Carneiro S , da-Costa E Lima
Published: February 2025

Background

Despite the benefits of metabolic and bariatric surgery (MBS), not all patients can maintain sustained weight loss in the long term. There is increasing awareness that weight regain (WR) is a common issue following MBS. However, WR is defined using various criteria, which makes it challenging to understand its prevalence and clinical impact after MBS. As a result, the factors that contribute to WR before, during, and after surgery are not well understood. This study aims to assess WR at two-years after bariatric surgery, using four definitions, and to identify clinically significant predictors of WR to improve patient counselling regarding prevention and optimize intraoperative bariatric procedures.

Methods

We conducted a single-centre retrospective cohort study with 1056 consecutive patients submitted to MBS between 2019 and 2021 and followed for at least 2 years. At two-years of follow-up, WR was defined based on four definitions: (1) an increase in weight of more than 10 kg from nadir, (2) an increase in excess weight loss (%EWL) higher than 30% from nadir, (3) an increase in BMI of 5 kg/m2 from nadir, (4) any weight regain. Nadir’s weight was determined based on all the postoperative weight measures available. Univariate and multivariate analyses were performed using logistic regression to compute the odds ratio (OR) and the 95% confidence intervals (95%c.i.).

Results and Discussion

A total of 1056 patients were included, with a mean age of 45.8 (±10.3) years, of which 82.9% were female. The proportion of WR ranged from 1.0 to 55.0% depending on the definition, being ‘any weight regain’ the definition with the highest proportion of patients (n = 581). Considering %EWL as the definition for WR, after multivariable adjustment, patients with lower presurgical BMI (adjusted odds ratio [adjOR]: 0.81, 95% c.i.:0.70–0.92), diabetes (adjOR: 3.72, 95% c.i.: 1.23–11.26) and history of intragastric balloon placement (adjOR: 9.07, 95% c.i.: 1.34–61.32) had higher risk of WR. Across the 4 definitions, there were no shared independent predictors of WR after MBS. However, in multivariable analysis, history of sleeve gastrectomy was a predictor of WR for 3 definitions, except for %EWL >30% from nadir. Moreover, presurgical BMI was a predictor for 3 definitions, but the direction of effect was not even.

Conclusion

In this cohort of patients, we found that identifying one single definition of clinically significant WR is challenging. The predictors of WR varied depending on the definition applied. No common predictors of WR after MBS were found, across all four definitions.
IBC Oxford University Poster Abstract 23 - Incidence and predictors of petersen’s hernia after laparoscopic antecolic Roux-en-Y gastric bypass—5 year results of an experienced center
Authors: de Almeida M Andrade , Sousa H Santos , Nogueiro J , Araújo Teixeira J P , Cruz D , Lemos J , Peleteiro B , Resende F , Pinho A Costa , Preto J , Freitas P , Carneiro S , da Costa E Lima
Published: February 2025

Background

Roux-en-Y gastric bypass (RYGB) is the second most frequent bariatric procedure worldwide. Internal herniation is a well-described late complication of this operation. Petersen’s hernia (PH) occurs within Petersen’s space, which is iatrogenically created between the transverse mesocolon, the Roux limb, and the retroperitoneum. The aims of this study were to investigate the incidence of symptomatic Petersen’s hernias (PH), to determine risk factors for their occurrence, and provide insight on the eventual benefit of systematic Petersen’s space closure in addition to mesenteric defect closure.

Methods

A single-centre retrospective descriptive study was performed. Patients submitted to laparoscopic RYGB from January 2019 to December 2023 in our centre were included. All patients were reconstructed in an antecolic anastomosis fashion. Only cases of symptomatic PH were eligible.

