Emerging evidence that ginseng components improve cognition in subjective memory impairment, mild cognitive impairment, and early Alzheimer's disease dementia.

Ginseng is a traditional herbal medicine used for prevention and treatment of various diseases as a tonic. Recent scientific cohort studies on life prolongation with ginseng consumption support this record, as those who consumed ginseng for more than 5 years had reduced mortality and cognitive decline compared to those who did not. Clinical studies have also shown that acute or long-term intake of ginseng total extract improves acute working memory performance or cognitive function in healthy individuals and those with subjective memory impairment (SMI), mild cognitive impairment (MCI), or early Alzheimer's disease (AD) dementia who are taking AD medication(s). Ginseng contains various components ranging from classical ginsenosides and polysaccharides to more recently described gintonin. However, it is unclear which ginseng component(s) might be the main candidate that contribute to memory or cognitive improvements or prevent cognitive decline in older individuals. This review describes recent clinical contributors to ginseng components in clinical tests and introduces emerging evidence that ginseng components could be novel candidates for cognitive improvement in older individuals, as ginseng components improve SMI cognition and exhibits add-on effects when co-administered with early AD dementia drugs. The mechanism behind the beneficial effects of ginseng components and how it improves cognition are presented. Additionally, this review shows how ginseng components can contribute to SMI, MCI, or early AD dementia when used as a supplementary food and/or medicine, and proposes a novel combination therapy of current AD medicines with ginseng component(s).

Cognitive function improvement effects of gintonin-enriched fraction in subjective memory impairment: An assessor- and participant-blinded placebo-controlled study.

Background: Gintonin is a new material of ginseng that acts through the ginseng-derived lysophosphatidic acid (LPA) receptor ligand. The gintonin-enriched fraction (GEF) inhibits amyloid plaque accumulation in the cortex and hippocampus, improves cognitive dysfunction by increasing acetylcholine levels, and promoted hippocampal neurogenesis in an animal model of Alzheimer's disease. We evaluated the effect of the GEF on the cognitive performance of subjects with subjective memory impairment (SMI). Methods: In this eight-week, randomized, assessor- and participant-blinded, placebo-controlled study, participants with SMI were assigned to three groups receiving placebo, GEF 300 mg/day or GEF 600 mg/day. The Korean versions of the Alzheimer's Disease Assessment Scale (K-ADAS), Mini-Mental State Examination (K-MMSE), and Stroop color-word test (K-SCWT) were also evaluated along with the safety profiles. Results: One hundred thirty-six participants completed the study. After eight weeks, we analyzed intergroup differences in primary or secondary outcome score changes. When we compared the GEF group with the placebo group, we observed significant improvements in the K-ADAS and K-SCWT scores. The GEF group did not show a significant improvement in K-MMSE and BDI scores compared to the placebo group. No adverse events were observed in the gintonin and placebo groups for eight weeks. Conclusion: The GEF is safe and effective in improving subjective cognitive impairment related to both the K-ADAS and K-SCWT in this study. However, further large-scale and randomized controlled studies are warranted to secure other cognitive function tests besides the K-ADAS and K-SCWT, and to confirm the findings of the current study.

Effect of Dispersing Carbon Nanotube in Aqueous Solution by Poly-Carboxylic-Based Surfactants on Mechanical and Microstructural Properties as Cementitious Composites.

The development of high-performance concrete using carbon nanotubes (CNTs), which is used in various industries owing to its excellent mechanical properties, has attracted much attention, leading to ongoing research in this area. However, when mixing CNTs into cement paste, there has been limited focus on the dispersibility, and, in most cases, aqueous dispersions of CNTs used in other industrial sectors are used. Because CNTs form the structures of bundles or aggregates owing to their high aspect ratio and van der Waals force between particles, the desired dispersibility cannot be obtained when mixing CNTs in powder form with other materials. Therefore, in this study, we examined the applicability of CNT aqueous dispersions using PC-based plasticizer used in concrete. Aqueous dispersions of CNT using PC-based surfactants are prepared and their properties are compared with those of a PVP-based aqueous dispersion. To analyze the mechanical properties, the compressive strength and flexural strength are measured on the 28th day. Then, the dispersibility and microstructure are analyzed using scanning electron microscopy image analysis, thermogravimetric analysis, and BET (Brunauer-Emmett-Teller) analysis. The analysis results show the enhancement of mechanical properties due to the mixing of the CNT dispersion, and the results confirm the applicability of the proposed CNT aqueous dispersions using PC-based surfactants.

