De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has become the most frequently performed bariatric procedure to date. However, LSG is known to worsen pre-operative and result in de novo gastroesophageal reflux disease (GERD). Pre-operative evaluation reveals a high percentage of silent GERD of so far unknown influence on post-operative GERD. METHODS: Prospective data of patients undergoing primary LSG between 01/2012 and 12/2015 were evaluated. Pre-operative GERD-specific evaluation consisted of validated questionnaires, upper endoscopy, 24 h-pH-manometry, and esophagograms. Patients were followed-up with questionnaires every 6 months, upper endoscopies after 1 year and 24 h-pH-metry after 2 years. Silent GERD was defined as esophagitis grade > B and/or abnormal esophageal acid exposure in absence of symptoms. LSG was performed over a 32F bougie, hiatal hernias > 1 cm were addressed with posterior hiatoplasty. Excluded were patients with hiatal hernias > 4 cm, patients with incorrect anatomy (stenosis, fundus too large) and conversion to RYGB for early leaks. RESULTS: 222 patients were included. Mean follow-up was 32 ± 16 months, mean preoperative body mass index 49.6 ± 7.2 kg/m2. 116 patients (52%) presented with post-operative GERD-symptoms, of which 85 (73%) had de novo symptoms. Of those, 48 (of 85, 56%) had no preoperative GERD and 37 (of 85, 44%) silent GERD. 57 patients (26%) had neither pre- nor post-operative GERD, 7 (3%) had silent pre-operative and no postop GERD, and in 19 patients (9%) GERD was cured with LSG. 31 patients (14%) stayed symptomatic. Of 56 patients (25%) with pre-operative silent GERD, 37 (of 54, 66%) became symptomatic. CONCLUSION: LSG leads to a considerable rate of post-operative GERD. De novo-GERD consist of around half of pre-operative silent GERD and completely de novo-GERD. Most patients with pre-operative silent GERD became symptomatic.

Sentinel pigeon surveillance for West Nile virus by using lard-can traps at differing elevations and canopy cover classes.

Sentinel pigeons, Columba livia, were installed in lard-can traps at heights of 1.5 m and 7.6-9.1 m within differing canopy cover classes in New York City. Adult mosquitoes were collected weekly from July to October 2002, as were serum samples from each pigeon. Culex pipiens L. and Culex restuans Theobald comprised 97% of mosquitoes collected and were most numerous in canopy-level, forested traps. The West Nile virus (family Flaviviridae, genus Flavivirus, WNV) seroconversion rate was significantly greater for pigeons in canopy-level traps, although seroconversions occurred concurrently with human cases in the city and were of little prognostic value to public health agencies. Our results indicate that sentinel pigeons were most effective for monitoring enzootic transmission of WNV when placed in single-sentinel caging 7.6-9.1 m above ground level.

Diet preferences for specific fatty acids and their effect on composition of fat reserves in migratory Red-eyed Vireos (Vireo olivaceous).

Fatty acid composition of body fat in birds often differs between bird species and between seasons, and changes in diet may be responsible for this variation. We tested two related hypotheses using Red-eyed Vireos, a long-distance migratory songbird: (1) birds prefer diets with certain fatty acids, and (2) fatty acid composition of the diet primarily determines the composition of lipid reserves. During paired-choice experiments, vireos preferred semi-synthetic diets with triolein (81% digestive extraction efficiency) over diets with tristearin (54% digestive extraction efficiency) and, in general, ate more when offered diets with unsaturated fats compared to saturated fats. These results demonstrate that vireos can discriminate between diets differing only in fatty acid composition and prefer diets with long-chain unsaturated fatty acids. When vireos were fed one of two diets for 1 month, the primary fatty acids in each diet also predominated in the tissues of birds fed each diet. However, some fatty acids that were absent in the diet occurred in bird tissues (e.g., 22:4, 22:5) suggesting that selective metabolism of fatty acids along with diet composition determine the fatty acid composition of lipid reserves in migratory birds.