Results

During a 5-year period, 2117 patients were submitted to laparoscopic RYGB without routine closure of Petersen’s space. Exploratory laparoscopy for suspicion of bowel obstruction and consecutive Petersen’s space closure with running non-absorbable suture was performed in 22 patients. Mean age of PH patients was 43.6 (±10.3) years. Regarding gender, twenty patients (90.9%) were female. In our study’s timeframe 9 patients had BGYR and consequently PH surgery leading to a 0.4% incidence. In this same period, 13 other patients who underwent RYGB prior to 2019 (7), or in another institution (6), were also operated for PH. The median time between RGYB and PH surgery was 28.1 months (IQR 42.7). Mean preoperative BMI at PH surgery was lower than mean 24 months’ post-RYGB BMI for non-PH patients (24.7 ± 4.0 versus 26.9 ± 4.0, P = 0.011). Revisional surgery and gastric remnant resection were not risk factors for PH (P = 0.185 and P = 0.988, respectively). We report no cases of bowel necrosis or mortality. No PH recurrences were recorded.

Conclusions

PH is a potentially serious complication of RGYB. Its clinical presentation ranges widely, from asymptomatic to mild and intermittent abdominal cramping and colicky pain to acute small bowel obstruction and ultimately intestinal strangulation. CT scan is helpful preoperatively and careful attention should be given to indicators of midgut volvulus such as the mesenteric swirl sign. PH must be suspected in RGYB patients even if their symptoms are scarce.
IBC Oxford University Poster Abstract 24 - Effects of bariatric surgery in individuals with PTEN hamartoma tumour syndrome (PHTS): a systematic review
Authors: Oceguera I N , Yang W , Parmar C , Pouwels S
Published: February 2025

Background

The aim of this systematic review is to provide an overview of the literature on the effects of bariatric surgery (BS) in patients with obesity and PTEN Hamartoma Tumour Syndrome (PHTS) diagnosis.

Methods

Two studies were included with a methodological quality ranging from poor to good. Both studies were case reports in young females (<35yo), with massive effects on weight loss and HbA1c levels.

Results

Bariatric surgery in patients with obesity and PHTS diagnosis results in significant decrease in weight and complete remission of Type 2 Diabetes Mellitus (T2DM). The effects on thyroid hormones, lipid levels, renal function, and psychological factors after bariatric surgery in PHTS remain unexplored.

Conclusion

More research is needed to fully understand how bariatric surgery can take part in the preventative treatment options for PHTS patients with obesity.
IBC Oxford University Poster Abstract 25 - Role of intraoperative oesophagogastroscopic guidance in minimizing laparoscopic bariatric surgery related morbidity
Authors: Amer Y
Published: February 2025

Background

Postoperative staple line and gastro-jejunal anastomosis (GJA) leak is one of the most serious complications after LSG and LRYGB. GJA leak has reported frequencies of 0.3–5.1% with mortality ranging from 1.5 to 3%. Early postoperative bleeding and anastomotic stricture are also significant complications in patients after LRYGB with reported frequencies of 3.4% to 11.1%. The use of a leak test is a common practice in bariatric surgery. Some surgeons advocate for an intra-operative endoscopy for their leak test, while others utilize air via a form of an oral gastric tube. Previous articles have demonstrated the value of endoscopy in surgical procedures and the low risk associated with its use.

Objectives

The current study will be conducted to assess the safety and efficacy of using endoscope that serves as the bougie tube and then it is already in place for early detection of complications for example leakage (positive air leak test),maladjustment of lumen size (sleeve or stoma) and bleeding.

Methods

Between September 2021 and August 2023, 100 laparoscopic bariatric surgery were performed. For sleeve gastrectomy, endoscope was used as Bougie tube then staple line will be checked, a positive air leak test was done. For bypass surgery, the stoma was entered by the endoscope for checking staples, patency and early detection and dealing with leakage and bleeding.

Results

Concerning intraoperative complications, no patient had bleeding. two patients had leak which was corrected by reinforcement suture. Another patient had twisting which was corrected. Postoperatively, all patients did not develop leak, bleeding or obstructive symptoms. Three patients had postoperative vomiting which was corrected by prescribing antiemetics. There were no statistically significant associations between incidence of intra/postoperative complications and either age, weight, body mass index, operative time or comorbidities.

