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Although Roux-en-Y gastric bypass (RYGB) is widely performed worldwide, its efficacy in patients with a body mass index (BMI) greater than 50 kg/m2 remains controversial. The aim of the present paper was to assess long-term (10 years or more) weight loss and metabolic results of RYGB in patients with superobesity (SO; BMI > 50 kg/m2), compared with patients with morbid obesity (MO; BMI 35-50 kg/m2). This study involved retrospective analysis of a prospectively followed cohort of adult patients operated on for a primary RYGB between 1999 and 2008. Long-term weight loss and metabolic parameters were compared between SO and MO patients, with a sex-specific subgroup analysis in SO patients. Multiple logistic regression assessed independent predictors of poor long-term weight loss. Among the 957 included patients, 193 (20.2 per cent) were SO (mean BMI 55.3 kg/m2versus 43.3 kg/m2 in MO). Upon 10-year follow-up, which was complete in 86.3 per cent of patients, BMI remained higher in SO patients (mean 39.1 kg/m2versus 30.8 kg/m2, P < 0.001) although total bodyweight loss (per cent TBWL) was similar (28.3 per cent versus 28.8 per cent, P = 0.644). Male SO patients had a trend to higher 10-year per cent TBWL, while initial BMI greater than 50 kg/m2 and low 5-year per cent TBWL were independent predictors of long-term TBWL less than 20 per cent. Diabetes remission was observed in 39 per cent SO and 40.9 per cent MO patients (P = 0.335) at 10 years, and all patients had a significant lipid profile improvement. Substantial improvement in co-morbidities was observed in all patients 10 years after RYGB. Total weight loss was similar in SO and MO patients, leaving SO patients with higher BMI. Suboptimal TBWL 5 years after surgery in SO, especially female patients, may warrant prompt reassessment to improve long-term outcomes.

Two main procedures currently dominate the panel of bariatric interventions. Sleeve gastrectomy is technically easier and the most widely performed in the world. It shows slightly inferior results and is also associated with a slightly lower morbidity compared to gastric bypass. This is counterbalanced by its irreversibility and a high prevalence of postoperative gastro-esophageal reflux. For this reason, gastric bypass remains the dominant procedure in Switzerland, thanks to its good long-term weight and metabolic results. Sleeve gastrectomy is also an important option in bariatric surgery, with some specific indications.

Background: One-anastomosis gastric bypass (OAGB-MGB) is currently the third performed primary bariatric surgical procedure worldwide. However, the procedure is hampered by numerous controversies and there is considerable variability in surgical technique, patient selection, and pre- and postoperative care among the surgeons performing this procedure. This paper reports the results of a modified Delphi consensus study organized by the International Federation for Surgery of Obesity and Metabolic Disorders (IFSO). Methods: Fifty-two internationally recognized bariatric experts from 28 countries convened for voting on 90 consensus statements over two rounds to identify those on which consensus could be reached. Inter-voter agreement of ≥ 70% was considered consensus, with voting participation ≥ 80% considered a robust vote. Results: At least 70% consensus was achieved for 65 of the 90 questions (72.2% of the items), 61 during the first round of voting and an additional four in the second round. Where consensus was reached on a binary agree/disagree or yes/no item, there was agreement with the statement presented in 53 of 56 instances (94.6%). Where consensus was reached on a statement where options favorable versus unfavorable to OAGB-MGB were provided, including statements in which OAGB-MGB was compared to another procedure, the response option favorable to OAGB-MGB was selected in 13 of 23 instances (56.5%). Conclusion: Although there is general agreement that the OAGB-MGB is an effective and usually safe option for the management of patients with obesity or severe obesity, numerous areas of non-consensus remain in its use. Further empirical data are needed.

Obesity is a major health problem with a prevalence that has tripled since 1976, affecting a large portion of the population across all ages. Bariatric surgery is currently considered as the most efficient and durable treatment in terms of weight loss and remission of long-term co-morbidities. The objective of this article is to describe briefly the different surgical options for patients with severe obesity and to report their effectiveness, as well as to provide primary care physicians with simple instructions, regarding initial management and the appropriate guidance of their patients to a specialized service.

Democratization of the cannabis consumption and its derivatives incite patients to ask ever more for medical cannabinoid prescriptions, especially in the context of chronic pain. Its use is only validated in certain limited cases, in particular spasticity linked to multiple sclerosis and refractory epilepsies. All other prescriptions require a special request to the OFSP. Moreover, cannabinoid intake may produce several dose-dependent side effects that require a close monitoring with a slow and gradual initiation of its dosage. In the absence of clear medical evidence, many other mechanisms of action need to be investigated with ongoing and future studies to clarify their indication.