Safety and efficacy of dietary supplement (gintonin-enriched fraction from ginseng) in subjective memory impairment: A randomized placebo-controlled trial.

BACKGROUND: Gintonin inhibits ß-amyloid production, increases acetylcholine level in the brain, and promotes neurogenesis. We evaluated the efficacy of gintonin-enriched fraction (GEF) in improving the cognitive performance in subjective memory impairment. METHODS: In this 8-week, randomized, assessor and participant blinded, placebo-controlled study, participants with subjective memory impairment but preserved cognitive function (Korean Mini-Mental State Examination [K-MMSE] score ≥23) were assigned to GEF 300mg/day or placebo. K-MMSE, Korean versions of the Alzheimer's disease assessment scale, color-word stroop test (K-CWST), clinical dementia rating, and Beck depression inventory-II were evaluated along with the safety profiles. The primary outcome was set as the change in the K-MMSE. RESULTS: Seventy-six participants complete the study protocol. After 8 weeks, there was no inter-group difference in the primary or secondary outcome score changes. However, GEF group showed an improvement in the K-MMSE scores (P= 0.026), and in the number of correct answers in both word reading (P= 0.008) and color reading (P= 0.005) of K-CWST, although only the improvement in the K-CWST scores were higher than the minimum clinically important difference. The frequency of adverse events was comparable between the groups and all were of mild severity. CONCLUSION: GEF is safe but might not be effective in treating subjective memory impairment within the current study setting. However, GEF showed a trend of improving the global cognition and the frontal executive function. Further large-sized studies with longer follow-up period are warranted. CLINICAL TRIAL REGISTRATION: This clinical trial was registered at Clinical Research Information Service of Korea Centers for Disease Control and Prevention: KCT0004636.

X-ray CT Analysis of the Cross-Section of a 3D-Printed Deformed Layer.

In this study, we experimentally analyzed the deformation shape of stacked layers developed using three-dimensional (3D) printing technology. The nozzle traveling speed was changed to 80, 90, 100, and 110 mm/s when printing the layers to analyze its effect on layer deformation. Furthermore, the cross-sectional area and the number of layers were analyzed by printing five layers with overall dimensions of 1000 (w) × 2200 (l) × 50 (h) mm (each layer was 10 mm high) using Vernier calipers. Moreover, we analyzed the interface and cross-sectional area of layers that are difficult to confirm visually using X-ray computed tomography (X-ray CT) analysis. As a result of measuring the deformation at the center of the layer, it was confirmed that the deformation was greater for lower nozzle traveling speeds. Consequently, the X-ray CT analysis verified that the layer had the same cross-sectional area irrespective of the layer printing order at the same nozzle travel speed, even if the layer was deformed.

Experimental Study on Time-Dependent Changes in Rheological Properties and Flow Rate of 3D Concrete Printing Materials.

Three-dimensional concrete printing (3DCP) materials require a relatively low water-to-binder ratio (W/B) of 0.3 or less to ensure their buildability and flow properties are sufficiently maintained after mixing. In this study, the rheological properties of 3DCP materials with W/B 0.28 were evaluated up to 60 min after mixing, and the yield stress and plastic viscosity were analyzed over time. A gradual decrease in flow rate with time was observed during the transport of 200 kg of material per batch through a 20 m hose. To examine the time-dependent changes in flow rate and layer volume, a 2200 mm × 1000 mm test specimen was printed. The dependence of the layer width over time during the printing process was measured and analyzed. The experimental analyses showed that the flow rate and layer volume of the 3DCP material gradually decreased with time after mixing, which was correlated with the rheological properties.

