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IntroductionData on postoperative bile reflux after one anastomosis gastric bypass (OAGB) is lacking. Bile reflux scintigraphy (BRS) has been shown to be a reliable non-invasive tool to assess bile reflux after OAGB. We set out to study bile reflux after OAGB with BRS and endoscopy in a prospective series (RYSA Trial).MethodsForty patients (29 women) underwent OAGB between November 2016 and December 2018. Symptoms were reported and upper gastrointestinal endoscopy (UGE) was done preoperatively. Six months after OAGB, bile reflux was assessed in UGE findings and as tracer activity found in gastric tube and esophagus in BRS (follow-up rate 95%).ResultsTwenty-six patients (68.4%) had no bile reflux in BRS. Twelve patients (31.6%) had bile reflux in the gastric pouch in BRS and one of them (2.6%) had bile reflux also in the esophagus 6 months postoperatively. Mean bile reflux activity in the gastric pouch was 5.2% (1–21%) of total activity. De novo findings suggestive of bile reflux (esophagitis, stomal ulcer, foveolar inflammation of gastric pouch) were found for 15 patients (39.5%) in postoperative UGE. BRS and UGE findings were significantly associated (P = 0.022). Eight patients experienced de novo reflux symptoms at 6 months, that were significantly associated with BRS and de novo UGE findings postoperatively (P = 0.033 and 0.0005, respectively).ConclusionPostoperative bile reflux in the gastric pouch after OAGB is a common finding in scintigraphy and endoscopy. The long-term effects of bile exposure will be analyzed in future reports after a longer follow-up.Trial registrationClinical Trials Identifier NCT02882685

Fish have a high ability to regenerate fins, including the caudal fin. After caudal fin amputation, original bi-lobed morphology is reconstructed during its rapid regrowth. It is still controversial whether positional memory in the blastema cells regulates reconstruction of fin morphology as in amphibian limb regeneration, in which limb blastema cells located at the same proximal-distal level have the same positional identity. We investigated growth period and growth rate in zebrafish caudal fin regeneration. We found that both the growth period and growth rate differed for fin rays that were amputated at the same proximal-distal level, indicating that it takes different periods of time for fin rays to restore their original lengths after straight amputation. We also show that more proximal amputation takes longer period to reconstruct the original morphology/size than more distal amputation. Statistical analysis suggested that both the growth period/rate are determined by amputated length (depth) regardless of the fin ray identity along dorsal-ventral axis. In addition, we suggest the possibility that the structural/physical condition such as width of the fin ray at the amputation site (niche at the stump) may determine the growth period/rate.

BackgroundLaparoscopic sleeve gastrectomy (LSG) restricts gastric volume to achieve weight loss. We aimed to compare the efficacy of LSG with and without antrectomy for achieving weight loss.MethodsThe prospective randomized study comprised 127 obese patients that underwent either LSG with antrectomy (2 cm to pylorus) (group 1) or LSG without antrectomy (6 cm to pylorus) (group 2), using 36 Fr and 32 Fr bougies, respectively. Patients were examined at 3-, 6-, 12-, and 24-month intervals for body mass index (BMI) measurements.ResultsOverall, 66 (51%) and 57 (49%) of patients were assigned to groups 1 and 2, respectively. The mean BMI of group 1 patients were 49.5 ± 8.01, 35.8 ± 5.40, 31.3 ± 4.9, 26.7 ± 4.02, and 22.9 ± 4.01 at the baseline, 3rd, 6th, 12th, and 24th month, respectively. The decreases in BMI were statistically significant. The mean BMI of group 2 patients were 46.7 ± 7.06, 39.3 ± 6.04, 32.4 ± 5.01, 26.6 ± 3.76, and 21.6 ± 3.70 at baseline, 3rd, 6th, 12th, and 24th month, respectively. The differences were also statistically significant. When compared with group 2, group 1 patients showed significantly lower BMI values on the 3rd month. Other differences were not statistically significant.ConclusionLSG with or without antrectomy is safe and effective for weight loss. Larger studies are required to identify patients likely to benefit from LSG with antrectomy.