Bariatric and metabolic surgery is the only effective long-term treatment for morbid obesity. The three main practiced surgeries during the last 30 years are the Roux-en-Y gastric bypass (RYGB), the sleeve gastrectomy (SG) and the laparoscopic adjustable gastric banding (AGB). These surgeries can lead to long-term complications of a functional or of a surgical nature. Rapid management in a specialized setting where appropriate investigations can be done is essential. Abdominal pain after bariatric surgery are frequent, multiple and difficult to apprehend. They should not be trivialized because the risks of severe complications without an adequate and quick management are important.

Bariatric surgery, the most effective treatment for obesity, can lead to long-term complications. These may be of functional nature (dumping, hypoglycemia, reflux) or of surgical nature. Acute or chronic abdominal pain is not unusual after gastric bypass. Often unrelated to surgery, it can be caused by an acute surgical problem (internal hernia, obstruction, intussusception), which can lead to extensive bowel necrosis if not treated quickly. Other complications (candy cane, anastomotic ulcer, reflux) can also develop. An « obstructed sleeve » can develop early or late after sleeve gastrectomy. Rapid management of acute abdominal pain is essential and should, ideally, be done in a specialized setting where appropriate imaging and specific surgical skills are readily available.

Bariatric surgery is the most effective long-term therapy for the management of patients with obesity but all bariatric surgical procedures have the potential to cause clinically significant micronutrient deficiencies due to reduced food intake, decreased gastric acid and intrinsic factor secretion, poor food choices and food intolerance. For clinicians, the acquisition of special knowledge is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present article, we summarize existing recommendations for monitoring and replacement of vitamins and minerals following bariatric surgery.

Adolescence is a stressful period where important biological, psychological and social changes occur. Adolescents are particularly vulnerable during this developmental period and can use various strategies to deal with daily stress, such as substance use or externalizing behaviors. In previous studies, stress in adolescents with externalizing behaviors was often linked to ineffective cognitive coping strategies (i.e., constructive thinking) and overlooking the biological aspects involved in stress management such as neuroendocrine regulation. Indeed, repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis in chronic stress situations may have long-term effects on subsequent cortisol regulation and lead to psychological difficulties. It was also shown that basal cortisol levels are lower in adolescents with externalizing behaviors. This study aims to assess the links between constructive thinking and neuroendocrine regulation in adolescent offenders and their association with externalizing symptoms (e.g., aggression, delinquency, psychopathic traits, substance use). Identifying particular biopsychological patterns can help to better understand stress management in youth with externalizing behaviors and to improve clinical treatments. Sixteen adolescent males aged from 12 to 18 years were recruited in an institution for juvenile offenders. Exclusion criteria were insufficient reasoning abilities assessed using the Raven Matrices Test. Regarding psychological dimensions, constructive thinking was assessed through the Constructive thinking inventory (CTI), psychopathic traits through the Youth psychopathic traits inventory (YPI), externalizing behaviors through 30 items (out of 113) and 2 subscales (aggressive behavior and delinquency problems) from the Child behavior checklist-youth self-report (CBCL), and substance use through the Dep-ado. Regarding biological dimensions, cortisol daily secretion and regulation were assessed through saliva samples that were collected during 3 consecutive days (4 samples per day: directly after awakening, at 10 a.m., at 4 a.m., and before going to bed). Adolescent offenders presented maladaptative thinking styles and a particular neuroendocrine regulation in their daily management with stress. In particular, their level of cortisol in the morning was higher than those expected in a general population (20.34 nmol/L while the norm is around 10 nmol/L). They also showed more agressive and delinquent behaviors (CBCL) as well as more psychopathic traits (YPI) than the general population. Moreover, constructive thinking style was associated with personality and behavioral dimensions. Indeed, results indicated positive and significant correlations between categorical thinking style (CTI), psychopathic traits (YPI) (r=0.57, P=0.021) and externalizing behaviors (CBCL) (r=0.55, P=0.028). In other words, the more adolescent offenders used categorical thinking, the more they presented psychopathic traits and externalizing behaviors. With respect to the association between psychological and biological dimensions in stress management, we observed a significant and positive correlation between cortisol regulation and esoteric thinking (r=0.57, P=0.028) and a trend with superstitious thinking (r=0.47, P=0.075). The more adolescent offenders used esoteric and superstitious thinking, the poorer was their cortisol regulation. We also observed a trend between the life style scale of the YPI (i.e., impulsive, irresponsible) and the daily secretion of cortisol (r=0.51; P=0.052) as well as cortisol regulation (r=0.49, P=0.065). The more adolescent offenders presented psychopathic traits, the higher tended to be their daily secretion of cortisol and the poorer their cortisol regulation. Finally, cortisol regulation (r=0.54, P=0.038) and secretion (r=0.73, P=0.002) were significantly correlated with the DEP-Ado score. In other words, a poor cortisol regulation and a high secretion of cortisol seem to be associated with substance use. Adolescent offenders face an important amount of daily stress and do not always have the appropriate skills to deal with it. Indeed, we know from clinical experience that they often report a sense of hopelessness toward their lack of professional perspectives as well as familial conflicts which can be important stressors in addition to the incarceration in itself. Therefore, treatment aiming to improve psychic elaboration can help these adolescents to make their thinking styles more flexible and use more appropriate ways of coping with stress instead of externalizing behaviors and substance use. Moreover, considering the complex cases of these adolescents and the many changes of caregivers and institutions where they have lived, which can be important stressors as well, professionals working with these youth should be aware of their emotional reactions toward them and try to encourage continuity of care.