Cognitive improvement effect of gintonin might be associated with blood-brain barrier permeability enhancement: dynamic contrast-enhanced MRI pilot study.

Along with the multiple neuroprotective effect, recent studies suggest that gintonin might increase the blood brain barrier permeability. We evaluated the effect of gintonin on the vascular permeability changes in different brain segments, using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). In this 8-week, randomized, open label pilot study, ten participants with subjective memory impairment but preserved cognitive function assigned to gintonin-enriched fraction (GEF) 300 mg/day or placebo groups. Korean versions of the Alzheimer's disease assessment scale (ADAS-K) and DCE-MRI parameters including Ktrans and Vp in different brain segments were evaluated at baseline and at 8 weeks after treatment. Nine participants completed the study protocol. No adverse events occurred during the observation period for 8 weeks in both groups. Following gintonin administration, increment trends of the brain permeability that did not reach a statistical significance were observed in the left hippocampus (Ktrans and Vp, both, p = 0.062), left thalamus and in left putamen (Ktrans, p = 0.062), and left insula and right amygdala (Vp, p = 0.062), but not in the control placebo group. The increment of the Ktrans value in the left thalamus from the baseline was highly correlated with the change of the ADAS scores (r = -0.900, p = 0.037). Gintonin might enhance the blood-brain barrier (BBB) permeability in the brain structures involved in cognitive functions. Further efficacy exploration for the synergistic effect of gintonin's BBB permeability enhancement to its other cognitive enhancing mechanisms are warranted. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003418.

Evaluation of the Mechanical Properties of a 3D-Printed Mortar.

The mechanical properties of 3D-printed mortars are determined in terms of their compressive and direct tensile bond strengths. To determine such properties using existing methods, a preliminary experiment was conducted. The compressive strength of the printed mortar was compared to mold-casted specimens and it was found that the compressive strength decreased by ~30%. Among the fabrication variables, an increase in nozzle height negatively influenced the direct tensile bond strength. For the same conditions and age, the direct tensile strength decreased by as much as 16-29% when the number of layers increased from 2 to 6. When the specimens were fabricated using a specially designed stainless steel frame and core drill, followed by extraction and the application of physical impact, the 28 days compressive strength of the specimen decreased by ~50%.

Development of a Polymer-Mediated Soybean Nanocomposite by Hot Melt Extrusion to Improve Its Functionality and Antioxidant Properties.

The poor bioaccessibility of the phenolic compounds of soybeans is a key challenge to developing functional food products. Therefore, a novel hydrophilic food-grade hydroxypropyl methylcellulose (HPMC) polymer was added to soybean to prepare a soybean food composite (SFC), in order to improve the soybean's functionality. The SFC was prepared with soybean (95%) plus HPMC (5%) (w/w) mixes (HSE), as well as 100% soybean extrudate (SE), at 80 °C and 130 °C by a hot melt extrusion (HME) process. A non-extrudate 100% soybean material was considered as a control. It is observed that water solubility was significantly increased (35.18%), and particle size reached to nano-size (171.5 nm) in HSE at 130 °C compared to the control (7.14% and 1166 nm, respectively). The total phenolic, flavonoid, and single isoflavones content, including daidzin, daidzein, glycitein, genistein, and genistin was significantly increased in HSE at 130 °C compared to the control. The antioxidant properties were also significantly increased in HSE at 130 °C compared to the control, measured by 2,2-diphenyl-1 picryl hydrazyl (DPPH), a ferric reducing antioxidant power assay (FRAP), and the phosphomolybdenum method (PPMD). Finally, it is concluded that the HPMC polymer could be used as a novel excipient to develop nanocomposite via HME, in order to improve the functionality of soybean food products.

Effect of Artificial LED Light and Far Infrared Irradiation on Phenolic Compound, Isoflavones and Antioxidant Capacity in Soybean (Glycine max L.) Sprout.