Conclusion

Overall, our experience has been very positive with utilization of intraoperative endoscopy after creation of our sleeve gastrectomy. Our leak rate is extremely low and occurred very early in our experience, and we believe that taking the extra time to perform a leak test using an endoscope will pay dividends for both the practitioner and the patient.
IBC Oxford University Poster Abstract 27 - Is distalization a good option for insufficient weight loss or weight regain after Roux-en-Y gastric bypass? The initial experience of a differentiated center
Authors: Oliveira A , Santos-Sousa H , Machado M , Coutinho C , Nogueiro J , Lemos J , Peleteiro B , Resende F , Pinho A , Preto J , Freitas P , Carneiro S , da Costa E Lima
Published: February 2025

Introduction

Bariatric surgery is recognized as the most effective long-term treatment for clinically severe obesity, leading to sustained weight loss. Among the common bariatric procedures, the laparoscopic Roux-en-Y gastric bypass (RYGB) is frequently performed and is known for its significant weight loss results and its ability to reduce obesity-related comorbidities in many patients. However, 10% to 40% of patients may experience insufficient weight loss (IWL) or weight regain (WR), along with the persistence or recurrence of comorbidities after 5 to 7 years, presenting a major challenge for bariatric surgeons. The distalisation of RYGB, a revisional malabsorptive procedure, can potentially address these issues but comes with its own complications.

Methods

We reviewed all distalisations of RYGB performed at our hospital between 2019 and 2023. During this period, a total of 2117 RYGB surgeries were performed. The primary outcomes assessed were weight loss progress and changes in comorbidities. Secondary outcomes included early postoperative complications and the need for surgical revisions.

Results

A total of 13 distalisations of RYGB type I (BPL distalisation) were performed, all on female patients with a median age of 49 years. The median BMI was 50.7 kg/m2 at the initial bypass and 41.2 kg/m2 before the distalisation. The median interval between the two surgeries were 103 months. In all the cases, the common limb length was more than 2.5 m and there was a median length of 2.32 m of the biliopancreatic limb. Total weight loss was 27.7% at 6 months, 30% at 1 year (n = 9), 25.2% at 1.5 years (n = 7), and 24.1% at 2 years (n = 6). Among the four patients with hypertension before the revisional surgery, there was one patient with remission at 6 months post-surgery, while the others continued to have hypertension. There were no cases of diabetes mellitus, dyslipidaemia, or sleep apnoea syndrome prior to the surgery. However, one patient developed diabetes mellitus 6 months post-surgery. The average surgery duration was 107 minutes, and patients were discharged after 2 days. There were no complications, and no surgical revisions were required. The median follow-up time was 23 months.

Discussion

Our hospital’s experience with distalisation procedures demonstrates that this surgery is both safe and effective, leading to significant BMI reduction without malnutrition. Furthermore, the initial surgery was highly effective in reducing comorbidities, as most patients had remission of these conditions following gastric bypass.

Conclusions

The limited number of cases hinders our ability to draw definitive conclusions. Increasing the number of cases will be crucial for obtaining more reliable results.
Differential links in 16p11.2 deletion carriers reveal aberrant connections between large-scale networks
Authors: Qureshi Abid Y , Nielsen Jared A , Sepulcre Jorge
Published: February 2025