Bariatric and metabolic surgery (BMS) is currently the cornerstone of treatment for severe obesity. It produces significant and lasting weight loss in the vast majority of cases, which depends on the procedure performed, in any case much greater than that observed with non-surgical treatments. This weight loss along with direct metabolic effects of BMS, result in a substantial and lasting improvement in many obesity-related comorbidities, notably metabolic ones, sometimes with complete remission. This leads to a reduction in cardiovascular risk and mortality. Any BMS must be carried out by a multidisciplinary team, which will ensure lifelong follow-up in order to optimize results and prevent complications, including micronutrient deficiencies, by adequate supplementations.

International audience; Different factors, such as age, gender, preoperative weight but also the patient's motivation, are known to impact outcomes after Roux-en-Y gastric bypass (RYGBP). Weight loss prediction is helpful to define realistic expectations and maintain motivation during follow-up, but also to select good candidates for surgery and limit failures. Therefore, developing a realistic predictive tool appears interesting. A Swiss cohort (n = 444), who underwent RYGBP, was used, with multiple linear regression models, to predict weight loss up to 60 months after surgery considering age, height, gender and weight at baseline. We then applied our model on two French cohorts and compared predicted weight to the one finally reached. Accuracy of our model was controlled using root mean square error (RMSE). Mean weight loss was 43.6 +/- 13.0 and 40.8 +/- 15.4 kg at 12 and 60 months respectively. The model was reliable to predict weight loss (0.37 \textless R (2) \textless 0.48) and RMSE between 5.0 and 12.2 kg. High preoperative weight and young age were positively correlated to weight loss, as well as male gender. Correlations between predicted weight and real weight were highly significant in both validation cohorts (R ae 0.7 and P \textless 0.01) and RMSE increased throughout follow-up between 6.2 and 15.4 kg. Our statistical model to predict weight loss outcomes after RYGBP seems accurate. It could be a valuable tool to define realistic weight loss expectations and to improve patient selection and outcomes during follow-up. Further research is needed to demonstrate the interest of this model in improving patients' motivation and results and limit the failures.

Existing country image (CI) literature tends to focus on consumer behaviour. In contrast, this paper approaches CI from the point of view of the firm. In doing so, it seeks to identify the means by which international companies associate a brand with a specific country of origin in order to build brand values. In particular, it looks at the use of CI cues in brand strategies. The\ud paper is based on exploratory research comprising a case study of two contrasting companies from the cosmetics industry, Natura, a domestic company, and the French-owned L’Occitane, both of which draw on images of Brazil to build their brands. Specific elements of CI used in branding are identified, and the extent to which the use of these differs depending on the\ud origin of the owning company is explored. The cases suggest that CI can be exploited in different contexts. Through analysis of the elements used by both companies to build strong brands associated with the Brazilian CI—Natura Cosméticos and L’Occitane au Brésil—six tools are identified that can be combined by firms to deliver brand values, derived from any country, through the use of CI.

BACKGROUND Chronic postsurgical pain (CPSP) is an important clinical problem. Prospective studies of the incidence, characteristics and risk factors of CPSP are needed. OBJECTIVES The objective of this study is to evaluate the incidence and risk factors of CPSP. DESIGN A multicentre, prospective, observational trial. SETTING Twenty-one hospitals in 11 European countries. PATIENTS Three thousand one hundred and twenty patients undergoing surgery and enrolled in the European registry PAIN OUT. MAIN OUTCOME MEASURES Pain-related outcome was evaluated on the first postoperative day (D1) using a standardised pain outcome questionnaire. Review at 6 and 12 months via e-mail or telephonic interview used the Brief Pain Inventory (BPI) and the DN4 (Douleur Neuropathique four questions). Primary endpoint was the incidence of moderate to severe CPSP (numeric rating scale, NRS ≥3/10) at 12 months. RESULTS For 1044 and 889 patients, complete data were available at 6 and 12 months. At 12 months, the incidence of moderate to severe CPSP was 11.8% (95% CI 9.7 to 13.9) and of severe pain (NRS ≥6) 2.2% (95% CI 1.2 to 3.3). Signs of neuropathic pain were recorded in 35.4% (95% CI 23.9 to 48.3) and 57.1% (95% CI 30.7 to 83.4) of patients with moderate and severe CPSP, respectively. Functional impairment (BPI) at 6 and 12 months increased with the severity of CPSP (P