This case report presents the successful arthroscopic resection of capsular hypertrophy in a 33-year-old female who underwent through-the-knee amputation following trauma. A minimally invasive surgical approach that has not yet been described in the literature for soft tissue hypertrophy at the amputation stump. The patient experienced persistent irritation and pain in the medial femoral condyle despite well-fit orthosis adjustments. Previous conservative treatments were unsuccessful. Given the patient’s complex history and risk of wound healing complications, an arthroscopic approach via the residual joint capsule was chosen to avoid open surgery. Postoperatively, the patient experienced rapid recovery, with symptoms resolving within months, and full prosthetic use was achieved at four months. This report highlights arthroscopy as a viable option for managing TKA stump complications. This provides other surgeons with a minimally invasive option for treating complaints on a joint stump with a residual joint capsule.

Background Postamputation neuroma pain can prevent comfortable prosthesis wear in patients with limb amputations, and currently available treatments are not consistently effective. Targeted muscle reinnervation (TMR) is a decade-old technique that employs a series of novel nerve transfers to permit intuitive control of upper-limb prostheses. Clinical experience suggests that it may also serve as an effective therapy for postamputation neuroma pain; however, this has not been explicitly studied. Questions/purposes We evaluated the effect of TMR on residual limb neuroma pain in upper-extremity amputees. Methods We conducted a retrospective medical record review of all 28 patients treated with TMR from 2002 to 2012 at Northwestern Memorial Hospital/Rehabilitation Institute of Chicago (Chicago, IL, USA) and San Antonio Military Medical Center (San Antonio, TX, USA). Twenty-six of 28 patients had sufficient (> 6 months) followup for study inclusion. The amputation levels were shoulder disarticulation (10 patients) and transhumeral (16 patients). All patients underwent TMR for the primary purpose of improved myoelectric control. Of the 26 patients included in the study, 15 patients had evidence of postamputation neuroma pain before undergoing TMR. Results Of the 15 patients presenting with neuroma pain before TMR, 14 experienced complete resolution of pain in the transferred nerves, and the remaining patient’s pain improved (though did not resolve). None of the patients who presented without evidence of postamputation neuroma pain developed neuroma pain after the TMR procedure. All 26 patients were fitted with a prosthesis, and 23 of the 26 patients were able to operate a TMR-controlled prosthesis. Conclusions None of the 26 patients who underwent TMR demonstrated evidence of new neuroma pain after the procedure, and all but one of the 15 patients who presented with preoperative neuroma pain experienced complete relief of pain in the distribution of the transferred nerves. TMR offers a novel and potentially more effective therapy for the management of neuroma pain after limb amputation. Level of Evidence Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

This study was designed to characterize morphologic stages during neuroma development post amputation with an eye toward developing better treatment strategies that intervene before neuromas are fully formed. Right forelimbs of 30 Sprague Dawley rats were amputated and limb stumps were collected at 3, 7, 28, 60 and 90 Days Post Amputation (DPA). Morphology of newly formed nerves and neuromas were assessed via general histology and neurofilament protein antibody staining. Analysis revealed six morphological characteristics during nerve and neuroma development; 1) normal nerve, 2) degenerating axons, 3) axonal sprouts, 4) unorganized bundles of axons, 5) unorganized axon growth into muscles, and 6) unorganized axon growth into fibrotic tissue (neuroma). At early stages (3 & 7 DPA) after amputation, normal nerves could be identified throughout the limb stump and small areas of axonal sprouts were present near the site of injury. Signs of degenerating axons were evident from 7 to 90 DPA. From day 28 on, variability of nerve characteristics with signs of unorganized axon growth into muscle and fibrotic tissue and neuroma formation became visible in multiple areas of stump tissue. These pathological features became more evident on days 60 and 90. At 90 DPA frank neuroma formation was present in all stump tissue. By following nerve regrowth and neuroma formation after amputation we were able to identify 6 separate histological stages of nerve regrowth and neuroma development. Axonal regrowth was observed as early as 3 DPA and signs of unorganized axonal growth and neuroma formation were evident by 28 DPA. Based on these observations we speculate that neuroma treatment and or prevention strategies might be more successful if targeted at the initial stages of development and not after 28 DPA.