The effect of light emitting diode (LED) light and far infrared irradiation (FIR) on total phenol, isoflavones and antioxidant activity were investigated in soybean (Glycine max L.) sprout. Artificial blue (470 nm), green (530 nm) LED and florescent light (control) were applied on soybean sprout, from three to seven days after sowing (DAS) in growth chamber. The photosynthetic photon flux density (PPFD) and photoperiod was 150 ± 5 µmol m-2s-1 and 16 h, respectively. The FIR was applied for 30, 60 and 120 min at 90, 110 and 130 °C on harvested sprout. Total phenolic content (TP) (59.81 mg/g), antioxidant capacity (AA: 75%, Ferric Reduction Antioxidant Power (FRAP): 1357 µM Fe2+) and total isoflavones content (TIC) (51.1 mg/g) were higher in blue LED compared to control (38.02 mg/g, 58%, 632 µM Fe2+ and 30.24 mg/g, respectively). On the other hand, TP (64.23 mg/g), AA (87%), FRAP (1568 µM Fe2+) and TIC (58.98 mg/g) were significantly increased by FIR at 110 °C for 120 min among the treatments. Result suggests that blue LED is the most suitable light to steady accumulation of secondary metabolites (SM) in growing soybean sprout. On the other hand, FIR at 110 °C for 120 min is the best ailment to induce SM in proceed soybean sprout.

Five-year results of laparoscopic sleeve gastrectomy in Korean patients with lower body mass index (30-35 kg/m²).

BACKGROUND: In Asia, laparoscopic sleeve gastrectomy (LSG) is the leading weight loss procedure for treating morbid obesity. However, long-term results of isolated LSG performed in patients with lower body mass index (BMI) (30-35 kg/m(2)) are scarce. METHODS: We retrospectively reviewed 75 patients with BMI of 30-35 kg/m(2) who underwent LSG from January 2003 to January 2013. Seventy-one of these patients who had more than 6 months of follow-up were included in this report. LSG was performed laparoscopically using a linear stapler over a 48-French bougie from 2003 to 2006. Since 2007, 36-French bougie was used for resection, and a continuous seromuscular suture at the resection margin was added. RESULTS: Mean age at the time of surgery was 33.7 ± 10.3 years in our patients. Mean weight was 85.7 ± 9.0 kg and mean BMI was 32.4 ± 1.6 kg/m(2) preoperatively. The percentage of excess BMI loss (%EBL) in the postoperative first, third, and fifth year was 84.1 ± 25.5, 79.8 ± 31.0, and 78.5 ± 28.5%, respectively. Follow-up rate at the first, third, and fifth year was 90.0, 71.9, and 42.9%. There were no 30-day perioperative mortality and major complications including bleeding and leakage. CONCLUSIONS: These findings show that LSG is a safe and effective weight loss option for Korean patients with lower BMI. Randomized prospective control studies between gastric banding, or Roux-en-Y gastric bypass, and LSG are needed to confirm long-term weight loss effect and safety of LSG in this group of patients.

Inhibition of IL-17A suppresses enhanced-tumor growth in low dose pre-irradiated tumor beds.

Ionizing radiation induces modification of the tumor microenvironment such as tumor surrounding region, which is relevant to treatment outcome after radiotherapy. In this study, the effects of pre-irradiated tumor beds on the growth of subsequently implanted tumors were investigated as well as underlying mechanism. The experimental model was set up by irradiating the right thighs of C3H/HeN mice with 5 Gy, followed by the implantation of HCa-I and MIH-2. Both implanted tumors in the pre-irradiated bed showed accelerated-growth compared to the control. Tumor-infiltrated lymphocyte (TIL) levels were increased, as well as pro-tumor factors such as IL-6 and transforming growth factor-beta1 (TGF-ß1) in the pre-irradiated group. In particular, the role of pro-tumor cytokine interleukin-17A (IL-17A) was investigated as a possible target mechanism because IL-6 and TGF-ß are key factors in Th17 cells differentiation from naïve T cells. IL-17A expression was increased not only in tumors, but also in CD4+ T cells isolated from the tumor draining lymph nodes. The effect of IL-17A on tumor growth was confirmed by treating tumors with IL-17A antibody, which abolished the acceleration of tumor growth. These results indicate that the upregulation of IL-17A seems to be a key factor for enhancing tumor growth in pre-irradiated tumor beds.