Carbohydrate mouth rinsing can improve endurance exercise performance and is most ergogenic when exercise is completed in the fasted state. This strategy may also be beneficial to increase exercise capacity and the energy deficit achieved during moderate intensity exercise relevant to weight control when performed after an overnight fast. Eighteen healthy men (mean(SD); age 23(4)years, body mass index 23.1(2.4)kg.m-2 ) completed a familiarisation trial and three experimental trials. After an overnight fast, participants performed 60-minutes of treadmill walking at a speed that equated to a rating of perceived exertion of 13 (“fairly hard”). Participants manually adjusted the treadmill speed to maintain this exertion. Mouth rinses for the experimental trials contained either a 6.4% maltodextrin solution with sweetener (CHO), a taste-matched placebo (PLA) or water (WAT). Appetite ratings were collected using visual analogue scales and exercise energy expenditure and substrate oxidation were calculated from online gas analysis. Increased walking distance during CHO and PLA induced greater energy expenditure compared with WAT (mean difference (90% CI); 79(60)kJ; P=0.035; d=0.24 and 90(63)kJ; P=0.024; d=0.27, respectively). Appetite area under the curve was lower in CHO and PLA than WAT (8(6)mm; P=0.042; d=0.43 and 6(8)mm; P=0.201; d=0.32, respectively). Carbohydrate oxidation was higher in CHO than PLA and WAT (7.3(6.7)g; P=0.078; d=0.47 and 10.1(6.5)g; P=0.015; d=0.81, respectively). This study provides novel evidence that mouth rinsing with a sweetened solution may promote a greater energy deficit during moderate exertion walking exercise by increasing energy expenditure and decreasing appetite. A placebo effect may have contributed to these benefits.

Summary Experimental infestation of cattle with ectoparasites and their effect on leather quality Four young cattle were experimentally infested at various sites with ticks (Ixodes ricinus), mange mites (Sarcoptes bovis and Psoroptes bovis), lice (Linognathus vituli) and Bovicola bovis for up to 49 days and then slaughtered. The skin was examined parasitologically and histologically after slaughter, tanned and the damage to the skin assessed. The ticks caused at the site of attachment a marked nodular dermatitis and the surface of the leather was marked by sharply demarcated crater-like depressions. Sarcoptic mange effects were acanthosis, eosinophilic pustules and a marked perivascular infiltration of the dermis. The leather surface showed a dirty discolouration and folds and was covered with collagen fibres. The psoroptic mites caused similar, but less severe, changes to those caused by the Sarcoptes. The surface showed occasional small pits. Lice caused a focal exocytosis and the leather revealed somewhat dilated hair pores. Bovicola bovis left no obvious changes in the skin and leather. Resume Infestation experimentale de bovins avec des ectoparasites et leur influence sur la qualite du cuir Quatre jeunes bovins ont ete infestes experimentalement sur des endroits delimites par des tiques (Ixodes ricinus) des acariens (Sarcoptes bovis et Psoroptes bovis), des poux (Linognathus vituli) et des mallophages (Bovicola bovis) durant 49 jours au maximum. Les peaux ont ete examinees parasitologiquement et histologiquement apres l'abattage des animaux, tannees et leurs lesions de surface comparees les unes avec les autres. Les tiques ont provoque une dermatite prononcee et en foyers aux emplacements de piqures. La surface du cuir etait parsemee de depressions en forme de crateres nettement delimitees. On a trouve histologiquement avec la gale sarcoptique une acanthose, des pustules eosinophiles et une forte infiltration perivasculaire du derme. La surface du cuir presentait une coloration salie, des plis et etait couverte de fibres collagenes. La gale psoroptique a provoque les memes lesions dans la peau mais moins marquees anatomo-pathologiquement que la gale sarcoptique. Le cuir a montre de temps en temps quelques depressions isolees. Les poux ont provoque une exocytose en foyers et des pores capillaires legerement dilates sur le cuir. Les mallophages n'ont pas laisse derriere eux des lesions morphologiques sur la peau et le cuir. Resumen Infestacion experimental de vacunos con ectoparasitos y el influjo de la misma sobre la calidad del cuero Se infestaron experimentalmente cuatro becerras en lugares circunscritos con garrapatas (Ixodes ricinus), acaros de la sarna (Sarcoptes bovis y Psoroptes bovis), piojos (Linognathus vituli) y malofagos (Bovicola bovis) durante 49 dias como maximo. Tras el faenamiento de los animales, se examinaron las pieles parasitologica e histologicamente, se curtieron y compararon entre si los danos superficiales causados. Las garrapatas ocasionaron en el lugar de picadura una dermatitis focal intensa. La superficie del cuero se hallaba intercalada por cavidades crateriformes con delimitaciones nitidas. En la sarna sarcoptica encontramos histopatologicamente una acantiosis, pustulas eosinofilas y una infiltracion perivascular intensa de la dermis. La superficie del cuero mostraba una decoloracion sucia y pliegues, estando cubierta por fibras colagenas. Los acaros psoropticos ocasionaron en la piel modificaciones similares, aunque anatomopatologicamente mas ligeras que los acaros sarcopticos. El cuero solo presento impresiones individuales. Los piojos ocasionaron una exocitosis focal y en el cuero poros del pelo ligeramente dilatados. Los piojos masticadores no dejaron ni en la piel ni en el cuero modificacion morfologica alguna.