PurposeTo assess the feasibility and outcome of ultrasound-guided cryoablation in patients with a sensitized stump neuroma after limb amputation.Material and MethodsSeven patients (3 females, 4 males; mean age 42 years) were included in this retrospective study. Ultrasound-guided cryoablation of a previously identified painful stump neuroma was performed. Pain was assessed on the visual analogue scale (VAS) and compared before and after cryoablation (Wilcoxon Test). The degree of pain alleviation was correlated with patient age, duration of pain before ablation and time interval between amputation and ablation (Spearman correlation). A p-value less than 0.05 was deemed statistically significant.ResultsNine cryoablations were performed for 8 neuromas. Technical success was 100%, there were no major complications. Mean follow-up was 27 months. There was a statistically significant decrease of pain from mean 8.3 / 10 (baseline) to 4 /10 (on day one), 2.1 / 10 (at one week) and 3 / 10 (at last follow-up) (p < 0.05). Patient satisfaction with cryoablation treatment was very high (median score 70 / 100).ConclusionIn our small population observational study, ultrasound-guided cryoablation of a sensitized stump neuroma was effective and safe for pain alleviation with very good long-term results.Level of EvidenceLevel 2, Observational study with dramatic effect

Decomposition of wood is an important component of global carbon cycling. Most wood decomposition models are based on tree characteristics and environmental conditions; however, they do not include community dynamics of fungi that are the major wood decomposers. We examined the factors explaining variation in sapwood decay in oak tree stumps two and five years after cutting. Wood moisture content was significantly correlated with sapwood decay in younger stumps, whereas ITS-based composition and species richness of the fungal community were the best predictors for mass loss in the older stumps. Co-occurrence analysis showed that, in freshly cut trees and in younger stumps, fungal communities were nonrandomly structured, whereas fungal communities in old stumps could not be separated from a randomly assembled community. These results indicate that the most important factors explaining variation in wood decay rates can change over time and that the strength of competitive interactions between fungi in decaying tree stumps may level off with increased wood decay. Our field analysis further suggests that ascomycetes may have a prominent role in wood decay, but their wood-degrading abilities need to be further tested under controlled conditions. The next challenging step will be to integrate fungal community assembly processes in wood decay models to improve carbon sequestration estimates of forests.

Management of residual limb volume affects decisions regarding timing of fit of the first prosthesis, when a new prosthetic socket is needed, design of a prosthetic socket, and prescription of accommodation strategies for daily volume fluctuations. This systematic review assesses what is known about measurement and management of residual limb volume change in persons with lower-limb amputation. Publications that met inclusion criteria were grouped into three categories: group I: descriptions of residual limb volume measurement techniques; group II: studies investigating the effect of residual limb volume change on clinical care in people with lower-limb amputation; and group III: studies of residual limb volume management techniques or descriptions of techniques for accommodating or controlling residual limb volume. We found that many techniques for the measurement of residual limb volume have been described but clinical use is limited largely because current techniques lack adequate resolution and in-socket measurement capability. Overall, limited evidence exists regarding the management of residual limb volume, and the evidence available focuses primarily on adults with transtibial amputation in the early postoperative phase. While we can draw some insights from the available research about residual limb volume measurement and management, further research is required.

Plants engage in many processes and relationships that appear to be wasteful of the highenergy compounds that they produce through carbon fixation and photosynthesis. For example, living trees keep leafless tree stumps alive (i.e. respiring) and support shaded understory trees by sharing carbohydrates through root grafts or mycorrhizal fungal networks. Plants exude a diverse array of organic compounds from their roots and leaves, which support abundant rhizosphere and phyllosphere microbiomes. Some plants release substantial amounts of sugar via extra-floral nectaries, which enrich throughfall and alter lichen communities beneath the canopy. Large amounts of photosynthetically fixed carbon are transferred to root associates such as mycorrhizal fungi and N-fixing micro-organisms. Plants also respire fixed C through an alternative pathway that does not generate ATP. Rates of each of these processes appear to be highest when plants are growing under mild-to-moderate deficiencies of nutrients or water. During this stage of deficiency, aboveground plant growth is curtailed more than photosynthesis, causing leaves to produce surplus carbohydrates. Each of the above phenomena provide a sink for these surplus carbohydrates, thereby preventing feedback inhibition of photosynthesis, and perpetuating the influx of C. Because these processes incur little cost to the source plant, they need not provide a benefit beyond the removal of surplus carbohydrates.