Catheter-free method is sufficient for preparation for transnasal endoscopy: randomized controlled trial.

BACKGROUND AND AIM: Although transnasal endoscopy (TNE) is generally a comfortable and safe procedure, it has some disadvantages, such as complicated preprocessing and occasional repulsion reaction during catheterization. In an attempt to simplify the preprocessing method, the efficacy of a catheter-free method in which a catheter is not inserted into the nasal cavity was assessed. METHODS: The present study was a prospective, open-label, single-center, randomized controlled study with parallel assignment allocation 1:1. Between March 2009 and August 2009, a total of 93 TNE-naïve patients were enrolled and randomized. Patients were prospectively randomized into two groups (catheter-free vs catheter-insertion method). Patients who prepared according to the catheter-free method and who were unsuccessful underwent the catheter-insertion method. Clinical characteristics, success rate, complications, vital signs, acceptability, and tolerability were assessed and compared. RESULTS: Success rates of the catheter-free and catheter-insertion methods were 88% (n=44) and 88% (n=38) (P>0.05), respectively. Causes of failure in the catheter-free method included severe rhinalgia (n=1, 2%) and narrowing of the nasal cavity (n=5, 10%). Causes of failure in the catheter-insertion method included narrowing of the nasal cavity (n=5, 11%). Six patients whose TNE failed with the catheter-free method also experienced failed TNE with the catheter-insertion method. There were no statistical differences in vital signs, acceptability, and tolerability. CONCLUSION: The catheter-free method is sufficient for preparation for TNE. The success rate of TNE depends more on the structure of the nasal cavity than the preprocessing method.

Determination and comparison of seed oil triacylglycerol composition of various soybeans (Glycine max (L.)) using ¹H-NMR spectroscopy.

Seed oil triacylglycerol (TAG) composition of 32 soybean varieties were determined and compared using ¹H-NMR. The contents of linolenic (Ln), linoleic (L), and oleic (O) ranged from 10.7% to 19.3%, 37.4%-50.1%, and 15.7%-34.1%, respectively. As is evident, linoleic acid was the major fatty acid of soybean oil. Compositional differences among the varieties were observed. Natural oils containing unsaturated groups have been regarded as important nutrient and cosmetic ingredients because of their various biological activities. The TAG profiles of the soy bean oils could be useful for distinguishing the origin of seeds and controlling the quality of soybean oils. To the best of our knowledge, this is the first study in which the TAG composition of various soybean oils has been analyzed using the ¹H-NMR method.

Pregnancy outcomes after laparoscopic sleeve gastrectomy in morbidly obese Korean patients.

Laparoscopic sleeve gastrectomy (LSG) is an effective procedure for treating morbid obesity, and the majority of female patients who received LSG were at childbearing age. Female patients, who successfully lost weight following LSG and became pregnant, need to be evaluated carefully. Information was gathered, through prospectively maintained database and phone interview, on women who underwent LSG from May 2003 to July 2011. A total of 136 women underwent LSG in this period. There were 13 (9.6 %) pregnancies in 12 patients after LSG. The age before surgery was 28.3 ± 4.0. The mean weight and body mass index (BMI) before LSG were 95.3 ± 9.4 kg and 35.1 ± 3.5 kg/m(2), respectively. The average time from LSG to the first live birth was 32.0 ± 19.1 months. Mean BMI decreased significantly after LSG, from 35.1 ± 3.5 to 24.9 ± 2.3 kg/m(2) at conception. The mean percentage of excess body mass index loss was 85.8 ± 16.7 % at conception and 42.7 ± 25.1 % at delivery. Gained weight during pregnancy was 15.1 ± 5.2 kg. The mean gestational age and birth weight were 39.0 ± 1.6 weeks and 3,229.0 ± 505.9 g. In two cases (15.4 %), cesarean section was performed. No cases of pregnancy-induced hypertension and diabetes developed. Major congenital anomalies and neonatal deaths were not recorded. Larger study with longer follow-up is needed to evaluate the effect of LSG in pregnancies. However, these findings show that LSG seems to be a safe option for morbidly obese women in their reproductive period.