National audience

Workshops are an important part of the IFPA annual meeting as they allow for discussion of specialized topics. At IFPA meeting 2014 there were six themed workshops, five of which are summarized in this report. These workshops related to various aspects of placental biology but collectively covered areas of animal models, xenobiotics, pathological biomarkers, genetics and epigenetics, and stillbirth and fetal growth restriction. © 2015 Published by IFPA and Elsevier Ltd.

OBJECTIVES:The purpose of this document is to make the output of the International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT) Standardization and Validation available to medical and scientific communities, through a peer-reviewed publication, in the interest of improving the diagnosis and treatment of patients with atherosclerosis, including coronary artery disease. BACKGROUND: Intravascular optical coherence tomography (IVOCT) is a catheter-based modality that acquires images at a resolution of ~10 μm, enabling visualization of blood vessel wall microstructure in vivo at an unprecedented level of detail. IVOCT devices are now commercially available worldwide, there is an active user base, and the interest in using this technology is growing. Incorporation of IVOCT in research and daily clinical practice can be facilitated by the development of uniform terminology and consensus-based standards on use of the technology, interpretation of the images, and reporting of IVOCT results. METHODS: The IWG-IVOCT, comprising more than 260 academic and industry members from Asia, Europe, and the United States, formed in 2008 and convened on the topic of IVOCT standardization through a series of 9 national and international meetings. RESULTS: Knowledge and recommendations from this group on key areas within the IVOCT field were assembled to generate this consensus document, authored by the Writing Committee, composed of academicians who have participated in meetings and/or writing of the text. CONCLUSIONS: This document may be broadly used as a standard reference regarding the current state of the IVOCT imaging modality, intended for researchers and clinicians who use IVOCT and analyze IVOCT data.

For severe obesity (BMI > 35 kg/m2), bariatric surgery is not only the best, but often the only means of obtaining sufficient and durable weight loss. This article aims to review the available bariatric procedures. Gastric bypass remains the reference when it comes to the risk/benefit ratio. Gastric banding is declining rapidly due to the high prevalence of long-term complications. Primary malabsorptive procedures remain largely unpopular because of their potential nutritional complications. Sleeve gastrectomy, although it is not reversible as it includes a significant gastric resection, increases currently in popularity because of its apparent simplicity and the fact that early results regarding weight loss mimic those obtained with gastric bypass.

Recent progress with compact ionization chambers has opened new possibilities for isobar suppression in accelerator mass spectrometry (AMS). Separation of 36Cl (t1/2 = 0.30 Ma) at natural isotopic levels from its stable isobar 36S became feasible at particle energies of 24 MeV, which are also accessible for mediumsized tandem accelerators with 3 MV terminal voltage like VERA (Vienna Environmental Research Accelerator). Investigations with an ionization chamber revealed how physics favors isobar separation even at energies below the maximum of the Bragg curve. The strong energy focusing effect at high energy losses reduces energy straggling significantly and isobar separation steadily increases up to almost full energy loss. With an optimized detection setup, sulfur suppression factors of 2 × 104 have been achieved. Refraining from the additional use of degrader foils has the benefit of high transmission to the detector (~16%), but requires a low sulfur output from the ion source. Therefore several backing materials have been screened for sulfur content. The dependence of the sulfur output on the AgCl sample size has been investigated as well. Precision and accuracy have been thoroughly assessed over the last two years. Since drifts in the spectra are efficiently corrected by monitoring the position of the 36S peak, the reproducibility for high ratio samples (36Cl/Cl > 10-12) is better than 2%. Our blank value of 36Cl/Cl ≈ (5 ± 5) × 10-16 is competitive to other labs. 36Cl has become a routine AMS-isotope at VERA. Recently we also explored novel techniques for additional sulfur suppression already in the ion source. While results with a small gas reaction cell in front of the sputter target were discouraging, a decrease in the sulfur/chlorine ratio by one order of magnitude was achieved by directing 300mW continuous wave laser beam at 445 nm towards the cathode in the ion source.

The molecular and cellular mechanisms controlling Ab isotype selection following encounter of a given Ag are still unclear, although the regulatory role of cytokines is established. In the present study we explored the possibility that the nonimmunologic interaction of an allergen with cells of the innate immune system might result in a release of mediators that promote IgE isotype selection in adaptive responses. Using the bee venom allergen phospholipase A2 (PLA2) and a mutant variant lacking enzymatic function, we show that PLA2, but not its catalytically inactive variant, is able to induce IgE-independent mediator release, including IL-4, from rodent mast cells. Assessing the in vivo relevance of these observations, we find that repeated injections of low doses of active enzyme into mice induce the synthesis of high levels of PLA2-specific IgE, while immunization with the inactive form yields no detectable IgE response. Both Ags were similarly immunogenic when high doses of Ag were used for immunization. These findings suggest that mast cells might be a source of IL-4 at the onset of specific immunity against sources of allergens such as bee venom that contain PLA2 and support the concept that the biologic action of an Ag on cells of the innate immune system can play a role in determining adaptive immune responses.