Qualitatively different topographical patterns of connections are thought to underlie individual differences in thought and behavior, particularly at heteromodal association areas. As such, we hypothesized that connections unique to 16p11.2 deletion carriers compared to controls, rather than hyper- or hypo-connectivity, would serve as a better model to explain the cognitive and behavioral changes observed in individuals carrying this autism-risk copy number variation. Using a spatially-unbiased, data-driven approach we found that differential links clustered non-uniformly across the cortex—particularly at the superior temporal gyrus and sulcus, posterior insula, cingulate sulcus, and inferior parietal lobule bilaterally. At these hotspots, altered local connectivity that spanned across the borders of cortical large-scale networks coincided with aberrant distant interconnectivity between large-scale networks. This was most evident between the auditory and the dorsomedial default (DNb) networks—such that greater between-network interconnectivity was associated with greater communication and social impairment. Entangled connectivity between large-scale networks may preclude each network from having the necessary fidelity to operate properly, particularly when the 2 networks have opposing organization principles—namely, local specialization (segregation) versus global coherency (integration).
Multi-parameter Persistence Modules are Generically Indecomposable
Authors: Bauer Ulrich , Scoccola Luis
Published: February 2025

Algebraic persistence studies persistence modules (typically, linear representations of the poset $\textbf{R}^{n}$ with $n \geq 1$) and the algebraic relationships between persistence modules that are interleaved. The notion of $\varepsilon $-interleaving between persistence modules is a generalization of the notion of isomorphism (recovering isomorphism when $\varepsilon = 0$), which can be used to quantify how far any two persistence modules are from being isomorphic. An emblematic example of this kind of study is the algebraic stability theorem, which strengthens the Krull–Schmidt property of one-parameter persistence modules (representations of $\textbf{R}$) by generalizing isomorphism to interleaving: If a pair of one-parameter persistence modules is $\varepsilon $-interleaved, then there exists a partial matching between the indecomposable summands of the two modules such that matched indecomposables are $\varepsilon $-interleaved and unmatched indecomposables are $\varepsilon $-interleaved with the zero module. Our first main result implies that the obvious extension of the algebraic stability theorem to the case of multi-parameter persistence modules (representations of $\textbf{R}^{n}$ with $n \geq 2$) fails spectacularly: Any finitely presentable multi-parameter persistence module can be approximated arbitrarily well by an indecomposable module. Our second main result states that modules that are sufficiently close to an indecomposable decompose as a direct sum of an indecomposable and a nearly trivial module. We derive from these two results several consequences about the interplay between the algebraic and the topological properties of multi-parameter persistence modules. These results provide strong motivation for approaching multi-parameter persistence in a way that does not rely on directly decomposing modules by indecomposables.
L-functions for Sp(2n) × GL(k) via Non-unique Models
Authors: Jin Yubo , Yan Pan
Published: February 2025

Let $n$ and $k$ be positive integers such that $n$ is even. We derive new global integrals for $\textrm{Sp}_{2n}\times \textrm{GL}_{k}$ from the generalized doubling method of Cai, Friedberg, Ginzburg, and Kaplan, following a strategy and extending a previous result of Ginzburg and Soudry on the case $n=k=2$. We show that these new integrals unfold to non-unique models on $\textrm{Sp}_{2n}$. Using the New Way method of Piatetski-Shapiro and Rallis, we show that these new global integrals represent the $L$-functions for $\textrm{Sp}_{2n}\times \textrm{GL}_{k}$, generalizing a previous result of the second-named author on $\textrm{Sp}_{4}\times \textrm{GL}_{2}$ and a previous work of Piatetski-Shapiro and Rallis on $\textrm{Sp}_{2n}\times \textrm{GL}_{1}$.
Mitochondrial RNA metabolism, a potential therapeutic target for mitochondria-related diseases
Authors: Duan Tongyue , Sun Liya , Ding Kaiyue , Zhao Qing , Xu Lujun , Liu Chongbin , Sun Lin
Published: February 2025