Tumor-infiltrating regulatory T cells delineated by upregulation of PD-1 and inhibitory receptors.

Foxp3(+) regulatory T (T(reg)) cells are dominant suppressor cells which regulate conventional T (T(conv)) cells. Inside tumor microenvironment, T(reg) cells have been known to become potent in suppressing T(conv) cell responses, thereby enabling tumor cells to circumvent immune response. However, the underlying mechanism by which tumor-infiltrating T(reg) cells display enhanced suppressive function is still unresolved. To understand characteristics and function of tumor-infiltrating T(reg) cells as well as T(conv) cells in the tumor site, we analyzed their phenotypes either within tumor burden or at distant site of tumor using both heterotopic and orthotopic mouse cancer models. Compared to CD8(+) T cells at distant site of tumor, tumor-infiltrating CD8(+) T cells dramatically upregulated programmed death 1 (PD-1) and other inhibitory receptors, thereby being more exhausted functionally. Tumor-infiltrating CD4(+) T cells also expressed higher level of PD-1 than CD4(+) T cells at distant site of tumor but very surprisingly, upregulation of PD-1 occurred in CD4(+)Foxp3(+) T(reg) as well as CD4(+)Foxp3(-) T(conv) cells. Moreover, tumor infiltrating T(reg) cells upregulated other inhibitory receptors such as T cell immunoglobulin mucin 3 (TIM-3), cytotoxic T lymphocyte antigen-4 (CTLA-4), glucocorticoid-induced tumor necrosis factor receptor (GITR), and lymphocyte activation gene-3 (LAG-3). These results suggest that upregulation of PD-1 and other inhibitory receptors on tumor-infiltrating T(reg) cells is related with their enhanced suppressive function.

Identification of proteins indicating radiation-induced hepatic toxicity in cirrhotic rats.

Radiation therapy (RT) has been emerging as one of the palliative treatments for locally advanced hepatocellular carcinoma (HCC). However, hepatic toxicity is a major obstacle in radiotherapy for HCC. The purpose of this study is to identify proteins indicating radiation-induced hepatic toxicity in cirrhotic rats, which can be used as possible biomarkers. Liver cirrhosis was induced in Wistar rats with thioacetamide (TAA) 0.3 g/L in drinking water for 9 weeks. The development of liver cirrhosis was observed histologically. Radiation hepatic injury was induced by treating 1/3 of the liver with 10 Gy single dose radiation. To find out commonly expressed proteins, liver tissue and serum were analyzed using two-dimensional electrophoresis and quadrupole time of flight mass spectrometry. Identified proteins were validated using western blotting. Histological examination showed that the degree of hepatic fibrosis increased by radiation in liver cirrhosis. It was associated with a decrease in the proliferation of cell nuclear antigen and an increase of apoptosis. The proteomic analysis of liver tissue and serum identified 60 proteins which showed significant change in expression between the TAA-alone and TAA-plus-radiation groups. Among these, an increase of heparanase precursor and decrease of hepatocyte growth factor were shown commonly in liver tissue and serum following radiation. Hepatic fibrosis increased following radiation in cirrhotic rats. These proteins might be useful in detecting and monitoring radiation-induced hepatic injury.

Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients.