In the human immune response to the main bee venom allergen phospholipase A2 (PLA2), Abs of the IgG4 isotype are associated with protection. The antigenic sites of PLA2 that are recognized by two mAb of this isotype have been analyzed at the molecular level. The interaction of PLA2 with these two Abs has previously been shown to depend on the conformation of the Ag and to be sensitive to lysine modifications. Therefore, genetically engineered Ag displaying single point mutations of lysine residues were generated. Nine out of twelve surface-exposed lysine residues were substituted by glutamate or glutamine, and the effect of individual mutations on mAb binding was analyzed in the context of the folded Ag. Substitution of lysine at position 25 with either glutamate or glutamine completely abrogates binding to both mAb. All other mutants do not show a difference in binding when compared with wild-type Ag. Probing of sera from bee keepers with lysine 25 mutants reveals that a significant proportion of serum Abs of the IgG4 isotype display specificity for this epitope, suggesting that this represents a major B cell-antigenic site in hyperimmune individuals. We further found that both mAbs inhibit the catalytic activity of PLA2, a property that may account for the protective role of IgG4 Abs in hyperimmune individuals.

Peripheral and neuraxial nerve blockades are widely used in the perioperative period. Their values to diminish acute postoperative pain are established but other important outcomes such as chronic postoperative pain, or newly, cancer recurrence, or infections could also be influenced. The long-term effects of perioperative nerve blockade are still controversial. We will review current knowledge of the effects of blocking peripheral electrical activity in different animal models of pain. We will first go over the mechanisms of pain development and evaluate which types of fibers are activated after an injury. In the light of experimental results, we will propose some hypotheses explaining the mitigated results obtained in clinical studies on chronic postoperative pain. Finally, we will discuss three major disadvantages of the current blockade: the absence of blockade of myelinated fibers, the inappropriate duration of blockade, and the existence of activity-independent mechanisms.

Small bowel intussusception is a rare long-term complication after Roux-en-Y gastric bypass, the etiology of which remains unclear. Except for one series reporting on 23 patients, case reports represent the vast majority of all cases reported so far. With this complete review of the world literature, based on a total of 63 patients including 2 of our own cases, we provide an extensive overview of the subject. The origin of intussusception after gastric bypass is different from that of intussusception of other causes, in that there is usually no lead point. It is likely related to motility disorders in the divided small bowel, especially in the Roux limb. This rare condition may cause obstruction and lead to bowel necrosis if not recognized and treated promptly. Clinical presentation is not specific. Computerized tomography scan represents the diagnostic test of choice, but surgery is sometimes the only way to establish the diagnosis. Treatment may be limited to reduction if the small bowel is viable, but resection of the affected segment is recommended on the basis of this review, since it seems to result in fewer recurrences. Knowledge of this entity and a high index of suspicion are required to make the correct diagnosis and offer appropriate treatment in a timely fashion.

Radiocarbon dating by means of accelerator mass spectrometry (AMS) is a well-established method for samples containing carbon in the milligram range. However, the measurement of small samples containing less than 50 lg carbon often fails. It is difficult to graphitise these samples and the preparation is prone to contamination. To avoid graphitisation, a solution can be the direct measurement of carbon dioxide. The MICADAS, the smallest accelerator for radiocarbon dating in Zurich, is equipped with a hybrid Cs sputter ion source. It allows the measurement of both, graphite targets and gaseous CO2 samples, without any rebuilding. This work presents experiences dealing with small samples containing 1-40 lg carbon. 500 unknown samples of different environmental research fields have been measured yet. Most of the samples were measured with the gas ion source. These data are compared with earlier measurements of small graphite samples. The performance of the two different techniques is discussed and main contributions to the blank determined. An analysis of blank and standard data measured within years allowed a quantification of the contamination, which was found to be of the order of 55 ng and 750 ng carbon (50 pMC) for the gaseous and the graphite samples, respectively. For quality control, a number of certified standards were measured using the gas ion source to demonstrate reliability of the data.

More than the number of real novelties, trends and preliminary results characterise the annual development in surgery. The wealth and diversity of topics to be covered require arbitrary choices, therefore not necessarily complete. The constant development of choledocolithiasis management, dominated by minimal invasive technology, treatments of unusual nature of two frequent proctological conditions, fistulae and haemorrhoids, the increasing importance of metabolic bariatric surgery, as well as the strict rules of effective melanoma treatment, represent as many directions in which the operating procedure, although unseen, continue to gain quality and security.