In recent years, the roles of mitochondrial RNA and its associated human diseases have been reported to increase significantly. Treatments based on mtRNA metabolic processes and nuclear gene mutations are thus discussed. The mitochondrial oxidative phosphorylation process is affected by mtRNA metabolism, including mtRNA production, maturation, stabilization, and degradation, which leads to a variety of inherited human mitochondrial diseases. Moreover, mitochondrial diseases are caused by mitochondrial messenger RNA, mitochondrial transfer RNA, and mitochondrial ribosomal RNA gene mutations. This review presents the molecular mechanisms of human mtRNA metabolism and pathological mutations in mtRNA metabolism-related nuclear-encoded/nonencoded genes and mitochondrial DNA mutations to highlight the importance of mitochondrial RNA-related diseases and treatments.
Unveiling Atrial Fibrillation
Authors: Hassan Muhammad Arslan Ul , Mushtaq Sana , Li Tao , Yang Zhen
Published: February 2025

Atrial fibrillation (AF) is a highly prevalent, progressive cardiac arrhythmia that significantly impacts the patient’s health-related quality of life. AF is linked to a 5-fold and 2-fold higher risk of stroke and cognitive dysfunction, respectively. With advancements in cardiac electrophysiology, many risk factors have been identified, which increase the risk for the development of AF. These risk factors encompassing age, hypertension, smoking, diabetes mellitus, male gender, obesity, alcohol intake, obstructive sleep apnea and so on, can be categorized into 3 major groups: modifiable, non-modifiable, and cardiac. Multiple AF prediction models have been successfully validated to identify people at high risk of AF development using these risk factors. These prediction models, such as CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology) and HARMS2-AF score can be used in clinical practice because of their easy applicability. It is crucial to address modifiable risk factors in individuals with a high risk of developing AF. Furthermore, the implementation of primary AF prevention in individuals at high risk can contribute to improved long-term outcomes. This review aims to provide the most recent, concise explanation of the risk factors linked to AF, the prediction of AF, and strategies for the primary prevention of AF.
Summary of Critical Care Nurses’ Understanding, Adherence, and Barriers in Applying Ventilator-Associated Pneumonia Prevention Guidelines
Authors: Asmar Imad , Almahmoud Omar , Manassrah Aya , Moqady Dalya , Hamed Raneen Abd Al , Soboh Rania , Fatafta Mahmoud
Published: February 2025

Both adults and pediatric patients who are on mechanical ventilation face high rates of mortality and morbidity due to ventilator-associated pneumonia (VAP), which is the most prevalent deadly hospital-acquired infection. Healthcare organizations provide evidence-based guidelines to help nurses decrease VAP in ICUs; however, there are obstacles to putting these guidelines into practice. An extensive investigation was conducted for pertinent English studies published from January 2014 to February 2024 in the databases of Science Direct, Scopus, PubMed, and CINAHL. The study centered on nurses’ understanding, adherence, and obstacles regarding introducing VAP prevention guidelines. The majority of ICU nurses have a basic to intermediate understanding of evidence-based methods to reduce VAP. The nurses in the ICUs typically followed the guidelines for preventing VAP about 60% of the time. A basic analysis of descriptive content identified the obstacles preventing critical care nurses (CCNs) from following VAP PGs. The obstacles were separated into 2 groups: barriers related to nurses (such as education, experience, and training) and barriers related to the work environment (such as lack of supplies, staffing shortage, lack of policies, and ineffective supervision). To improve their skills, CCNs should get frequent updates on courses and seminars related to the VAP PG implementation. Healthcare administrators must be aware of these obstacles and implement work procedures that help CCNs overcome them if they want to increase compliance.
Crisis Management and Problem-Solving Skill Levels of Nurses Caring for Patients With COVID-19 and Affecting Factors
Authors: Kesemen Cansu , Polat Ülkü
Published: February 2025