BACKGROUND: In Asia, the type and main cause of obesity is different than in western society. Therefore, the treatment plan should be differentiated, and the surgery for morbid obesity should be carefully chosen. The early results of laparoscopic sleeve gastrectomy (LSG) without duodenal switch that has been performed in the Korean population is reported. METHODS: We retrospectively reviewed 130 patients who underwent LSG from January 2003 to May 2004. 60 of these patients now had >1 year of regular follow-up, and are the subject of this report. LSG was performed through 4 12-mm ports and 1 15-mm port, using the Endo-GIA stapler to create a lesser curve gastric tube over a 48-Fr bougie. RESULTS: For the 60 patients, the postoperative EWL was 71.6+/-21.9% at 6 months and 83.3+/-28.3% at 12 months. At 12 months after LSG, decrease in BMI was 9.2+/-3.7 kg/m2, and median weight loss was 24.6+/-10.0 kg. Dyslipidemia resolved in 75% of patients within 12 months. Diabetes resolved in 100% of patients within 6 months of operation. Hypertension resolved in 92.9% and improved in 100%. Joint pain resolved in 100% within 12 months. Weight loss plateaued at 12 months in the majority of patients. One patient has undergone a malabsorption procedure (duodenal switch) as a second-stage operation. CONCLUSION: Additional studies and follow-up are needed to determine the best surgical treatment for morbidly obese Asian patients. However, LSG without the second-stage duodenal switch operation has been an effective weight loss operation thus far, in most of the Korean patients.

Comparison between open hand-sewn, laparoscopic stapled and laparoscopic computer-mediated, circular stapled gastro-jejunostomies in Roux-en-Y gastric bypass in the porcine model.

BACKGROUND: In this porcine survival model, we compared laparoscopic computer-mediated flexible circular stapled (SurgASSIST) gastro-jejunostomies in Roux-en-Y gastric bypass (RYGBP) to open hand-sewn (HS) and laparoscopic end-to-end (EEA) anastomosis. METHODS: RYGBP was performed in 15 pigs. Depending on the technique used to create the gastro-jejunostomy, the pigs were divided in 3 groups. In group A, a standard two-layer hand-sewn anastomosis were performed. In group B and C, gastro-jejunostomies using EEA (B) or SurgASSIST (C) were attempted. Operation time, intraoperative technical failure, postoperative anastomotic leakage, and necropsy results were measured. RESULTS: 14 pigs survived surgery. One leakage from the gastro-jejunostomy was detected intraoperatively in group B. There was no evidence of leakage postoperatively from the proximal gastro-jejunostomy in any groups. No statistical difference was found between the groups concerning the operation time or the diameter and degree of healing of the anastomosis. CONCLUSION: We found the SurgASSIST system safe for performing gastro-jejunostomies in laparoscopic RYGBP. There were no anastomotic failures intra- or postoperatively. At necropsy, there was no evidence of anastomotic stricture or delayed healing processes.

Laparoscopic vs. open biliopancreatic diversion with duodenal switch: a comparative study.

Biliopancreatic diversion with duodenal switch (BPD-DS) is a well-known emerging open procedure that appears to be as effective as other bariatric operations and has been shown to provide excellent long-term weight loss. Therefore we looked at the safety and efficacy of the laparoscopic BPD-DS procedure compared to open BPD-DS in superobese patients (body mass index >60). A retrospective study of 54 superobese patients (body mass index >60) was carried out from July 1999 to June 2001: laparoscopic BPD-DS in 26 patients and open BPD-DS in 28 patients. Median preoperative body weight was 189.8 kg (range 155.1 to 271.2 kg) in the laparoscopic BPD-DS group and 196.5 kg (range 160.3 to 298.9 kg) in the open BPD-DS group. Median body mass index was 66.9 kg/m(2) in the laparoscopic group and 68.9 kg/m(2) in the open group. The two groups were compared by means of the unpaired t test, which yielded the following results: Major morbidity occurred in six patients (23%) in the laparoscopic BPD-DS group and in five patients (17%) in the open BPD-DS group (P = 0.63). There were two deaths in the laparoscopic BPD-DS group (7.6% mortality) and one death (3.5% mortality) in the open BPD-DS group (P = 0.51). Preoperative comorbidity was improved in eight patients in the laparoscopic BPD-DS group and two patients in the open BPD-DS group (P < 0.02). Laparoscopic BPD-DS is a technically feasible procedure that results in effective weight loss similar to the open procedure. However, both open and laparoscopic BPD-DS procedures are associated with appreciable morbidity and mortality in the superobese population. Additional studies are needed to determine the best surgical treatment for superobesity.