International audience; Heterotrimeric AMP-activated protein kinase (AMPK) is crucial for energy homeostasis of eukaryotic cells and organisms. Here we report on (i) bacterial expression of untagged mammalian AMPK isoform combinations, all containing gamma(1), (ii) an automated four-dimensional purification protocol, and (iii) biophysical characterization of AMPK heterotrimers by small angle x-ray scattering in solution (SAXS), transmission and scanning transmission electron microscopy (TEM, STEM), and mass spectrometry (MS). AMPK in solution at low concentrations (~1 mg/ml) largely consisted of individual heterotrimers in TEM analysis, revealed a precise 1:1:1 stoichiometry of the three subunits in MS, and behaved as an ideal solution in SAXS. At higher AMPK concentrations, SAXS revealed concentration-dependent, reversible dimerization of AMPK heterotrimers and formation of higher oligomers, also confirmed by STEM mass measurements. Single particle reconstruction and averaging by SAXS and TEM, respectively, revealed similar elongated, flat AMPK particles with protrusions and an indentation. In the lower AMPK concentration range, addition of AMP resulted in a significant decrease of the radius of gyration by approximately 5% in SAXS, which indicates a conformational switch in AMPK induced by ligand binding. We propose a structural model involving a ligand-induced relative movement of the kinase domain resulting in a more compact heterotrimer and a conformational change in the kinase domain that protects AMPK from dephosphorylation of Thr(172), thus positively affecting AMPK activity.

OBJECTIVES: For the treatment of septic arthritis in large animals, the local application of antibiotics as a slow release system may be an appropriate means to reach high local bioactivity and low systemic side effects and drug residues. In this study, doxycycline microspheres were developed and tested in vitro for their drug-release properties, suitability for intra-articular application and antimicrobial activity. METHODS: The development of a slow release system was achieved by microencapsulation of the drug into poly(lactide-co-glycolide) microspheres by a novel ultrasonic atomization method. Drug elution was evaluated from microspheres dispersed in elution medium at pre-defined time points by HPLC. Joint-tissue compatibility was tested on cultured bovine synoviocytes by evaluating the expression of pro-inflammatory cytokine mRNA and the production of nitric oxide (NO). Finally, the antimicrobial activity of the released antibiotic was assessed with gram-negative and gram-positive bacteria exposed to release medium sampled at days 1, 7 and 12 after microsphere suspension. RESULTS: An adequate size of the microspheres, sufficient stabilization of doxycycline in aqueous environment and drug release (25 mg microspheres in 4 mL medium) above MIC for bacteria usually isolated in bovine and equine joints were obtained over 15 days. Although the cytokine mRNA expression reflected the excellent tissue compatibility, the results with NO yielded contradictory results. Antimicrobial tests of the release medium proved to match perfectly the activity of non-encapsulated, free doxycycline as reported in the literature. CONCLUSIONS: The newly developed doxycycline delivery system achieved the target specifications and is ready for in vivo testing

Visceral surgery has benefited from several significant therapeutical improvements in 2005. They involve more specifically endocrine surgery, obesity, ovarian cancer, rectocele and cystic pancreatic neoplasia. Minimal invasive surgery is increasingly used, for example in endocrine conditions and obesity treatment. New techniques also emerge, such as electrical gastric stimulation for obesity or Stapled Trans Anal Rectal Resection (STARR) for anterior rectocele. Accurate diagnosis criteria allow better management of cystic pancreatic neoplasia, especially to choose the best treatment of this condition.

ResumenEste trabajo reflexiona en los nuevos desafíos que los profesionales de la salud en las Universidades deben enfrentar para expandir su perspectiva, roles, y servicios y así ofrecer programas alternativos que respondan a las necesidades de salud de los individuos, familias, comunidades, y sociedad a la cual pertenecen. El ampliar la visión profesional hacia el bienestar, la salud, la prevención, la promoción de la salud, y articular estos conceptos con la ocupación como agente de salud, hace posible realizar diagnósticos del desempeño ocupacional de la persona en etapas preventivas de la enfermedad. Se realiza una definición de conceptos como salud comunitaria, prevención primaria, promoción de la salud, y su relación con la ciencia de la ocupación. También presenta y clasifica desde bibliografía internacional los efectos no saludables de la inactividad y define los factores de riesgo de la disfunción ocupacional: el desequilibrio, la deprivación, y la alienación ocupacional en población de la tercera edad.Como cierre realiza una reflexión sobre el programa de adultos mayores de la Universidad de Quilmes, que funciona desde el año 1999 desde la Secretaría de Extensión Universitaria y la Carrera de Terapia Ocupacional. Invita y promueve en los Profesionales de la Salud que trabajan en ambientes educativos a poner el foco de atención en crear y completar posiciones en los ambientes comunitarios, y no solo seguir en los tradicionales ambientes clínicos disociando educación y salud. Considera esto último como una oportunidad para el desarrollo del arte de las profesiones.AbstractThis work is a reflection on new challenges which health professionals at university have to face to widen their perspectives, roles and services, so they can offer alternative programs answering to health needs of individuals, families, communities and the society they belong to. The fact of widening this professional vision towards the well-being, the prevention and the promotion of health, together with the articulation of these concepts through the occupational therapy as a health agent, both make possible the diagnosis of the occupational performance of the person in a preventive stage of the illness.So then, concepts such as community health, early prevention, promotion of health (and its relation with the science of occupation) are defined. Likewise and from international bibliographic sources, the unhealthy effects of the inactivity are presented and classified, and risk factors of the occupational malfunction such as unstability, deprivation and occupational alienation of the elders, are explained.It finishes with a reflection on the program for elders designed by the university of Quilmes, which is working since 1999 from the Department of University Extension and the Career of Occupational Therapy.It’s an invitation for health professionals working within the educational world to focus their attention on creating and completing positions in community environments and not only on the traditional clinical fields dissociating education and health. This latter point is considered as an opportunity for the development of art of professions.