This study aims to assess the crisis management and problem-solving skills of nurses caring for patients with COVID-19. The participants of this descriptive cross-sectional were 132 nurses who cared for patients with COVID-19 in a public hospital. The crisis management scale (CMS), problem-solving inventory (PSI), and Nurse Introduction Form were used to collect data. In this study, the nurses’ CMS total score average was 3.75 ± 0.442, the average PSI total score was 86.32 ± 24.420, and it was determined that their crisis management ability was at a good level and their problem-solving skills were at a medium level. A significant difference was found between the nurses’ descriptive characteristics of having children (P = .029), being informed about crisis management (P = .035), and their total average score on the CMS (P < .05). A statistically significant negative relationship was found between the nurses’ total CMS and PSI scores (P < .05).This study showed that the problem-solving skill levels of nurses caring for patients with COVID-19 affected their crisis management skills.
Efficacy and safety of PD-1/PD-L1 inhibitor monotherapy or combination therapy versus platinum-based chemotherapy as a first-line treatment of advanced urothelial cancer: A systematic review and meta-analysis
Authors: He Xiaohui , Huang Shibo , Jiang Qiuhong , Huang Conghui , Huang Weisheng , Liang Weiming
Published: February 2025

Background

Recent clinical trials have shown that inhibitors targeting programmed cell death protein 1 (PD-1) or its ligand (programmed cell death-ligand 1 [PD-L1]) provide significant efficacy and clinical benefit in the treatment of advanced or metastatic urothelial carcinoma. This systematic review and meta-analysis aimed to compare the effectiveness and safety of PD-1/PD-L1 inhibitors in combination with chemotherapy or PD-1/PD-L1 inhibitor monotherapy versus platinum-based chemotherapy as a first-line treatment for advanced urothelial carcinoma.

Materials and methods

From the beginning of the database construction to February 4, 2024, a combination of MeSH and free-text words was searched using the population intervention comparison outcome study design framework. The PubMed, Cochrane Library, Embase, and Web of Science electronic databases were searched. Meta-analyses of progression-free survival, overall survival, objective response rate (ORR), complete remission rate, duration of remission, and grade ≥3 adverse events were performed.

Results

Four studies were included in the meta-analysis. The PD-1/PD-L1 inhibitors plus chemotherapy therapy is associated with significantly better ORR rate compared with chemotherapy. Unfortunately, there were no significant differences between PD-1/PD-L1 inhibitor monotherapy and chemotherapy in terms of ORR, duration of remission, or overall survival.

Conclusions

Our findings indicate that PD-1/PD-L1 inhibitors plus chemotherapy therapy provides more oncological advantages than standard chemotherapy and should be recommended as a first-line treatment for advanced or metastatic urothelial carcinoma. Attention must also be paid to the adverse effects of the combination of PD-1/PD-L1 inhibitors and chemotherapy.
Efficacy and safety of a fully covered self-expandable metallic stent equipped with square flare in EUS–guided drainage/anastomosis: A multicenter retrospective study
Authors: Takahashi Sho , Matsubara Saburo , Fujisawa Toshio , Otsuka Takeshi , Suda Kentaro , Ushio Mako , Fukuma Taito , Suzuki Akinori , Takasaki Yusuke , Ito Koichi , Tomishima Ko , Ishii Shigeto , Nagoshi Sumiko , Isayama Hiroyuki
Published: February 2025

Background and Objectives

Recent technological advances in interventional EUS have improved EUS-guided drainage/anastomosis (EUS-D/A), yet challenges remain. This study evaluated the safety and feasibility of a square flare fully covered self-expandable metallic stent (SF-FCSEMS) with anti-migration properties for EUS-D/A.

Methods

This retrospective cohort study was performed at 2 academic centers and analyzed patients who underwent SF-FCSEMS placement for EUS-D/A from April 2015 to November 2022. We have used an SF-FCSEMS that has a square flare at both ends that is 4 mm larger in diameter than the stent body, providing an anti-migration effect.

Results

Thirty-six patients (median age: 74 years), 41.6% male, were included. Malignancies accounted for 83.3%. Among the EUS-D/A procedure types, EUS-abscess drainage was performed in 52.8%, EUS-guided gallbladder drainage in 30.6%, and EUS-guided abscess drainage in 16.7%. The technical success rate was 97.2%, and the clinical success rate was 97.1%. The median procedure time was 36 minutes, with puncture tract dilation conducted in all cases. Adverse events occurred in 11.1%; recurrent symptoms were observed in 11.8%, with no migration. SF-FCSEMS removal was performed in 26.5% of patients during the follow-up period, with a median duration of 154 days. The total cost of deploying SF-FCSEMS was approximately 40% less than that of using lumen apposing metal stent.