By screening phage display random peptide libraries with purified immunoglobulin E (IgE) from birch pollen-allergic patients, we previously defined peptides mimicking natural IgE epitopes (mimotopes) of the major birch pollen allergen Bet v 1. The present study aimed to define a monovalent carrier for the IgE mimotopes to induce protective antibodies directed to the IgE epitopes, suitable for mimotope-specific therapy. We expressed the selected mimotopes as fusion proteins together with streptococcal albumin binding protein (ABP). The fusion proteins were recognized specifically by anti-Bet v 1 human IgE, which demonstrated that the mimotopes fused to ABP resemble the natural IgE epitope. Bet v 1-specific IgG was induced by immunization of BALB/c mice with fusion proteins. These IgG antibodies could inhibit IgE binding to Bet v 1. Skin testing of Bet v 1 allergic mice showed that the ABP mimotope constructs did not elicit type I skin reactions, although they possess IgE binding structures. Our data suggest that IgE mimotopes are safe for epitope-specific immunotherapy of sensitized individuals, when presented in a monovalent form. Therefore, ABP-fused mimotopes are promising candidates for a new type of immunotherapy based on the precise induction of blocking antibodies.

Thick spherical targets made of gabbro (R=25 cm) and of steel (R=10 cm) were irradiated isotropically with 1.6 GeV protons at the Saturne synchrotron at Laboratoire National Saturne (LNS)/CEN Saclay in order to simulate the interaction in space of Galactic cosmic-ray (GCR) protons with stony and iron meteoroids. Proton fluences of 1.32×10(sup 14) cm(sup -2) and 2.45×10(sup 14) cm(sup -2) were received by the gabbro and iron sphere, respectively, which corresponds to cosmic-ray exposure ages of about 1.6 and 3.0 Ma. Both artificial meteoroids contained large numbers of high-purity target foils of up to 28 elements at different depths. In these individual target foils, elementary production rates of radionuclides and rare gas isotopes were measured by X- and gamma-spectrometry, by low-level counting, accelerator mass spectrometry (AMS), and by conventional rare gas mass spectrometry. Also samples of the gabbro itself were analyzed. Up to now, for each of the experiments, approximatly 500 target-product combinations were investigated of which the results for radionuclides are presented. The experimental production rates show a wide range of depth profiles reflecting the differences between low-, medium-, and high-energy products. The influence of the stony and iron matrices on the production of secondary particles and on particle transport, in general, and consequently on the production rates is clearly exhibited by the phenomenology of the production rates as well as by a detailed theoretical analysis. Theoretical production rates were calculated in an a priori way by folding depth-dependent spectra of primary and secondary protons and secondary neutrons calculated by Monte Carlo techniques with the excitation functions of the underlying nuclear reactions. Discrepancies of up to a factor of 2 between the experimental and a priori calculated depth profiles are attributed to the poor quality of the mostly theoretical neutron excitation functions. Improved neutron excitation functions were obtained by least-squares deconvolution techniques from experimental thick-target production rates of up to five thick-target experiments in which isotropic irradiations were performed. A posteriori calculations using the adjusted neutron cross sections describe the measured depth profiles of all these simulation experiments within 9%. The thus validated model calculations provide a basis for reliable physical model calculations of the production rates of cosmogenic nuclides in stony and iron meteorites as well a in lunar samples and terrestrial materials.

The long-lived radionuclide 129I (T 1/2 = 15.7 My) occurs in the nature in very low concentrations. Since the middle of our century the environmental levels of 129I have been dramatically changed as a consequence of civil and military use of nuclear fission. Its investigation in environmental materials is of interest for environmental surveillance, retrospective dosimetry and for the use as a natural and man-made fracers of environmental processes. We are comparing two analytical methods which presently are capable of determining 129I in environmental materials, namely radiochemical neutron activation analysis (RNAA) and accelerator mass spectrometry (AMS). Emphasis is laid upon the quality control and detection capabilities for the analysis of 129I in environmental materials. Some applications are discussed.