Conclusions

EUS-D/A with an SF-FCSEMS, which has anti-migration properties, not only was effective and feasible in the present study but also demonstrated a cost advantage.
Multiple features of cell-free mtDNA for predicting transarterial chemoembolization response in hepatocellular carcinoma
Authors: Dang Miao , Wang Siyuan , Peng Fan , Zhang Runjiao , Jiao Huanmin , Zhang Huanqin , Dong Haiying , Zhang Hongxin , Xing Jinliang , Guo Xu , Liu Yang
Published: February 2025

Background:

Transarterial chemoembolization (TACE) is the primary treatment modality for advanced HCC, yet its efficacy assessment and prognosis prediction largely depend on imaging and serological markers that possess inherent limitations in terms of real-time capability, sensitivity, and specificity. Here, we explored whether multiple features of cell-free mitochondrial DNA (cf-mtDNA), including copy number, mutations, and fragmentomics, could be used to predict the response and prognosis of patients with HCC undergoing TACE treatment.

Methods:

A total of 60 plasma cell-free DNA samples were collected from 30 patients with HCC before and after the first TACE treatment and then subjected to capture-based mtDNA sequencing and whole-genome sequencing.

Results:

Comprehensive analyses revealed a clear association between cf-mtDNA multiple features and tumor characteristics. Based on cf-mtDNA multiple features, we also developed HCC death and progression risk prediction models. Kaplan-Meier curve analyses revealed that the high-death risk or high-progression–risk group had significantly shorter median overall survival (OS) and progression-free survival than the low-death risk or low-progression-risk group (all p<0.05). Moreover, the change in cf-mtDNA multiple features before and after TACE treatment exhibited an exceptional ability to predict the risk of death and progression in patients with HCC (log-rank test, all p<0.01; HRs: 0.36 and 0.33, respectively). Furthermore, we observed the consistency of change between the cf-mtDNA multiple features and copy number variant burden before and after TACE treatment in 40.00% (12/30) patients with HCC.

Conclusions:

Altogether, we developed a novel strategy based on profiling of cf-mtDNA multiple features for prognosis prediction and efficacy evaluation in patients with HCC undergoing TACE treatment.
N-Acetylcysteine for Nonsuicidal Self-Injurious Behavior in 3 Adults With Williams Syndrome
Authors: Kandel Hagar , Cruz Ava R. , Thom Robyn P. , McDougle Christopher J.
Published: February 2025

Background

Williams syndrome (WS) is a genetic disorder that results from a microdeletion of 25 to 27 genes on chromosome 7q11.23. Individuals with WS often exhibit comorbid neuropsychiatric symptoms, especially anxiety. To our knowledge, nonsuicidal self-injurious behavior (NSSIB) has not been reported in WS. N-acetylcysteine (NAC) is a safe and readily available drug that may modulate glutamate activity in the brain. NAC is effective for treating various neuropsychiatric symptoms and disorders. There are limited reports in the literature where NAC has been used to treat NSSIB effectively, but none in WS.

Methods

This report describes using NAC to treat NSSIB in 3 adults with WS.

Findings

Nonsuicidal self-injurious behavior was successfully treated in 3 adults with WS using NAC in doses ranging from 2400 to 3600 mg a day, resulting in significant improvement in their daily functioning. Additionally, NAC was well tolerated.

Conclusions

NAC was effective for treating NSSIB in 3 adults with WS. By addressing these challenging behaviors, NAC offers a promising pharmacological intervention that can significantly improve the quality of life for patients with WS who engage in NSSIB. Further research and clinical trials are necessary.